Breastfeeding takes some time to learn and understand! Sometimes challenges come up along the way, so here are some solutions.

Is My Baby Getting Enough?

Many new moms wonder about this! Ask yourself these questions:

1. Can I hear my baby swallowing when he is breastfeeding?  
2. Am I nursing at least 10-12 times in 24 hours in the early weeks? 
   • Most newborns will nurse from both breasts and feed for 20-45 minutes at each feeding. It is okay for a baby to nurse more often than 12 times a day. You cannot nurse too often—but you can nurse too little.
3. Does my baby seem content after feedings? 
4. Is my baby gaining a pound or more per month? 
   • Remember! It’s normal for babies to lose weight right after birth. They should be back to birth weight within a couple of weeks and then continue to gain.  
5. Does my baby have enough dirty diapers?

Baby's Age	Dirty Diapers
Day 1 (Birth)	1 (Thick, tarry, black)
Day 2	2 (Thick, tarry, blackish brown)
Day 3	3 (Greenish and pasty)
Day 4 (or when milk increases)	3 (Greenish yellow)
Day 5 and up to 6-8 weeks of age	5+ (Yellow, seedy)

It’s okay for your baby to have more dirty diapers than what is listed!

Leaking

Leaking is normal, although it may not occur in every mother. You will leak less over time. Until then:

• During your feedings, press firmly on the nipple area of your breast to stop the leaking.
• Wear washable or disposable nursing pads during and between feedings. Be sure to replace pads as they become saturated! 

Too Little Milk (Milk Production)

Many mothers worry about not producing enough milk, particularly in the first few days when the baby is only receiving tiny amounts of colostrum. Family and friends may support this concern. However, a true low milk supply is extremely rare and would be confirmed by poor growth in your baby. 

Ideas For Building Milk

• Increase the number of feedings you feed your baby. 
• Hold baby skin-to-skin to increase oxytocin levels and help with milk flow. 
• Nurse on one side and pump on the other side to help increase supply. Alternate the nursed breast and breast pump breast at each feeding. 
• If breasts are not able to be emptied by your baby, hand express or pump after feedings. 

Be cautious about building your milk supply so that you do not overproduce.

Uncomfortable Full Breasts (Engorgement)

Some breast fullness is normal in the first weeks. However, if milk is allowed to build up in your breasts, they may feel uncomfortably full, hard, or warm to the touch. 

To Prevent Engorgement

• Make sure your baby has your entire nipple and most of the areola well into his/her mouth. 
• Nurse on demand, at least 10 times or more every 24 hours in the early weeks. 
• Watch for baby’s early signs of readiness to feed. Feed day and night when you see these early signs. 
• Keep baby skin-to-skin.

To Relieve Engorgement

• Place a warm—not hot—washcloth on your breasts or take a warm shower before feeding to help your milk flow. 
• Use a cold compress between feedings to help decrease the swelling. Bags of frozen peas wrapped in a cold washcloth work well for this. 
• Massage your breasts gently to release a little milk before feedings. Hand express or pump a small amount of milk to soften the breast and make it easier for the baby to latch on. 
• Begin feedings on the fullest breast. Offer both breasts at each feeding to relieve fullness. 

If your breasts become red and tender, call your doctor. You may have a medical condition that could require further care.

Sore Nipples

Breastfeeding can cause mild discomfort at the beginning of a feeding when your baby first latches on to the breast. This is fairly common but should only last a few seconds and usually only for a few days. 

Breastfeeding should not hurt!

Pain that lasts more than a minute, pain that continues during or between feedings, discoloration of the nipple, or misshaped nipples may be signs of an ineffective latch or a breast infection. 

To prevent/relieve soreness: 

• Make sure your baby nurses with the entire nipple well into his/her mouth—not just the end of the nipple. 
• If your baby is latched on incorrectly, break the suction by inserting your finger in the corner of his/her mouth and re-latch. 
• Be sure the baby is positioned properly, tummy to tummy. 
• Try changing your nursing position. 
• Let your nipples air dry after feedings. 
• Express a drop of breast milk and rub around your nipple/areola and then air dry. 
• Avoid soaps, lotions, creams, and breast pads with plastic liners. 
• If you are very sore, start feeding on your least sore side first. 

Tender Breast Lump (Plugged Duct)

If you notice a tender lump in one of your breasts, you may have a 'plugged duct'. The area around it may be red and you may ache. It occurs when there is swelling in the breast which then restricts the flow of milk.

TO PREVENT a plugged duct: 

• Ensure your baby has a good latch. 
• Avoid tight-fitting clothing or other things that can press against the breast (too tight bra, tight front baby carrier). 
• Nurse at least 10 times every 24 hours in the early weeks. 
• Change your nursing positions often.

TO RELIEVE a plugged duct: 

• Continue to nurse on demand.
• Use cool packs to help reduce inflammation (make sure there is a shirt, bra or thin towel between your skin and the cool pack).
• Position your baby so his/her nose or chin is closest to the sore spot. 
• Gently massage the lumpy area before and during the feedings. Always massage the breast up towards the armpit. 

With a few feedings, the plug should move toward then out of your nipple (it may look like thin spaghetti). 

Call your doctor if you have a fever or a plugged duct that does not go away.

Breast Infection (Mastitis)

If one of your breasts is red and tender to touch (from a plugged duct or engorgement) and you feel like you have the flu (fever, chills, body aches), you may have a breast infection. 

• Call your doctor.
• Do not stop nursing. Breastfeed on demand! The infection won’t spread to your baby. 
• Put a warm, wet washcloth on your breast before feedings and offer your baby the affected breast first. 
• You can use cold packs after breastfeeding to help relieve the pain and decrease the swelling. 
• Make sure your baby is positioned correctly.
• Drink enough fluids to satisfy your thirst and get plenty of rest.

Breastfeeding When You Are Ill

• You can (and should) keep breastfeeding even with most illnesses like coughs, colds, fevers, or common diarrhea. 
• Your milk is still good and continues to protect your baby from many illnesses. 
• If you have questions about breastfeeding when you are sick, call your doctor. 
• Call the WIC office before you consider offering formula to your baby! 

Teething

There is no reason to wean your baby just because he/she is getting teeth. While many babies never bite, some do try. However, this usually occurs at the end of a feeding or times when you try to nurse and he/she isn’t hungry. 

The fact is—it is impossible for your baby to bite and nurse at the same time because his/her tongue is between the bottom teeth and your nipple. 

Only when your baby has stopped nursing will he be able to bite, so watch your baby and remove him from the breast once he has stopped sucking or swallowing? If he does bite, gently take your baby off your breast and firmly say “no.” Most babies learn very quickly not to bite! 

Breastfeeding Multiples

Milk Supply

• Whether you are nursing one baby or two, your milk supply depends on one thing… HOW MUCH YOU NURSE. 
• Breastfeed as soon as possible after birth and feed on demand. 
• Your breasts do not need time to fill up after nursing, so there is no reason to wait a certain amount of time between feedings. 
• THE MORE YOU NURSE, THE MORE MILK YOU WILL HAVE. Nurse at least 10-12 times every 24 hours in the early weeks. 
• While in the hospital, ask that your babies room-in with you or request that babies be brought to you for all feedings. 
• If you are separated from one or more of your babies, you will need to express (pump) milk to maintain your supply. Check out the section Pumping & Storing Breast Milk for information about three ways to express milk.
• If your babies are born early, pump often to increase milk supply. 
• Do not give your babies a bottle or pacifier during the first month, until breastfeeding is well established. If your babies do need a supplement, ask about all feeding options (cup, spoon, eye-dropper, syringe, finger feeding). Remember, even if your baby does receive a bottle, you can still breastfeed. 
• In the first days, do not let either baby sleep more than 4-5 hours without nursing.

Positioning

• Good positioning is important for pain-free nursing, and even more necessary when breastfeeding twins. 
• Keep trying different positions until you find ones that work for you and your babies. Ask for a helping hand to get comfortable, especially when your babies are tiny.

Be Prepared

• Learn as much as you can about breastfeeding during your pregnancy. 
• Discuss your plans to breastfeed with your health care provider, family members, and daycare provider if returning to work or school. 
• Take a breastfeeding class.
• Join a support group for parents of multiple. 
• Talk to your WIC Breastfeeding Peer Counselor or breastfeeding expert.
• Contact your local WIC Office to discuss the availability of a breast pump.

Tips

• Nurse both babies together to save time. This can be a big help during nighttime feedings. If one baby wakes to nurse, wake the other baby to nurse at the same time or right after the first baby. 
• Breastfeeding both babies at the same time can also help with letdown and may increase milk supply. 
• Use pillows to help support your babies.
• Get the stronger nurser latched on first before positioning your other baby. 
• If you nurse one baby at a time, pump the other breast. This helps with milk production and builds a supply of milk that you can freeze for later use. 
• Even if your babies prefer one breast over the other, switch between breasts when nursing. If one baby is a bit weaker at nursing, the stronger sucking infant will help to stimulate milk production in both breasts and assist in letdown. 
• Switching breasts also gives your babies different views that are important for visual stimulation. 
• Nurse the hungriest baby on the fullest breast to help empty your breast and promote milk production. 
• Keep the crib or pack ‘n’ play in your room so there is less moving around when the babies need to nurse at night. 
• Nursing twins at the same time has several benefits, but many moms enjoy breastfeeding their babies separately. This provides the chance to interact with them one-on-one and get to know them individually. 
• You may want to try to nurse your twins together at night and separately during the day at some of the feedings. 
• If you are concerned that your baby is not getting enough breast milk, keep a daily log to record diapers and have his or her weight checked. All newborns have a strong sucking reflex and will take a bottle even right after they nurse. This is not an indication that they are still hungry and do not get enough breast milk. 
• Ask for help! Let friends and family help as much as possible with housework, chores, errands, and meals. Limit visitors in the first few weeks, but plan to have help when you come home from the hospital. 
• Take care of you! You don’t need a special diet but it is helpful to have healthy snacks on hand that take little preparation (fresh vegetables and fruit, cheese slices, nuts, hard-cooked eggs, whole grain bread, and crackers). And you don’t need to have a certain amount of fluids. Just drink to thirst. Rest whenever you can. Sleep when your babies sleep.

Remember—the first several weeks are a time of learning and adjusting for you and your babies. 

When to Ask for Help

If you notice any of these signs, call your health provider or the WIC office! 

• Baby is breastfeeding fewer than 10 times in 24 hours in the early weeks. 
• There is no sign of a milk letdown.
• There is no sign of baby swallowing.
• Baby continues to lose weight after day 5. 
• Baby is below birth weight at 2 weeks.
• Baby is restless, fussy listless, and sleepy for long periods. 
• Baby is having less than 3 stools per day in the first month. 
• There is a change in the baby’s appearance. 
• Baby unlatches several times through a feeding.