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Breastfeeding -- Answers to Moms' Most-Asked Questions

In the 25-plus years that I've been counseling new moms about nursing, I've probably heard every possible concern. Worrying about breastfeeding is completely normal -- especially if you're doing it for the first time. Such doubts, however, can sometimes lead a woman to wean earlier than she otherwise would have. But knowledge is power; if you learn all you can about breastfeeding, you'll be better able to keep yourself -- and your baby -- on track. The following seven concerns are ones that I'm often asked about:

Marianne Neifert, M.D., is a PARENTING contributing editor and the author of Dr. Mom's Guide to Breastfeeding.

Sudden Hunger, Biting, and Pumping

1. Why is my baby suddenly acting so hungry?

It may seem as if you're always nursing your infant, especially in the beginning. Breast milk is easily digested, so a newborn needs to eat at least eight times in a 24-hour period.

But don't be alarmed if your baby suddenly wants to feed even more frequently than usual. Hunger spurts are common in breastfed infants, especially those who nurse exclusively. They often occur around 10 days, 3 weeks, 6 weeks, and 3 months of age, though they can happen at any time. In some cases, they're caused by a temporary decrease in a mother's milk production, due to overexertion or fatigue. Although you may be tempted to give your baby formula or even cereal to satisfy him, doing so may only reduce your milk supply.

Instead, simply follow his cues and put him to the breast as often as he asks. You'll probably need to breastfeed for 20 minutes every two hours or so for a couple of days until your supply adjusts to his increased demand. During this time, eat a balanced diet and drink plenty of fluids. And get extra rest: Even though you've heard it a hundred times, try to nap when the baby does, get someone else to cook dinner, and ask your partner, friends, or relatives to pitch in with chores (or let the house go for a couple of days).

2. What if my infant bites me?

It's one thing to nurse a toothless newborn; it's another to put a baby with a few tiny choppers to your breast. But your little one

isn't likely to nibble while she's actively feeding -- her tongue will cover her lower teeth when she's suckling. At the end of a meal, however, when the flow of milk has tapered, an infant can get restless or playful and take a nip.

To discourage her, gently remove her from your breast as soon as she stops swallowing. If she manages to chomp down anyway, say no in a firm voice and end the feeding. Nearly all babies learn pretty quickly not to bite the mom who feeds them!

3. When's the best time to start pumping?

Mothers, whether they're going back to work or not, often tell me that they've waited six weeks (or until they think breastfeeding's been well established) to begin using a pump. But it's fine to start sooner -- even the day your milk comes in.

There are several advantages to expressing your milk during the first week of your baby's life. The key to stimulating production is to empty the breasts. So if your newborn doesn't nurse vigorously, pumping for about ten minutes immediately after each feeding can drain most of the remaining milk. It can also help relieve engorgement and coax flat or inverted nipples to protrude more.

After the first week, you can express any leftover milk after your baby's early-morning and/or midmorning feed -- the times of day when your supply is most plentiful. This practice will continue to increase your daily production as well as provide milk that you can store or freeze for later use.

Formula, Medicine, and Getting Over Shyness

4. Will giving formula derail nursing?

Though exclusive breastfeeding is ideal, feeding your infant some formula occasionally (a bottle every couple of days or so, for example) most likely won't turn your baby off the breast.

If you're considering whether to bottle-feed once in a while, it's important to take into account your baby's age. It's best to delay formula until he's about 1 month old and your milk supply is well established. Newborns are also more susceptible than older babies to nipple confusion (when they prefer an artificial nipple, which is easier to grasp than the real thing) because they're still learning how to latch on and suckle effectively.

A better option? Expressing your milk and then bottle-feeding it to your infant. Breast milk is healthier, and pumping it won't limit your production.

If, for some reason, your baby begins to prefer the bottle to the breast, don't panic. You can retrain him to nurse correctly, especially if you have a generous milk supply. Until he's back on track, try the following: Stop all convenience bottles; offer your breast as soon as your little one seems hungry -- he's awake, he's rooting, he's bringing his hand to his mouth; and create positive associations by allowing him to nurse for comfort and by holding him skin to skin against your bare chest.

However, if your pediatrician says to supplement with formula, do it. This is usually the fastest way for an infant to regain the pounds he needs to get to a healthy weight.

5. Why does my infant prefer to feed on one side only?

A baby may favor one breast because the nipple is easier to grasp, there's more milk on that side, or the milk flows easier. Sometimes a mom may unintentionally nurse more often on one side (usually the left breast if she's right-handed). The unequal milk supply can cause a woman's breasts to become lopsided.

An unequal supply isn't usually a problem. If your baby is gaining weight and seems content after feedings, she's probably getting enough milk between the two breasts. If you recognize her preference early on, you can increase production on the weaker side by pumping after she feeds or by starting her off on that side, if she'll let you. (The longer you wait, though, the more difficult it'll be to boost milk production on the side that has the lower amount.)

6. How can I get over my shyness about breastfeeding in front of others?

Although nursing in public isn't against the law in any state, many moms feel self-conscious about baring their breasts away from home. But with practice, you can become confident feeding your baby almost anywhere. Some tips:

  • Opt for a bra with a release mechanism that's easy to manipulate with a single hand.

  • Put a receiving blanket or nursing shawl over your shoulder to shield your baby from public view, or use a sling, which lets your newborn breastfeed out of sight while you carry him.

  • Wear two-piece outfits. A vest or cardigan over your blouse can keep your midriff covered when you lift your shirt to nurse. Or undo a button-down shirt from the bottom up for less exposure.

  • Before venturing out in public, practice nursing in front of a mirror to get a feel for doing it discreetly.

    If you still feel embarrassed -- so much so that you postpone a feeding when you're out -- attend a La Leche League meeting or talk to other nursing mothers so you can learn how they've managed to make it work.

    7. Do nursing and medicines mix?

    Mothers are often mistakenly advised to interrupt breastfeeding when they're taking medication, such as antibiotics. The truth is that most drugs are safe for nursing; only minimal amounts actually pass into breast milk.

    But it's best to be cautious. Whenever your doctor prescribes medicine, make sure he knows you're breastfeeding. Let the baby's pediatrician know as well. Ask both about possible side effects -- for you and your infant. (The same is true for any over-the-counter drugs. Check the label and notify both doctors.)

    Try to take any medication right after you've finished nursing, since the peak drug concentration in breast milk will usually be reached between feedings.

    That said, there are a few drugs that are toxic for breastfed babies, such as some antidepressants or those used for chemotherapy. But even if you must take a drug that isn't safe for your infant, you don't have to wean her: You can stop nursing temporarily and pump and dump your milk. This can preserve your supply and allow you to start breastfeeding again when you're ready.

    Armed with the information you need, you can overcome these and other hurdles. It's worth it -- after all, nursing a baby is one of the precious rewards of motherhood.

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