Breast Feeding

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common queries that mothers — new and veteran — may have.

When will my milk come in?

For the first few days after your baby's birth, your body will produce colostrum, a nutrient-rich "pre-milk" or "practice milk." Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that aren't available in infant formula.

For some women, colostrum is thick and yellowish. For others, it is thin and watery. The flow of colostrum is slow so that a baby can learn to nurse — a process that involves coordination to suck, breathe, and swallow.

After about 3 to 4 days of producing colostrum, your breasts will start to feel firmer. This is a sign that your milk supply is increasing and changing from colostrum to breast milk, which resembles skim (cow's) milk.

Sometimes a mother's milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don't need much more than colostrum for the first few days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed often to stimulate milk production.

When should I begin breastfeeding?

If possible, try to start nursing within an hour of your baby's birth. This timing takes advantage of the natural wakefulness of a newborn immediately after birth. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So it may be more difficult to get your baby to latch on after those first few hours.

A newborn baby placed on the mother's chest after birth will naturally "root" (squirm toward the breast, turn the head toward it, and make sucking motions with the mouth). To breastfeed, the baby will latch onto the breast by forming a tight seal with the mouth around the nipple and areola. Even if your baby doesn't actually latch on at this time and just "practices," it's still good for your baby (and you!) to get used to the idea of breastfeeding.

In the first few days of life, your baby will want to feed on demand, usually about every 1-3 hours day and night. As babies get older and their bellies grow to accommodate more milk, they will go longer between feedings.

Are bottles or pacifiers OK?

If you plan to exclusively breastfeed, it's best to allow your baby time to practice breastfeeding without being confused by a bottle or a pacifier. Sucking on a bottle or a pacifier requires a different set of skills than breastfeeding. So until breastfeeding is well established (sometime within the first month or so), experts suggest not introducing a bottle or pacifier to avoid "nipple confusion." (But while some babies experience this confusion, others have no problem moving between a bottle and the breast.)

There's also a chance that breastfed babies who are given a bottle early on may prefer it. Since drawing milk from a bottle requires less effort and the milk flows much quicker than at the breast, sometimes babies stop breastfeeding altogether and will only take bottles.

Experts also worry that giving a pacifier early on and often will prevent parents from recognizing a baby's hunger cues, causing a baby to miss necessary feedings. Giving a pacifier occasionally (such as during a circumcision, when baby boys may be given pacifiers with sugar water) is OK and usually won't undermine breastfeeding efforts.

In certain situations, doctors may recommend supplementing your breast milk with formula. If this happens, it's still possible to simulate breastfeeding by feeding your baby through a nursing system that lets formula be delivered through a small tube attached to your nipple.

How do I know that my baby is hungry?

Despite what you might think, crying is a late sign of hunger. Try to nurse your baby before he or she is upset from hunger and is difficult to calm down.

Other signs that babies are hungry include:

moving their heads from side to side
opening their mouths
placing their hands and fists to their mouths
puckering their lips as if to suck
nuzzling again their mothers' breasts
stretching
showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

What is let-down?

During the first few days to weeks after delivery, you may feel a pins-and-needles or tingling sensation in your breasts just after your baby starts to suckle. Milk may seep from the other breast. This is called the let-down reflex, or milk-ejection reflex.

The let-down reflex happens when your baby's sucking (or a machine pumping) triggers nerves in the nipple. The nerves send a message to your brain telling it to release milk. The brain releases a hormone called oxytocin that causes tiny muscles in the breast to tighten and squeeze the milk out, or "let it down." Oxytocin also can make you feel cramps in your uterus when your milk lets down. This is helpful in returning your uterus back to its original size.

Let-down also can happen if a feeding is overdue or before you start nursing (some women have let-down from simply seeing their baby or hearing a baby cry). Or it can happen after your baby is latched on and has sucked a few times. Some women have multiple let-downs during a single feeding.

Some women, however, never have a feeling of let-down, which is OK, too. Even if you don't feel it, you should still see milk coming from your nipple and hear and see your baby swallowing.

How do I latch my baby on correctly?

Many new mothers have trouble getting their baby to latch correctly. An incorrect latch can be frustrating for babies and very painful for mothers.

Here's how you can make sure your baby gets a good latch every time:

Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.
Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the darker circle of skin around the nipple) to latch onto.
Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.
When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible.
Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple. Some babies may also make small noises when they swallow that sound like little clicks.)
Have a nursing session observed by someone knowledgeable about breastfeeding.

When your baby is properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into the baby's mouth). Then the pain should ease. It will then feel like a tug when your baby is sucking.

If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If you still feel pain during feeds even after repositioning, talk to your doctor or lactation consultant to make sure something else isn't going on, such as an infection.

How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong also fall sleep at the breast more often and may not seem satisfied because they may not be getting enough. If this happens, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your doctor or a lactation consultant if:

you're unable to nurse your baby without pain (you may just need help getting your baby to latch on correctly, or it could be a sign of a nipple injury or breast infection)
your baby consistently sleeps at the breast
your baby is nursing but doesn't seem satisfied when feedings are over
your baby does not gain weight as expected or does not produce the usual numbers of wet and soiled diapers (about 6 wet and 4 soiled each day at first)

How can I tell if my baby is getting the milk?

Once a baby is latched onto the breast, he or she usually takes four to five sucks, followed by a 5- to 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

Newborns will often fall asleep while breastfeeding. If this happens, try to wake your baby by tickling the feet, rubbing the back, or taking off some clothing. Sometimes burping your baby or changing the diaper also can be helpful.

What are the best nursing positions?

You can try several different nursing positions (or holds) to figure out which one is the most comfortable for you and your baby.

The Cradle Hold

This is the first hold many mothers will try, often soon after their babies are born. To start, cradle your baby's head in the crook of your arm with your baby's nose opposite your nipple. Use that hand to support your baby's bottom. Turn your baby on his or her side, so that your baby is belly to belly to you. Then, raise your baby to your breast. You can support your breast with your other hand.

The Cross-Cradle or Crossover Hold

This hold is similar to the cradle hold, but your arms are positioned differently. Instead of supporting your baby's head in the crook of your arm, use the hand of that arm to support your breast. Your opposite arm should come around the back of your baby. Support your baby's head, neck, and shoulder by placing your hand at the base of your baby's head with your thumb and index finger at your baby's ear level. Like the cradle hold, your baby will be belly to belly to you. You may need to use a pillow on your lap to raise your baby to nipple level.

The cross-cradle position allows you to have more control over how your baby latches on (takes the breast into his or her mouth). Many moms find that they're able to get their babies latched on more deeply with this hold.

The Side-Lying Position

This position is comfortable for mothers who've had a cesarean section (C-section) because the baby doesn't put pressure on the mother's abdomen. Mske sure that you return your baby to the crib or bassinet before falling asleep.

Start by lying on your side with your baby on his or her side, facing you. Your baby should be positioned so his or her nose is opposite your nipple. Use your lower arm to cradle your baby's back, or you can tuck a rolled-up receiving blanket behind your baby to help nestle your little one close to you while you use your arm to support your own head. You can support your breast with your other hand.

The Clutch or Football Hold

This is also a good position for the mom who's had a C-section and also for mothers with large breasts or small babies. Mothers with twins who want to feed the babies at the same time may also choose this position.

The football hold allows babies to take milk more easily — which is also good for mothers with a forceful milk ejection reflex (or let down).

To achieve the clutch (or football) hold, place a pillow next to you. Cradle your baby — facing upward — in your arm. Use the palm of your hand on that same arm to support his or her neck, and nestle your baby's side closely against your side. Your baby's feet and legs should be tucked under your arm. Then lift your baby to your breast.

Latching On

After your baby is positioned correctly, make sure he or she latches on properly:

Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.
Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the dark circle of skin around the nipple) to latch onto.
Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.
When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of the areola into his or her mouth as possible, with more areola showing at the top lip than at the bottom.
Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple.)

When properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into your baby's mouth), then the pain should subside. It will then feel like a tug when your baby is sucking. If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast.

Your baby should give four to five sucks, followed by a 5- to 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Breaking the Suction

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, you can slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

If your baby consistently latches on improperly, sucking on your nipple without getting much of your areola in the mouth, you'll probably feel discomfort throughout each feeding. Some moms say it's painful or feels like a pinch as their babies nurse.

Babies who tend to latch on incorrectly will also fall asleep often at the breast and may not seem satisfied because they may not be getting enough. If either of these happens, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your child's doctor or a lactation consultant if:

you can't nurse your baby without pain
your baby often falls asleep at the breast
your baby is nursing but doesn't seem satisfied when feedings are over

Getting comfortable

Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cellphone (so you don't have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, or stereo nearby.
Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.
Give your feet and back a break. Footstools and pillows can give extra support. Pillows that some women find helpful are the wraparound nursing pillows or the "husband" back pillows with arms on each side for nursing in bed.

How long should I plan to breastfeed my baby?

That's a personal choice. Experts do recommend that babies be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months, and that breastfeeding continue until 12 months (and beyond) if it's working for both mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding also may protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

Breastfeeding also burns calories and helps shrink the uterus, so nursing moms might be able to return to their pre-pregnancy shape and weight quicker. And studies show that breastfeeding helps lower a woman's risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

I'm having a hard time. What can I do?

Nursing comes easily for some moms, but takes time and practice for others. In fact, it can be one of the most challenging and rewarding things you do as a mother.

While you're in the hospital, seek help from a lactation consultant, who can help you through most of your breastfeeding challenges. If your hospital doesn't provide a lactation consultant, the nursing staff, your baby's pediatrician, or your OB-GYN can be very helpful in guiding you through the dos and don'ts of breastfeeding.

Doctors usually want to weigh infants and evaluate breastfeeding within 24 to 48 hours after a mother and newborn leave the hospital. But if you have any concerns or difficulties before then, make sure to talk to your doctor.

Whatever you do, try not to become too discouraged. With a little patience and some practice, it will likely become easier for both you and your baby in the coming weeks. Like the old saying goes, practice makes perfect.

How often should I breastfeed?

Your newborn should be nursing 8-12 times per day for about the first month. If you feel like you're feeding your little one more often than a friend whose baby is formula fed, you might be. Why? Because breast milk digests easier than formula, which means it moves through your baby's digestive system faster and, therefore, your baby is hungry more often.

Frequent feedings also will help stimulate your milk production during the first few weeks. By 1 to 2 months of age, a breastfed baby will probably nurse 7-9 times a day.

Before your milk supply is established, breastfeeding should be "on demand" (when your baby is hungry), which is generally every 1½ to 3 hours. As newborns get older, they'll nurse less often, and may develop a more reliable schedule. Some might feed every 90 minutes, whereas others might go 2 or 3 hours between feedings. Newborns should not go more than about 4 hours without feeding, even overnight.

Are feeding intervals counted from the time my baby starts or stops nursing?

You count the length between feedings from the time when your baby begins to nurse — rather than when he or she ends — to when your little one starts nursing again. In other words, when your doctor asks how often your baby is feeding, you can say "about every 2 hours" if your first feeding started at 6 a.m. and the next feeding was at around 8 a.m., then 10 a.m., and so on.

This means that, especially at first, you may feel like you're nursing around the clock, which is completely normal. Soon enough, you'll both be on a more routine, predictable schedule.

How can I tell when my baby's ready to eat?

It's usually recommended that moms feed a newborn whenever the baby seems hungry. But crying is a late sign of hunger. So try to feed before your baby gets so hungry that he or she gets really upset and becomes difficult to calm down.

It's also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold.

Signs that babies are hungry include:

moving their heads from side to side
opening their mouths
sticking out their tongues
placing their hands and fists to their mouths
puckering their lips as if to suck
nuzzling again their mothers' breasts
showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

Watch for signs that your baby is full (slow, uninterested sucking; turning away from the breast or bottle) and stop the feeding when you see them.

How long does it take to nurse?

That depends on both you and your baby and many other factors, such as whether:

your milk supply has come in completely
your let-down reflex (which causes milk to flow from the nipple) is immediate or takes a few minutes into the feeding to start
your milk flow is slow or fast
you're positioning your baby correctly on your breast
your baby tends to get right down to business or dawdles a bit
your baby is sleepy or easily distracted (which can be the case in older babies, especially)

How long babies nurse also depends on their age. As babies get older, they become more efficient, so they may take about 5-10 minutes on each side, whereas newborns may feed for up to 20 minutes on each breast.

Make sure your baby is latched on correctly from the beginning to ensure the most productive feeding possible. It's important that your baby nurses with a wide-open mouth and takes as much as possible of your areola in his or her mouth (not just the tip of the nipple).

But be sure to call your doctor if you're concerned about the length of your baby's feedings — whether they seem too short or too long.

How often should I alternate breasts?

To keep up your milk supply in both breasts — and prevent painful engorgement in one — it's important to alternate breasts and try to give each one the same amount of nursing time throughout the day. Again, that amount of time differs for every baby and every woman — some babies may be satisfied after 5 minutes on each breast, others may need 10 or 15 minutes on each side.

Some experts recommend switching breasts in the middle of each feeding and alternating which breast you offer first for each feeding. Can't remember on which breast your baby last nursed? Some women find it helpful to attach a subtle reminder — a safety pin or small ribbon — to their bra straps indicating which breast they last nursed on so they'll know to start with that breast at the next feeding. Or, keep a notebook handy to keep track of how your baby feeds.

Your baby may seem to prefer both breasts with each feeding and may be doing well. Or, your little one may like to nurse on just one breast with each feeding. Whichever way you choose, it's important for you to do whatever works and is the most comfortable for you and your baby.

How often should I burp my baby during feedings?

Let your baby breastfeed at one breast then switch to the other side. Try burping your baby when switching breasts and at the end of the feed. Often, the movement alone can be enough to cause a baby to burp.

As your milk comes in and your baby has established good latch-on, you can try burping as often as you think helps your baby. Some infants need more burping, others less, and it can vary from feeding to feeding depending on what the mother has been eating.

If your baby spits up a lot, you may need to try burping more frequently. While it's normal for infants to "spit up" a small amount after eating or during burping, a baby should not vomit after feeding. Vomiting after every feeding may be a problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

How can I tell if my baby's eating enough?

New mothers, especially breastfeeding moms, are often concerned that their infants may not be getting enough to eat. You can be assured that your baby is getting enough to eat if he or she:

seems satisfied and content after eating
produces about 4-6 wet diapers a day
has regular bowel movements
sleeps well
is alert when awake
is gaining weight

Your baby may not be getting enough to eat if he or she:

does not appear to be satisfied after feeding
seems hungry often
isn't making several wet and soiled diapers a day
is fussy or cries a lot
isn't gaining weight

If you're concerned that your baby isn't getting enough to eat, call your doctor. Breastfed infants should also be seen by their doctor 24 to 48 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and the mother's breastfeeding technique can be evaluated. It's also an opportunity for nursing mothers to ask questions.

Even if a breastfed baby is doing well, the doctor probably will schedule another visit for when the baby is around 2 weeks old. These postnatal checkups can help you be sure that your baby is gaining weight and getting enough nutrients.

For your own peace of mind, it can help to keep a notebook or first-week breastfeeding log to write down each time your baby feeds, how long the baby fed on each breast, and each time the baby stools (poops) or makes a wet diaper.

If you're concerned or notice any signs that your infant isn't getting enough nutrients, call your baby's doctor.

What should my newborn's diapers look like?

Your baby's diapers are excellent indicators of whether your breastfed baby is getting what he or she needs. Because colostrum (the first milk your newborn gets) is concentrated, your baby may have only one or two wet diapers in the first 24 hours.

Your newborn's stools (or poop) will be thick and tarry at first and become more greenish-yellow as your milk comes in, which is usually about 3 or 4 days after birth. The more your baby nurses, the more dirty (or "soiled") diapers he or she will have; but it may be just one a day in the first days after birth.

After 3 to 4 days, here are some signs you should look for:

six or more wet diapers per day, with clear or very pale urine. Fewer diapers or darker urine may mean your baby's not getting enough to drink. If you see orange crystals in a wet diaper, contact your baby's doctor. They're common in healthy, well-fed babies and usually not a cause for concern, but sometimes can be a sign that a baby isn't getting enough fluids.
four or more yellow, seedy bowel movements per day, usually one after each feeding. After about a month, though, breastfed babies usually have fewer bowel movements and many may go a few days without pooping.

My baby wants to nurse for comfort. Is this OK?

If your baby seems to be getting enough milk, but continues to suck longer than usual, he or she might be nursing for comfort rather than for nourishment. So, how do you know? Once your baby has fed vigorously, he or she may stay on your breast but show these signs of non-nutritive sucking:

seems satisfied
moves the jaws but stops sucking and swallowing
plays with your nipple

Early on, it's OK to let your baby nurse for comfort, but it can become a problem as your little one gets older because he or she may need to nurse to take a nap or go to bed at night. So, at some point you may want to wean your baby off of sucking for comfort and make breastfeeding sessions only about nourishment.

Instead of nursing, you might offer your baby his or her thumb or hand to suck on. You also could give your little one a pacifier if your child doesn't seem to be hungry. Because pacifiers are associated with a lower risk of sudden infant death syndrome (SIDS), experts now recommend letting babies go to sleep with a pacifier. But only do this after breastfeeding is well established (usually after 1 month).

If possible, also hold off on introducing a bottle until breastfeeding is well established. Some babies have "nipple confusion," though the likelihood of this happening is much less after 4 to 6 weeks.

My baby is hungrier than usual. Is this normal?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:

7 to 14 days old
2 months
4 months
6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues. You may need to temporarily increase the frequency of feedings.

How can I increase my milk supply?

Your milk supply is determined by the stimulation that your baby provides while nursing. In other words, the more you breastfeed, the more milk your body produces. So, if you seem to be producing less milk than usual, try to feed your baby more often. You also can pump after nursing to help stimulate more milk production.

Stress, illness, and some medicines can temporarily decrease your supply. Drinking plenty of water and eating good, nutritious food can help. But also try to take some time for yourself each day, even if it's only for 15-30 minutes.

If your baby is younger than 6 months old and you're away from your little one for long stretches during the day (for instance, at work), pump or hand express every 3 hours to maintain your supply. Your freshly pumped breast milk can stay at room temperature for 6-8 hours, or in the refrigerator for up to 5 days. When keeping it in the refrigerator, never store it on the shelves in the door.

If the milk is not going to be used within 5 days, store it in the freezer. Pumped breast milk can be safely stored in the freezer compartment of a refrigerator that has a separate suction-sealed door for 3-6 months or in a deep freezer for 6-12 months.

If your milk supply still seems low and you're concerned, you may want to talk to your doctor, your pediatrician, or a lactation consultant.

If I wait to nurse, will my milk supply increase?

Actually, no — it's the opposite. Waiting too long to nurse or pump can slowly reduce your milk supply. The more you delay nursing or pumping, the less milk your body will produce because the overfilled breast sends the signal that you must need less milk.

Once babies are back to their birth weight, they can sleep for longer stretches at night and will gradually lengthen the time between nighttime feedings. Letting your baby sleep for longer periods during the night won't hurt your breastfeeding efforts. Your baby is able to take more during feedings, and that, in turn, will have him or her sleeping longer between nighttime feedings. Your body will adjust to the longer spacing.

Some moms wake during the night with full breasts and a sleeping baby. If that happens, pump for comfort and to help your body adjust to your little one's new schedule at night.

The interval for daytime feedings usually stays between 1-3 hours for the first few months and then may lengthen to 4 hours or so. Cutting back on feedings during the day can lead to a decreased milk supply over time.

If you follow your baby's cues and spread out the feedings as he or she wishes, your milk supply should remain at what your baby needs.

I'm producing too much milk. What can I do?

Whereas some women may feel like they don't have enough milk, others may feel like they're making too much. Some mothers' bodies just produce more milk than their babies need. Others overstimulate their breasts by pumping or expressing milk between feedings. If expressing or pumping to relieve discomfort, remove just enough to feel comfortable but don't empty the breast.

Alternate the breast that you start each feeding with. Let the baby stay at the first breast until either the breast is very soft or the baby is full. If the baby is not satisfied with the first breast, then offer the second breast.

A mom may try nursing on only one breast during a feeding to help to lessen her milk supply. Over time, she should notice her milk supply and "let-down reflex" (the milk ejection reflex) become easier to handle.

Sometimes a woman's let-down is really strong and causes the baby to gag and pull off of the breast. If your baby is staying on the breast and handling the flow of milk, you don't need to do anything. If the baby is pulling off and coughing, sit your baby up in a seated burp position. Pat your baby's back to help him or her regain composure. You can use a burp cloth pressed into the breast to help slow the flow, then latch your baby back onto your breast when ready to resume feeding.

Nursing your baby in a more upright position (head above the breast) also may decrease the force of the let-down. A side lying position also might help slow the flow of milk.

My baby favors just one breast. Is this OK?

Some babies might prefer one breast over the other. If this happens, to keep up your milk supply in both breasts (and prevent painful engorgement), alternate breasts and keep your baby on the first breast until it's soft, then move your baby to the second breast. This ensures that your little one gets the hindmilk, which is creamier and contains more calories than the foremilk, which comes at the beginning of a feeding.

Some babies will always take the second breast and some will be satisfied with just the first breast. At the end of the feeding, if both breasts are comfortable, you don't need to pump. But if either breast is still full and uncomfortable, pump or hand express to comfort.

Of course, if your baby won't latch onto one of your breasts, pump or hand express that breast to maintain its milk supply until your little one is latching onto both breasts easily.

How do I store my breast milk?

You can freeze and/or refrigerate your pumped (or expressed) breast milk. Store it in clean bottles with screw caps, hard plastic cups that have tight caps, or nursing bags (pre-sterilized bags meant for breast milk).

It's helpful to label each container with the date when the milk was pumped (and your baby's name if the milk is going to childcare providers). You can add fresh cooled milk to milk that is already frozen, but add no more than is already in the container. For example, if you have 2 ounces of frozen milk, then you can add up to 2 more ounces of cooled milk.

How long, exactly, can I store my breast milk?

For healthy full-term infants:

You can store it at room temperature:
- for 6 to 8 hours (at no warmer than 77°F, or 25°C)
You can store it in the refrigerator:
- for up to 5 days at 32°–39°F (0°–3.9°C)
You can store it in the freezer (be sure to leave about an inch of space at the top of the container or bottle to allow for expansion of the milk when it freezes):
- for up to 2 weeks in a freezer compartment located inside the refrigerator
- for 3 to 6 months in a freezer that's self-contained and connected on top of or on the side of the refrigerator and is kept at 0°F (–18°C). Store the milk in the back of the freezer, not in the door.
- for 6 to 12 months in a deep freezer that's always -4°F (–20°C)

To thaw frozen milk, you can move it to the refrigerator (it takes 24 hours to thaw), then warm by running warm water over the bag or bottle of milk and use it within the next 24 hours. If you need it immediately, then remove it from the freezer and run warm water over it until it's at room temperature. Do not refreeze it. Once your baby has started to drink from the bottle, you should use it within 1 hour.

You may find that different resources provide different variations on the amount of time you can store breast milk at room temperature, in the refrigerator, and in the freezer. Talk to your doctor if you have any concerns or questions.

How much of my milk should I store in the freezer?

Although some women may choose to pump large volumes to be frozen, it's a good idea to actually store the breast milk in 2- to 4-ounce (59.1 to 118.2 milliliters) portions so as not to waste any. Label the bottles, cups, or bags with the date, then freeze them.

You also could pour the milk into ice cube trays that have been thoroughly cleaned in hot water, let them freeze until hard, store them in freezer bags, then count up the amount of cubes needed to make a full bottle.

My frozen breast milk changed color. Is this OK?

Breast milk that's been frozen or refrigerated may look a little different from fresh breast milk, but that doesn't mean it's gone bad. It's normal for early breast milk to look kind of orange and the mature milk to look slightly blue, yellow, or brown when refrigerated or frozen. And it may separate into a creamy looking layer and a lighter, more milk-like layer. If this happens, just swirl it gently to mix it up again.

Thawed milk may smell or taste soapy due to the breakdown of fats in the milk. The milk is still safe to drink, and most babies won't have a problem with it. If your baby doesn't like it, the milk can be heated to scalding (bubbles around the edges) right after it is pumped or expressed and then quickly cooled and frozen. This switches off the enzyme that breaks down the milk fats.

How do I clean bottles and pump parts?

Before their first use, wash and then sterilize the nipples, bottles, and washable breast pump supplies (for example, the breast shields and any other part that touches your breasts or your milk) by boiling them for 5 to 10 minutes. Check the manufacturer's recommendations for the length of time to boil the parts.

You also can sterilize the parts with a countertop or microwaveable sterilizer, but boiling works just as well and costs nothing. After that, wash the bottles, nipples, and pump supplies in hot, soapy water (or run them through the dishwasher) after every use. They can transmit bacteria if not cleaned properly.

Is it safe to microwave my baby's bottles?

The microwave can create dangerous "hot spots" in bottles of formula or breast milk, so you should never microwave them. Instead, you can run the bottle or freezer bag under warm water for a little bit, swirl the bag or bottle around in a bowl of warm water, or thaw the milk in the refrigerator.

You also can put your baby's bottles in a pan of warm water (away from the heat of the stove) and then test the temperature by squirting a drop or two on the inside of your wrist before feeding your baby. And bottle warmers are available for use at home or in the car.

Reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: February 2015