Commonly Asked Breastfeeding Questions:

Can I breastfeed if I have inverted, flat, or pierced nipples?

The type of nipple is less important than how well your baby latches. Remember, babies breastfeed, they do not nipple feed! Also, truly inverted nipples are extremely rare and usually only affect one breast. If you have concerns about your nipples, consult a breastfeeding specialist or lactation consultant. Quite often, inverted or flat nipples can be drawn out or may even be corrected during pregnancy as breast tissue becomes more elastic in preparation for breastfeeding.

Checking for Inverted Nipples (“Pinch” Test) 

• Place your thumb and first finger at the base of your nipple near the areola.
• Press your thumb and finger together.
• If your nipple pushes out, it is not inverted.
• If your nipple doesn’t move, it may be flat.
• If your nipple sinks in like a dimple, it may be inverted. However, your baby may be able to draw it out during breastfeeding!

Breastfeeding with Pierced Nipples

In most cases, pierced nipples do not cause a problem during breastfeeding. However, always remove any type of nipple jewelry before breastfeeding as it can interfere with your baby’s ability to nurse and pose a choking hazard.

Can I breastfeed if my breasts are small?

Breast size is determined by the amount of fatty tissue in the breast and is not related to the ability to produce milk. However, size may affect storage capacity, which simply means that a mom with smaller breasts may need to feed her baby more frequently than a mother with larger breasts. Overall, the milk production is the same. Remember—your breasts are perfect for your baby!

Can I breastfeed if I have had breast surgery?

Several factors can influence a woman’s ability to produce milk after breast surgery. These include where the incisions are located, how the surgery was done, and the reason for her surgery. Severing of nerves can interfere with letdown, whereas damage to milk ducts, removal of tissue during breast reduction, or the placement of an implant that puts pressure on milk glands can all impair actual milk production. Likewise, if a woman had implants because her breasts did not develop, she may be lacking enough milk-producing glands to produce a full supply.

If you are considering breast surgery, tell your surgeon about your desire to breastfeed and discuss options that minimize damage to milk ducts and major nerves.

Generally, if a woman experiences injury or damage to only one breast, as may occur with breast cancer, she should be able to produce plenty of milk to fully breastfeed from one breast. Frequent weight checks may be necessary to ensure adequate supply/transfer.

Ultimately, the only way to know if you can breastfeed following surgery is to try!

How do I care for my breasts?

Your breasts don’t need any special cleaning or care. Be sure to use mild soap. Do not use lotions, creams, or oils.

Montgomery glands are the small pimple-like bumps on the areola that produce an oily substance to keep your nipples clean and moist. However, if your skin gets dry, you can use a small amount of lanolin…a little goes a long way!

Choose a comfortable cotton bra that is easy to adjust. If you wear breast pads, remember to change them often. (Don’t use pads with plastic liners that trap moisture.)

If your nipples are tender, put a few drops of colostrum or breast milk on your nipples and areola after breastfeeding and allow to air dry.

Can I breastfeed if I have a tattoo?

Most breastfeeding experts agree that having a tattoo should not interfere with breastfeeding as the ink will not leak into your breast milk.

Can I breastfeed if I smoke?

The American Academy of Pediatrics has recently stated that research seems to indicate that the beneficial effects of breastfeeding outweigh the negative effects of the mother’s smoking. Babies who are exposed to secondhand smoke have a higher rate of upper respiratory infections, but breastfeeding helps protect babies from these illnesses. However, it is always better to quit smoking. NEVER smoke around your baby! If you can’t quit, try cutting back—you and your baby will both be healthier.

Can I breastfeed if I have diabetes?

Breastfeeding is especially important for families with diabetes. If you have diabetes while you are pregnant, your baby may have a greater risk of developing diabetes early in life. Breastfeeding can help lower this risk for your baby, and it can benefit you, too. Your blood sugars will likely be lower— although your milk will be fine regardless of your blood sugar levels—and you may lose weight. Just know that some women with diabetes notice that it takes longer for their milk to come in. This is normal! Be sure to let your diabetes healthcare provider know that you are breastfeeding.

Can I breastfeed while I am pregnant?

Many women continue to feed their older babies throughout pregnancy and after delivery. This is called “tandem” nursing and is usually okay as long as you do not experience contractions or have a history of pre-term labor. The composition of your milk is regulated by the hormones involved in pregnancy, so your breast milk will adjust to meet your newborn’s needs. If you continue to breastfeed both children after delivery, try to allow your newborn infant to nurse first—particularly early on to ensure he/she gets the all-important colostrum.

Can I breastfeed if my baby is jaundiced?

Jaundice occurs when extra bilirubin is stored in your baby’s body tissues and blood. Bilirubin is the pigment produced from the process of breaking down extra blood cells. ALL babies break down extra red blood cells after being born as part of getting used to life outside the womb. The liver gets rid of this extra bilirubin, but sometimes a newborn’s liver isn’t able to remove it as fast as it’s made.

Jaundice is fairly common for babies in the first weeks after birth—occurring in nearly half of all newborns. In most cases, it is harmless and will go away by itself in 2 or 3 weeks. Breastfed babies tend to have higher bilirubin levels, but breastfeeding itself does not cause jaundice. Frequent breastfeeding helps to lower bilirubin levels since it leaves the body in the stool. Your doctor may recommend formula for a couple of days—but that is not needed! Explain to your doctor that breastfeeding is important to you and you would like to make it part of your baby’s treatment plan!

Jaundice can make your baby sleepy, so you may need to wake him/her for breastfeeding!

If your baby still looks jaundiced after 2 to 3 weeks of age, talk with your baby’s doctor about other tests your baby might need.

Can I give my baby a pacifier if I breastfeed?

Avoid pacifiers for the first 3-4 weeks when you have established a good milk supply. In the first month, it is important to put baby to breast each time he shows he is hungry. When a baby sucks at your breast, it signals to your body to produce more milk. The more often the baby breastfeeds, the more milk you will make. Never use a pacifier in place of breastfeeding or try to have the baby wait longer to eat. Remember, your newborn should be fed whenever they show they are hungry, not on a schedule.

After you and your baby have learned to breastfeed well and you have learned the baby’s hunger cues, a pacifier can be used at naptime and bedtime as the baby is falling asleep to reduce the risk of Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID). 

What is nipple confusion?

Some breastfeeding experts actually prefer the term “Nipple Preference” rather than “Nipple Confusion.” Why? Because sucking on an artificial nipple is much different and usually much easier than removing milk from your breast. When your baby breastfeeds, he/she must latch correctly, move his jaws appropriately, and use his tongue a certain way. With a bottle, all he has to do is create a suction and swallow. It makes sense, that given a choice, your baby would “prefer” the easier option! For this reason, it is important not to introduce a bottle before you both have had time to learn how to nurse effectively at the breast.

If your baby does begin to show a preference for an artificial nipple, he/she can be re-taught to breastfeed. Eliminate all bottles and pacifiers and continue to offer only your breasts. If he refuses any amount of nursing, pump your breasts and feed him breast milk with a spoon, a cup, or an eyedropper. It usually only takes a couple of days to get a baby back on the breast but call for help if it continues to be a struggle!

What is a nursing strike?

Occasionally, some babies suddenly refuse to nurse. This may be due to sore gums during teething or might be related to an ear infection, sore throat, or cold. Quite often, there is no apparent reason! However, it is important that you continue to gently offer your breast for nursing and protect your milk supply by pumping every 3—4 hours. Most strikes are temporary, although it might take several days! In the meantime, you will need to find other methods to feed your baby. You can start by feeding your expressed milk with a cup, a spoon, or even a medicine dropper. Using a bottle can make it even harder to get him/her back on the breast because your baby will quickly realize that it takes less work to get milk from a bottle than from your breast! (In fact, using a bottle could have caused the nursing strike in the first place.) During this time, provide lots of skin-to-skin contact and cuddling. You can even try nursing while your baby is sleeping—some babies will nurse in their sleep even if they’re on strike!

Don’t confuse a strike with weaning—weaning usually occurs gradually, while strikes are often sudden! Hang in there and keep offering your breast. Soon your baby should be back to normal.

What are cluster feedings?

Many babies go longer between feedings during the day and then seem to want to nurse all the time in the evenings. This is called “cluster feeding” and is particularly common in the early weeks. Sometimes your baby will seem to want to nurse simply for comfort, and if that is what he/she needs, be sure to offer him/her the opportunity. You cannot overfeed a breastfed baby. He/she will stop when he has enough.

Does my baby need extra Vitamin D?

Unfortunately, a large percentage of women – even those trying to eat healthy and taking their prenatal vitamins – do not have adequate Vitamin D levels and therefore do not produce sufficient quantities in their breast milk. However, this is an environmental issue more than a nutritional deficiency.

The primary source of Vitamin D for humans (including infants) has always been sunlight—not diet. (Dietary sources are somewhat limited. Your best bets are cod liver oil, fatty fish, eggs, milk, and some fortified foods such as cereal and margarine.) Although sunlight can be a major source of Vitamin D, factors such as the latitude where you live, the amount of pigment in your skin, the amount of sun exposure you receive, and the use of sunscreen products to protect against skin cancer all affect how much Vitamin D your body can produce from sunlight. Ask your WIC dietitian if you have questions about foods rich in Vitamin D.

The bottom line is that we simply do not get the necessary sun exposure that is needed for sufficient Vitamin D production. For that reason, the American Academy of Pediatrics recommends that all breastfed infants receive a supplement of 400 IU of Vitamin D daily beginning at birth.

Visit with your healthcare provider if you have questions about Vitamin D supplementation!

When will my baby sleep through the night?

After your baby is breastfeeding well and gaining weight, you can begin to let him/her set his feeding schedule. This may happen around 4-6 weeks of age. But remember, every baby is different! Some babies will continue to breastfeed every 2-3 hours, day and night, for weeks or months—while others may sleep from midnight to 5 am when they are 3 months old. Keep in mind how tiny your baby’s tummy is and how easily digested breast milk is! The fact is, babies were not built to sleep all night without eating. Five hours is a pretty good stretch, so you may simply need to change your idea of the night!

Should I give my baby water or cereal?

Your breast milk is all your baby will need for the first 6 months— even in hot weather. You DO NOT need to give your baby water, juice, or a breast milk substitute!

Starting food too soon can cause choking, be hard for the baby to digest, and prevent the baby from getting enough breast milk or formula for best growth. Speak to your WIC staff about when it is appropriate to introduce solids to your baby.

When should I wean my baby?

There is no set age at which to fully wean your baby from breastfeeding and no one rule that works best for everyone. Health experts recommend breastfeeding through at least the first year. However, you may choose to breastfeed longer. Some babies nurse along with eating table foods well into their second or third year, all the while continuing to reap the health benefits from nursing. Ultimately, you and your baby will decide when it is time! If both of you enjoy the experience, there is no reason not to continue!

Weaning from breastfeeding can be hard for both mom and baby—especially when they both have a different idea of when weaning should start! To ease the difficulty*:

• Plan to wean gradually. Sometimes this is not possible, as you or your baby will decide abruptly that breastfeeding has ended.
• Avoid weaning during times of family stress— breastfeeding may have become a method of comfort for your baby.
• Take away a feeding that the child is least interested in.
• Offer comfort in other ways such as rocking, cuddling, singing, reading, or playing together.
• Ask for help. Your child’s father, grandparents, and babysitter can provide extra love and comfort while weaning. They can also help entertain and distract during former nursing times.

*Neifert, The Essential Guide to Breastfeeding, 2009