1. I plan to give my baby a substitute feeding using expressed 
    breastmilk. How much milk will I need to express for a feeding?

2. I need to stop breastfeeding when the baby's teeth come in?

3. Can I exercise if I am breastfeeding?

4. Will breastfeeding change the size and shape of my breasts?

5. When should I call my baby's doctor?

6. Do I need to drink extra fluid while I am breastfeeding?

7. When and how do I introduce solid foods to my baby?

8. How can I successfully continue to breastfeed when I return to 
    work?

9. Sometimes my baby is sleepy and difficult to wake for a feeding,    
     what should I do?

10. What are the feeding patterns in a breastfed infant?

11. How do I know when my baby is ready to be fed?

12. What are some of the ways I can soothe my fussy baby?

13. Since having my baby, my sexual response seems to be slower. 
      What can I do about this?

14. Why am I experiencing vaginal dryness?

15. My partner complains that I pay too much attention to my baby 
      and not enough attention to him. What can I do?

Question:     I plan to give my baby a substitute feeding using expressed breastmilk.  How much milk will I need to express for a feeding?  

Answer :  (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):

A healthy, full term baby needs about 2½ oz. per lb. each day.  For example, an 8lb. baby would require 2½ oz. x 8lb. or 20 oz.   If the baby breastfeeds every 2 – 3 hours or 10 times a day, then he eats about 2 oz. at each feeding.  To be on the safe side, express 3 – 4 oz. of breastmilk and store the milk in 2 oz. servings to avoid waste.  You can use more than 1 serving if necessary.  

Question:  I need to stop breastfeeding when the baby’s teeth come in?

  Answer:  (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):  

No.  You do not need to wean when your baby’s teeth come in.  Both of my children got their first tooth at 3 months of age but were breastfed more than a year.  Biting can occur at the end of feeding, when the baby is no longer hungry, but playful.  Simply remove the baby from the breast with a firm “no”.  If the baby is still hungry, offer the breast again.  If the biting continues, remove the baby from the breast for several minutes.   Your baby will soon learn that biting brings an end to breastfeeding, and the biting will stop.

Question:            Can I exercise if I am breastfeeding?

Answer: (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):  

Yes.  Moderate exercise does not affect the amount of milk produced. However, exercise can increase the level of lactic acid in the milk and give the milk a sour taste.  In addition, some babies dislike the taste of the sweat on the mother’s skin and refuse to breastfeed.  If this occurs, rinse the breast before you breastfeed or breastfeed no sooner than 1½ hours after exercising.

Question:  Will breastfeeding change the size and shape of my breasts?

Answer: (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):  

No.  Breastfeeding does not change breast size and shape.  Some women find that their breasts get smaller and sag or droop after birth.  This is true whether you choose to breastfeed or bottle-feed.  These changes are due to heredity, age and weight gain.  Usually, the more weight you gain during pregnancy, the more your breasts will shrink or sag when the added pounds are lost.

Question:    When should I call my baby’s doctor?

Answer: (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):

Problems can occur during the early weeks when a mother and baby are learning to breastfeed.  You can prevent serious problems if you know the early warning signs that your baby may not be getting enough to eat.  If your baby is less than 6 weeks of age and any of the following occur, call your baby’s doctor:

·         fewer than 3 bowel movements a day during the first 3 days or fewer than 4 bowel movements a day during the next 4 weeks

·         fewer than 3 wet diapers a day during the first 3 days or fewer than 6 wet diapers a day during the next 4 weeks

·         fewer than 8 breastfeedings a day

·         no sign of suckling and swallowing (milk transfer) when breastfeeding

·         no sign of milk release (let down)

·         your baby is either restless and fussy or listless and sleepy for long periods of time

·         your baby has lost more than 7% of his birth weight

·         your baby is below birth weight at 2 weeks of age

·         your baby is gaining less than 4 – 8 oz a week

Question:  Do I need to drink extra fluid while I am breastfeeding?

Answer: (by Amy Spangler, from Breastfeeding A Parent’s Guide, RN, MN, IBCLC):  

Fluid intake is best regulated by thirst.  In fact, excess fluids can actually decrease milk production!  Many studies have looked at fluid intake and milk output and have found that the mother’s thirst is the best guide.  So follow your own thirst (about 6 – 8 glasses a day) and drink healthy beverages such as low or non-fat milk, 100% fruit or vegetable juices, or water. Limit caloric containing beverages (sodas, punch, alcoholic drinks) and non-caloric beverages (artificially sweetened “fruit” drinks and sugar-free sodas).

Amy Spangler earned her bachelor’s degree in nursing from Ohio State University and her master’s degree in maternal and child health from the University of Florida.  She is an International Board Certified Lactation Consultant and a Past President of the International Lactation Consultant Association.  Amy currently serves as the Chair of the United States Breastfeeding Committee.  She is the author of BREASTFEEDING, A Parent’s Guide; BREASTFEEDING, Your guide to a healthy, happy baby, and Evidence-Based Guidelines for Breastfeeding Management during the First Fourteen Days as well as numerous other publications.  Amy lectures extensively on a wide variety of maternal and child health topics.  Her educational materials are distributed widely in a variety of languages.  Amy lives in Atlanta, Georgia with her husband Dennis, a physician, and their two sons, Matthew and Adam.

Question: When and how do I introduce solid foods to my baby?

Answer (by Dr. Kenneth R. Keer): 

Being a parent is on the job training with various parental and childhood milestone to be passed during the flow of infant and parent development.

One of the most common questions asked is when, what and how to introduce solid foods in the infant.

Most pediatricians suggest the introduction of solid foods between the ages of 4 to 6 months. (Earlier feeding of solids do not help an infant sleep through the night)

The most common first food is iron-enriched rice cereal. I suggest starting with 2 tablespoonfuls at breakfast time and then again at dinnertime. The cereal can be mixed with breast milk, formula or even water and should be fed to the infant with a spoon.

When the infant seems comfortable handling the cereal, then new food can be introduced. The introduction of each new food should be separated by an interval of 3-4 days to be able to identify intolerance to the newest food.

I generally introduce yellow vegetables (carrots, squash, and sweet potatoes) followed by applesauce, bananas, and the “P” fruits, (peaches, plums, and pears) and finally the green vegetables. Each pediatrician has their favorite food regimen but this has worked well for my patients over the past 30 years.

Infants should be given each food individually and with a spoon rather than all mixed up together in a bowl or plunked in a bottle. This enables the infant to distinguish both different flavors and different textures.   

I suggest the avoidance of juices in the first 9-12 months of life as they basically fill the child with “empty calories”. Being mostly sugar, juices probably allow the infant to acquire a preference for sugary foods rather than for the important varieties of richly colored fruits and vegetables.

You can tell if the baby likes the food by his or her smacking their lips, opening their mouths or even smiling. On the other hand, turning away, crying or making pursed lips often means, “I’m done or “I don’t like it”. If your child doesn’t seem to like a particular food don’t push it. There are plenty of other yellow or green vegetables to try. 

Dr. Kenneth R. Keer is a board-certified pediatrician and a fellow of the American Academy of Pediatrics. He is in private practice and also an assistant Clinical Professor of Pediatrics at U.C.L.A. He is married with grown children and three grandchildren.

Question: How can I successfully continue to breastfeed when I return to work?        

Answer (by Debbie Albert, Ph.D., IBCLC):   

It is not unusual to feel overwhelmed at the prospect of returning to work and continuing to breastfeed.  However, many moms have managed this feat, and here are just a few suggestions to send you on the road to success:

1.  Four to six weeks prior to your return to work, start collecting one bottle of breastmilk per day.  Leave your pump prepared for pumping.  Whenever the baby nurses one side, but not the other--pump the other side.  If your baby takes a long nap, try to pump in the middle.  Try to pump one side while the baby nurses the other.  A good surplus milk supply can keep you going even during a serious dip in supply. If you would like to mix two different pumpings, please make sure that both milks are refrigerator level cold before combining them, and it is best to only combine milk pumped on the same day.

2.  Start work on a Wednesday or Thursday.  This way, your first week back at work doesn't appear to be soooo long.

3.  Make sure you bring supplies for self-care.  The top three are extra bra pads, boxes of quart and gallon size (sealable) plastic bags, and a sweater.  Even if you don't leak, you could if you skip a pumping time, so be sure to bring extra bra pads.  The quart and gallon size bags come in handy for a number of reasons.  If you put ice in the quart size bags, they can be used as makeshift freezer packs (if you forgot them at home), and they can also be ice packs for plugged ducts or an engorged breast. 

The gallon size bags keep your pump bag clean.  Put the word "clean" on one bag, and "dirty" on the other.  Use these bags depending upon the condition of your parts at the time.  This will prevent you from putting dirty or wet parts directly into your pump bag.  Replace plastic bags as needed.

The sweater comes in quite handy on a day that you might have chosen to wear a light color, and experienced an accidental leak.  A black sweater hides even the most embarrassing leak.

4.  Recognize your limits.  You have just come back from maternity leave.  Make sure that you don't overdo it.  Try to take care of yourself--just as you did during pregnancy.  Eat right, drink plenty of water, take your prenatal vitamins, and try to get the rest you need.

5.  Ideally, a nursing mom who works full-time should plan to pump three times per day.  Note the word IDEAL.  The average person pumps twice.  It pays to start off as zealously as you possibly can.  Keep in mind that whatever amount of breastmilk that you provide to your baby is a gift, and one less formula supplement that you will have to pay for.  Babies who are partially breastfed still reap health benefits from breastmilk.  So it does pay to pump--even if it is only once a day.

6.  Keep track of your surplus milk supply.  Use older milk first.  Know your collection and storage guidelines.  On a conservative note, remember 5-5-5.  That is, five hours on the counter, five days in the refrigerator, and five months in the freezer. 

7.  Make sure your daycare provider or nanny knows how to handle your breastmilk.  Make them aware of the fact that your breastmilk is liquid gold.  Ask them to utilize it efficiently, and avoid wasting it.  For example, if baby just drank an 5 oz. bottle, suggest that they heat a 1-2 oz bottle if the baby is still hungry 10 minutes later.  Heating another 5 oz. bottle could mean wasting 2-4 oz. of your milk.  During growth spurt periods (3 weeks, 6 weeks, 3 months, and 6 months -- remember 36-36), provide 2 oz. bottles in addition to regular size bottles for this very reason.

8.  Do your best to keep your pumping times.  You have an hour window to play with if you do not have to follow a particular schedule at your office.  However, if you work in customer service, you may not be that lucky.  For some women, skipping the 10 a.m. pumping time three days in a row could drastically reduce an a.m. milk supply.  Regular pumping keeps your milk supply up.  REMEMBER:  The more you pump or feed, the more milk you will produce.

9.  STAY ABOVE THE OVERWHELM.  Many new moms have a lot to feel overwhelmed about, and the first week of work is no exception.  Often the first week back at work marks the first time you have had considerable time away from the baby.  Many mothers are dealing with a new caretaker for the first time.  Also, sometimes there are 823 emails or a desk full of work just waiting for you while you were out on maternity leave.  Keep it real.  Rome was not built in a day, and you will not get it all back in order in a day either.  Just take each day, and do the best you can.                              

10.  Nurse your baby whenever you are home, and especially throughout the weekend.  Breastfeeding is a wonderful way to physically and emotionally reunite with your baby when you return home from work. Nurse the baby at night, in the morning, and on weekends.  Remember that the baby is the best pump, and whenever you experience a dip in supply try to have a nursing marathon over the weekend.  Basically relax at home, drink plenty of liquids and nurse, nurse, nurse.  Usually this is all a mom really needs to get a supply back up by Monday.

Question: Sometimes my baby is sleepy and difficult to wake for a feeding, what should I do?

Answer (by Debbie Albert, PH.D, IBCLC): 
We have all heard the cliche, "Let sleeping babies lie."  It sounds like a lovely idea, but for newborns there is a slight flaw in the logic. A typical breastfed newborn needs to eat 8-12 times in a 24 hour period.  That works out to approximately every 2-3 hours.  Sadly, some newborns can be very tired as a result of difficult labor or jaundice.  It is not uncommon for some of these babies to be so sleepy that they may want to sleep 5-6 hours at a time, especially during the day.

Initially, this might seem like every mothers dream child, but such extended periods without feeds can put a baby at serious health risk, and it can greatly reduce your milk supply.  Also, at the very least, you may be dealing with a baby who has nights and days mixed up. Therefore, baby is sleeping for long stretches throughout the day, and waking up continuously throughout the night.

It is important for a new mom to feed often during the day, when she is most alert.  Night feeds don't tend to go as well for new moms because they are exhausted and positioning may not be up to par.  Dim any bright lights, and be especially careful to use dim lighting during feeding time.  Otherwise, you may end up with a real dancing baby at 2:00 a.m.!   

So how do we wake this sleepy baby during the day?  First, make sure that your home is bright during the day.  Schedule active things, like walks and outings, during the day.  Keep the baby lightly clothed.  In hot climates, I recommend a T-shirt that snaps on the bottom and some baby socks. Keeping the baby "wrapped up" often encourages long periods of sleep, but please make sure that there are no temperature issues with your baby.  Some infants get too cold without a regular blanket.  Obviously, in cold climates, the blanket is a necessity.

Babies can typically be roused by rubbing the bottoms of their feet or walking your fingers down their spine. Sometimes with particularly sleepy babies, it is helpful to give them a little mini-bath with a luke warm washcloth.  At times it is helpful to do what I describe as the "wet turban"--keep the washcloth on the baby's head to help keep the baby awake.

It is important to feed a breastfed baby frequently due to the fact that breastmilk is digested quickly and easily.  Waking your newborn when (s)he is beginning to go beyond 3 hours between feeds will ensure that your baby is getting enough and it will help establish a strong milk supply.

Question: What are the feeding patterns in a breastfed infant?

Answer (by Debbie Albert, PH.D., IBCLC):  

So you have a newborn and you wonder if he/she is eating correctly?  Perhaps you have been told that the baby should eat on a schedule? You will be surprised to know that there are a number of feeding patterns that are quite common, and that no one way is absolutely correct.  Just make sure that the baby is eating at least 8-12 times and you are getting at least 6-8 wet diapers in a 24 hour period.  And by the way, just when you think you know the pattern, baby will change it for one particular reason or another.

Four basic patterns are easily discernible: grazing, sleeping, cluster, and angelic.  Babies who graze tend to nurse fairly often through the 24 hour period.  There seems to be no set pattern, and it is quite common for them to nurse one side at a time.  Sleepy babies must be roused to be fed. Often this occurs due to the uterine sleep pattern that they developed during pregnancy, and you often hear "(s)he has her days and nights mixed up."  It is helpful to wake this baby often during daylight hours to achieve a more humane schedule.  Cluster feeds are quite common during early infancy and growth spurts which occur at about 3 weeks, 6 weeks, 3 months, and 6 months (just remember: 36-36).  During cluster feeds, the baby may eat every hour for 3 feeds in a row, and then sleep for 3-4 hours.  The angelic nurser is the rare type of baby that seems to do everything by the book.  This baby nurses every 2-3 hours during the day, and every 3-4 at night.  Often this is the same child that will be sleeping through the night at an early age.  Although there are no guarantees, most babies start spreading feeds and sleeping for longer stretches at night after the six week growth spurt. Keep in mind that change of routine, illness and teething will also affect your baby's eating patterns, and that the baby's individual pattern will change as well over time. 

Question: How do I know when my baby is ready to be fed?

 Answer (by Debbie Albert, PH.D., IBCLC) :   

Being a new breastfeeding mom can be tough.  Chances are several people have told you to notice feeding cues, and you may be thinking to yourself, "I can't tell what my baby needs?"  You may be wondering if you will ever have that "instinct" that you are supposed to have. 

There is really nothing ominous about feeding cues.  In most cases, they help us feed the baby before the baby becomes too anxious or the mom gets too engorged.  Symbolically, babies provide feeding cues in their sleep or as they are waking up to feed.  Typically, they may make a gutteral sound like they are a parched person wandering through the desert.  Hands are brought to the mouth with smacks and sucking sounds.  In very sleepy babies, you may see serious levels of rapid eye movement or REM. 

It is not uncommon, particularly if a mom has sore nipples, to ignore these feeding cues until the baby is extremely hungry.  This is not beneficial.  First, a frustrated baby is less likely to feed well.  Both mother and baby are liable to end up having an simultaneous emotional melt down.  Feedings can be so much nicer when baby and mom are content.  Second, as mom ignores feeding cues, she risks becoming too engorged to feed the baby--particularly in the early days.  If nipples are sore, they will become even more sore as the baby nurses on a very solid nipple that has been flattened by engorgement.  Third, and perhaps most importantly, spreading feeds causes a reduction in milk supply.  If nursing is painful, the best solution is to see a lactation consultant.  Reducing feeds typically irritates the problem.  REMEMBER:  Soreness is caused by poor position and latch--NOT the amount of time the baby actually breastfeeds.

It is important to heed feeding cues quickly.  As soon as the baby starts cuing, begin feeding.  Don't even worry about the diaper (unless the baby is too sleepy and diapering will help increase alertness).  Start feeding, and use diapering and burping as a way for the baby to wake up and take the second side.  Feeding cues help you to develop a natural harmony with your baby, and establish a strong milk supply.

Question: What are some of the ways I can soothe my fussy baby?

Answer (by Debbie  Albert, PH.D., IBCLC): 

Most new moms are surprised to find out that fussiness is quite common in babies.  Even the best babies are not easily placed down every time.  Particularly during growth spurt periods (3 weeks, 6 weeks, 3 months, and 6 months) they tend to need consistent care.  In some cases, the baby may also have colic. Most mothers describe these times as "trying" and even "draining".  

First of all, please don't blame yourself.  We are discovering more and more that personality appears to have a strong genetic component.  Most new moms make a frantic attempt to discover what is troubling the baby, and they often want to know what they are doing wrong.  However, in most cases, there is no specific answer.  The solution is to comfort the baby as best you can, and try to avoid feeling overwhelmed and overly responsible. Although it can be very trying, please don't escalate emotionally with the baby.  Especially during growth spurts, the baby may need to feed more frequently to increase your milk supply.  Letting the baby cry it out does not increase lung capacity, often reduces your milk supply, and generally exacerbates the issue. 

Instead try to calm the situation.  If baby is hungrier--feed more frequently.  However, once feeding needs are met, use lots of skin-to-skin contact, learn baby massage, and give the baby warm baths. Some babies appreciate "white noise", and that is why so many can be calmed by a car ride.  At 2:00 a.m. you can mimic that experience by placing the baby in a safe carrier on top of your clothes dryer.  Sometimes a slow baby swing does the trick, or a good walk with daddy.  Many babies can be calmed by the deep singing voice most dads can provide. 

If the fussiness is related to gas or colic, it might be helpful to look at your diet.  The three top human allergens are milk, soy, and eggs.  Milk could be the culprit if baby's stools are excessively loose or there is blood in the stool.  It is helpful to avoid milk products with lactose intolerant babies.  There are other foods that cause gas--beans, brocolli, brussel sprouts, etc., but try not to go overboard with food restriction.  Chances are you may feel like a prisoner of your own diet!

If change in diet doesn't help, often over the counter remedies like mylicon drops or baby mylanta can do the trick.  Discuss medication options with your pediatrician.

Please do your best to stay above the overwhelm.  Taking care of a baby that is demanding and fussy is very challenging.  It is also not unusual to be particularly emotional during the post-partum period.  It is estimated that approximately 40% of women out there experience some form of post-partum depression.  Therefore, take some moments for self-care.  A 10 minute shower or power-walk can do wonders.  Also, massages, listening to your favorite music, naps with baby, a few moments out in the sun, or even a decaf latte or a quick snack can do the trick.

Dr. Debbie Albert has been a corporate lactation service provider since 1997.  Through MCH Services Inc., she provides prenatal and post-partum lactation services to employees in several major companies.  Debbie Albert received her doctorate in Counseling from the University of South Florida in 1991, she has been an International Board Certified Lactation Consultant since 1995 and Licensed Mental Health Counselor since 1987.  Dr. Albert has over 12 years of experience working with breastfeeding mothers and 21 years experience in the mental health field.  She taught at the University of South Florida for 12 years.  Through her private practice Tampa Lactation Counseling (TLC) in Tampa, Florida, she provides lactation consulting, breast pump rentals, sales, and support services.  Debbie Albert has been married for almost 20 years to Dan Albert, and has two healthy, breastfed sons, Joshua and David (now 14 and 10 years old, respectively).

Question: Since having my baby, my sexual response seems to be slower.  What can I do about this?

Answer  (Rona Cohen, RN, MN, IBCLC):          

Mothers may find that their sexual response cycle has slowed.  Ask your partner to give you adequate time for sexual arousal. You may need extra kissing, cuddling and caressing.  Open discussion of you sexual needs and your partners eliminates performance pressure and relieves anxiety.  You may want to discuss your concerns with a physician or with a sex educator.

Question: Why am I experiencing vaginal dryness?

Answer  (Rona Cohen, RN, MN, IBCLC):          

Vaginal lubrication may decrease in breastfeeding mothers after delivery.  This dryness is a result of an estrogen decrease and is not permanent.

If your vaginal tissue is sensitive, use a sensual, water-soluble, non-perfumed lubricant (check your pharmacy) as part of lovemaking. Or you might want to try a natural flavored massage oil (check your health food store). In addition to providing lubrication, the oil feels good on the body, has a pleasant aroma and does not inhibit lovemaking.

Question: My partner complains that I pay too much attention to my baby and not enough attention to him.  What can I do?

Answer  (Rona Cohen, RN, MN, IBCLC):          

If your need for intimacy is being satisfied through the warmth and bonding of breastfeeding, you may be inadvertently slighting your partner.  Nurture an intimate relationship with your partner through conversation, sharing feelings and spending time as a couple away form the baby and away from the bedroom.  Shower together, for example, or exchange massages with no expectation of sexual performance.

Being overly concerned about your baby may be contributing to a lack of sexual desire.  Arrange your lovemaking time for after your baby is fed and asleep. Try for early in the morning or in the evening, at a time when you are least fatigued.  If you make love soon after feeding the baby, the chances of your breasts leaking will be lessened.  But do allow some time for relaxation and transition into lovemaking, through a shower, exercise or just talking.          

It is also important to set aside some time just for you.  Take a long shower or bath.  Read or exercise.  Socialize with your friends away from the baby and other children.  These gifts to yourself are renewing, refreshing and relaxing-and may well encourage new interest in sex with your partner.