How is breast milk made?
Each breast is divided into 20 sections containing bundles of milk-producing glands. During pregnancy, milk producing tissues accumulate in your breast. The hormone prolactin increases so that by the time you give birth it's levels are very high. The process of birth, in particular the delivery of the placenta, signals your breasts to begin milk production. Though your prolactin levels lower eventually (after several weeks), every time your baby nurses your prolactin levels increase 10 fold, thus stimulating milk production. This is one of the reasons why it is so important to allow your new baby unrestricted access to the breast. Milk production works on a supply and demand system...the more you breastfeed, the more you will produce. Thus mothers of twins, and even triplets, can produce enough milk to feed their babies.

What is colostrum?
This is the first milk made by the breasts and is usually present for about three days. Colostrum is very rich and slightly yellow in color. It is very important that babies recieve this "liquid gold" as it contains high levels of antibodies which help to build a strong immune system. It is also richer in protein, vitamins and minerals than mature milk and has slightly less fat and lactose. Colostrum is also rich in essential fatty acids. It acts as a laxative and helps to clear out the meconium (the initial dark-green b.m) from your baby's bowels which helps to prevent jaundice. Colostrum is only produced in a small amount but it is all a newborn needs until your mature milk comes in.

What is transitional milk?
3 to 10 days after birth, colostrum is replaced by a creamy white milk called transitional milk before the mature breast milk is established.

What is foremilk?
Milk production occurs constantly between feedings. The breast is never actually empty. Foremilk, a bluish-white milk that is is lower in fat than the hindmilk is the milk your baby receives in the first part of the feeding.

What is hindmilk?
The hindmilk, which follows the foremilk, is richer and higher in fat than the foremilk. The hindmilk provides most of the nutrients your baby needs to gain weight and grow, and it satisfies his hunger. That is why it is very important to allow your baby to finish one breast before moving him to the other breast.

How often should I feed my baby?
Breastfeed frequently.... at least 8-12 times in each 24 hour period when your baby is a newborn. This ensures an adequate milk supply and greatly reduces your chances of engorgement. Current research shows that limiting the amount of time at the breast or going too long between feedings can diminish your milk supply and reduce the fat content of your milk. This can leave your baby hungry, unsatisfied and can cause problems with growth. Occasionally, it can also cause your baby to have green, stinky b.m's and a tummy ache.

Do not let your baby sleep through feedings until your milk supply has been developed, which usually takes about 2 to 3 weeks. If your baby is not awake and wanting to feed, wake her if 3 to 4 hours have passed since the last feeding. If this persists, call your pediatrician. Once your baby is older, feed on her cue.

How long should I feed my baby?
Babies need different amounts of food at different times of the day. Since the composition of breast milk changes while you nurse, it's important to allow your baby to finish one breast untimed before switching her to the other breast. This will allow her to get to the rich hind milk which is important for growth. The average feeding time of a breastfeeding baby is 20 to 30 minutes but your baby may nurse for a longer or shorter time. When she is relaxed, content and satisfied she has probably had enough. Begin the next feeding on the breast that she took second.

How can I tell if I am producing enough milk?
Your baby is getting enough milk if:

• she is nursing regularly, at least 8 times a day
  
• she makes clear sucking and swallowing sounds
  
• she is wetting at least 6 diapers every 24 hours by the fifth day after birth and her urine is pale.
  
• she passes between 1 and 5 stools in 24 hours and those stools are soft or liquid, not dry or hard
  
• she has regained her birthweight by 3 weeks of age
  
• she is active, alert and has good skin color

Can I take medicine if I am breastfeeding?
Most medications have not been tested in nursing women, so few medical experts are as knowledgable about the effects of different drugs on a breastfed child as they should be. However, since very few problems have been reported, most over-the-counter and prescription drugs are considered safe taken in moderation and only when necessary.

Even mothers who must take daily medication can usually breastfeed. They should first check with the child's pediatrician, however. If he or she says the drug is unsafe, consider checking with a lactation consultant who is likely more knowledgable about medications and breastfeeding than most doctors. By taking the drug just after nursing or before the child sleeps, you can minimize the baby's exposure.

In the January 1994 issue of Pediatrics, the American Academy of Pediatrics included the following in a list of drugs that are usually compatible with breast-feeding:

• acetaminophen

• many antibiotics

• antiepileptics (although one, Primidone, should be given with caution)

• most antihistamines

• alcohol in moderation (large amounts of alcohol can cause drowsiness, weakness, and abnormal weight gain in an infant)

• most antihypertensives

• aspirin (should be used with caution)

• caffeine (moderate amounts in drinks or food)

• codeine

• decongestants

• ibuprofen

• insulin

• quinine

• thyroid medications

Some drugs can be taken by a nursing mother if she stops breast-feeding for a few days or weeks. She can pump her milk and discard it during this time to keep up her supply, while the baby drinks previously frozen milk or formula.

Radioactive drugs used for some diagnostic tests like Gallium-69, Iodine-125, Iodine-131, or Technetium-99m can be taken if the woman stops nursing temporarily.

Drugs that should never be taken while breast-feeding include:

Bromocriptine (Parlodel): A drug for Parkinson's disease, it also decreases a woman's milk supply.

Most Chemotherapy Drugs for Cancer: Since they kill cells in the mother's body, they may harm the baby as well.

Ergotamine (for migraine headaches): Causes vomiting, diarrhea, convulsions in infants.

Lithium (for manic-depressive illness): Excreted in human milk.

Methotrexate (for arthritis): Can suppress the baby's immune system.

Drugs of Abuse: Some drugs, such as cocaine and PCP, can intoxicate the baby. Others, such as amphetamines, heroin and marijuana, can cause a variety of symptoms, including irritability, poor sleeping patterns, tremors, and vomiting. Babies become addicted to these drugs.

Tobacco Smoke: Nursing mothers should avoid smoking. Nicotine can cause vomiting, diarrhea and restlessness for the baby, as well as decreased milk production for the mother. Maternal smoking or passive smoke may increase the risk of sudden infant death syndrome (SIDS) and may increase respiratory and ear infections.

Adapted from Breastfeeding: Best Bet for Babies by Rebecca D. Williams
Source: FDA

For more on this topic see: You Can Still Breastfeed

The Lactation Pharmacology Website
(use your browser back button to return to Parentingweb)

What should I do if my breasts leak?
Use breast pads or inside your bra. If you are leaking excessively on one side while you are feeding on the other, a cloth diaper works well to catch the excess. For leakage when you are not nursing, try pressing your elbows firmly against the outside of your breasts to help reduce the flow. You might want to tuck an extra shirt for yourself into your diaper bag for outings. Leakage will slow down or disappear once your milk level settles.

How do I express my milk by hand?
see: hand expression of breastmilk

More questions will be added to this FAQ soon.