Category: Breastfeeding

Are you planning a pregnancy or thinking of getting pregnant sometime in the future? If so, it’s
never too early to get ready for a healthy pregnancy and a healthy baby! That means focusing on
your 1.1 preconception health, which is your health before you get pregnant.
Good preconception health includes getting a 1.2 preconception checkup. This is a medical
checkup you get before pregnancy to help make sure you’re healthy when you get pregnant.
Preconception checkups can treat and sometimes prevent health problems that may affect your
pregnancy and your baby. Making sure you’re healthy before pregnancy can even improve your
chances of getting pregnant.
It’s a good idea to get your preconception checkup with the same provider you want to take care
of you when you get pregnant.
What happens at a preconception checkup?
At your preconception checkup, your provider checks your overall health to make sure your
body is ready for pregnancy. Your provider does a physical exam, including checking your blood
pressure. Your provider may also do blood tests and a pelvic exam. A pelvic exam is an exam of
the pelvic organs to make sure they’re healthy. During a pelvic exam, your provider may do a
Pap test. This is a medical test in which your provider collects cells from your cervix to check for
cancer. 
You and your provider can talk about:
Health conditions that can affect your pregnancy. Some health conditions, like preexisting
diabetes or high blood pressure, can increase your baby’s risk of having a birth defect or other
problems. Certain infections also can harm your baby. If you have a health problem, your
provider can help you manage it before you get pregnant.
Any problems you had in a past pregnancy. Let your provider know if you had a health condition
like gestational diabetes or preeclampsia in a past pregnancy, or a problem like premature birth.
Your provider may be able to help you avoid the same problem in your next pregnancy.
Medicines you take. Tell your provider about any prescription medicines, over-the-counter
(OTC) medicines, supplements and herbal products you take. Your provider can make sure

they’re safe for your baby or recommend other options. But don’t start or stop taking any
medicine without talking to your provider first.
Your family health history. Your provider asks about your family health history to see if any
health conditions run in your family or your partner’s family. Use the March of Dimes Family
Health History Form to gather information. If certain health conditions run in your family, your
provider may recommend that you see a genetic counselor.
Your vaccinations. Ask your provider if you need any vaccinations. It’s best to get caught up on
certain vaccinations before you get pregnant. And talk to your provider if you have questions
about the COVID-19 vaccine. The COVID-19 vaccine gives the body’s cells instructions that
help the immune system fight COVID-19. This is especially important for pregnant people, who
are at higher risk for severe illness with COVID-19 and may be at higher risk for pregnancy
problems. Pregnant people who are vaccinated against COVID-19 also produce antibodies that
could protect their babies from COVID-19.
Taking folic acid. Taking a daily multivitamin with 400 micrograms of folic acid before
pregnancy and during early pregnancy can help prevent certain birth defects. These birth defects
can happen early in pregnancy, so it’s important to have enough folic acid in your body before
you get pregnant. Some people need a higher amount of folic acid. Talk to your provider about
how much you need.
Getting to a healthy weight. You’re more likely to have a healthy pregnancy if you start out at
a healthy weight. Talk to your provider about the right weight for you.
Your lifestyle. This includes:
 Eating healthy and exercising. Eating healthy foods and being active each day can help
you have a healthy pregnancy.
 Managing stress. Your provider can recommend ways to decrease stress and anxiety
before you get pregnant.
 Avoiding harmful substances. Substances like alcohol, drugs and tobacco can harm your
baby. Your provider can help you quit if you need help.
 Avoiding harmful chemicals. Talk to your provider about protecting yourself from any
unsafe chemicals at home or at work.
When to stop using birth control. Your provider may recommend stopping certain types of birth
control a few months before you start trying to get pregnant.
When should you get a preconception checkup?
You can get a preconception checkup anytime – even up to a year before you want to get
pregnant. But it’s best to start focusing on your preconception health at least 3 months before
you start trying to get pregnant.
Do you need a preconception checkup if you’ve already had a baby?

Get a preconception checkup each time you’re planning a pregnancy, even if you’ve already had
a baby. Your health may have changed since you were last pregnant.
March of Dimes
25 January 2022

We can help you make it work for you.

How often should I feed my baby?

Your baby has a tiny stomach and is used to being fed continuously in the womb, so she will need to feed often and for as long as she wants at least in the first few weeks:

• Newborns will typically feed around 8-12 times a day, which means it might feel like you are feeding around the clock. Don’t worry, this doesn’t last too long.
• Your baby should feed at least every 3-4 hours in the first few weeks, so if they are sleeping you need to wake them up.
• For a more detailed guideline on feeding, click here.

How do I know when my baby is hungry?

It is best not to breastfeed according to a strict schedule but whenever your baby shows signs of hunger, which include:

• Increased alertness or activity.
• Mouthing, or rooting around for your nipple.
• Putting her hand to her mouth.
• Sucking movements or sounds.
• Crying, however this is a late sign of hunger; ideally you should start feeding your baby before she starts crying.

How long does each feeding last?

Let your baby feed as long as she wants at one breast; this usually takes about 15 to 30 minutes. Your baby may take more or less time. When she is finished with one breast, burp her. Then switch her to feed from the other breast. It’s OK if she only wants to nurse from one breast. Just be sure to start her on the other breast at the next feeding. Let your baby end breastfeeding on her own.

How do I know if my baby is getting enough milk?

Lots of new moms ask this question. Your body is pretty amazing; as you breastfeed, your body learns when your baby needs more milk. Your body makes exactly the right amount for your baby. But what if you’re still not sure he’s eating enough? Your baby is probably getting enough milk if he is:

1. Baby has 3-5 wet diapers and 3-4 soiled diapers by 3-5 days of age. Baby has 4-6 wet diapers and 3-6 soiled diapers per day by 5-7 days of
age. After 6 weeks, the number of soiled diapers may decrease to one every few days.
2. Gaining weight; baby should regain her birth weight within two weeks. For a more detailed guideline on weight gain, click here.

Other ways to know baby is getting enough:

1. Baby makes swallowing/gulping sounds (it might be hard to hear, so listen or watch carefully).
2. Your breasts feel softer after a feed.
3. Baby seems relaxed and satisfied after a feed.

How do I ensure a great milk supply?

Milk production is a supply and demand system; the amount of milk created depends on how much has been taken out.

• Milk removal is especially important in the first 2-3 weeks because that is when your milk production capacity is established. The more milk you remove in this time, the more you will have for your baby over the longer term.
• But don’t worry if you have trouble in those first few weeks, there are ways to improve your supply later on.
• Once you start producing milk, it is always being made; faster when the breast is less full, and slower when the breast is more full. This is why your milk production will slow if you wait until your breasts “fill up” to feed your baby, so don’t wait! It is also why your breasts are never truly empty; you can always get more out!

Does my baby need vitamin supplements?

Yes. A supplement is a product you take to make up for certain nutrients that you don’t get enough of in the foods you eat. Breast milk doesn’t have enough vitamin D for your baby. Vitamin D helps make bones and teeth strong and helps prevent a bone disease called rickets. Give your baby vitamin D drops starting in the first few days of life. Talk to your baby’s doctor about vitamin D drops for your baby.

Further information and help

While breastfeeding is natural, many women, especially first-time mums, have lots of questions and need help. While family and friends mean well, they might provide advice that is not based on facts, so encourage them to check out our website. Your husband might feel unable to help if you are having trouble, but we outline ways he can be supportive here. Most importantly, don’t be afraid to ask for help. Here are some places to turn:

• We offer free classes on breastfeeding and free one-on-one counseling at our Mother’s Classes Centers. Find your local Center here.
• Your family and friends. While they might not have all the right information, they can support you by:

1. Contact your local Mother’s Classes for advice.
2. Cooking meals and having plenty of food available, especially ‘one-handed’ meals.
3. Reminding you to drink lots of clean water to stay hydrated.
4. Doing more around the house, like clean, shop and pick up other kids from school.
5. Giving you lots of love and support, reminding you that you are doing a great job, how beautiful your child is and how the hard part is only temporary and it will take at least a few months to get the handle of motherhood.

• Your doctor or your baby’s doctors, but keep in mind they might not have much experience or training in breastfeeding support. For example, if one of their first suggestions is to stop breastfeeding, then you should seek more advice.
• There are lots of great online resources and forums, although mostly in English. Here are a few of our favorites:

1. La Leche League International
2. International Breastfeeding Centre
3. BabyCenter
4. March of Dimes
5. https://www.verywellfamily.com/breastfeeding-overview-4581827

There is also an excellent breastfeeding support APP you can download on your smartphone by Nancy Mohrbacher Solutions Inc., “Breastfeeding Solutions”.

Hiccups

Hiccups are common in babies under one year old and are a normal, harmless nuisance caused by spasms in the diaphragm. Breastfeeding does not cause hiccups and it is safe to continue to breastfeed a baby who is hiccuping if they are happy to continue to nurse. In fact, breastfeeding can help stop hiccups in the same way as when an adult drinks water to stop their own hiccups. Hiccups will decrease in frequency and severity as both she and her digestive system mature. Some common causes of hiccups include:

• Overfeeding, so try slowing down feedings, giving small/more frequent feeds and burp your baby as you switch from one breast to the other.
• Swallowing air during feeding, so ensure your baby has a good latch and try positioning your baby upright during nursing. Also keep her upright for 20 minutes after feeding.

If your baby has persistent and excessive hiccups, she might have reflux.

Source: Marchofdimes

Engorgement

Engorgement is when your breasts swell dramatically and seem filled to bursting, most often when your milk becomes more plentiful during the first and/or second week after birth. This might make nursing on the affected breast more painful when the baby first latches on due to swelling. Usually, the fullness/swelling subsides within 12-48 hours as your body adjusts and your baby drinks from your breast. “You can prevent or minimize the effects of engorgement by:

• Nursing early and often. Nurse as soon after the birth as possible, and at least ten times a day after that.
• Ensuring that your baby is positioned well and is latched on properly (click here for instructions).
• Nursing “on cue”. If your baby sleeps more than two to three hours during the day or four hours at night, wake him to nurse.
• Allowing the baby to finish the first breast before switching sides. This means to wait until the baby falls asleep or comes off the breast on his own.
• If your baby is not nursing at all, or is not nursing well, hand expressing or pumping your milk as frequently as the baby would nurse.”

If this doesn’t relieve your symptoms, you can try:

• Warm compresses: apply a warm, moist compress and express some milk just before feedings. Using heat for too long will increase swelling and inflammation, so it is best to keep it brief. Cold compresses can be used between to reduce swelling and relieve pain. Source: La Leche League International, http://www.llli.org/faq/engorgement.html
• Breast massage: with the palm of your hand and starting from the top of your chest (just below your collar bone), gently stroke the breast downward in a circular motion, toward the nipple. This may be more effective when done while you are in the shower or while leaning over a basin of warm water and splashing water over your breasts. Source: La Leche League International, http://www.llli.org/faq/engorgement.html
• Areola massage: with your fingers positioned as shown in the image below, press inward toward the chest wall and count slowly to 50. The pressure should be steady and firm, and gentle enough to avoid pain.

Source: K. Jean Cotterman, http://www.nbci.ca/index.php?option=com_content&view=article&id=83:engorgement&catid=5:information&Itemid=17

• Cabbage compress: rinse the inner leaves of a head of cabbage, remove the hard vein, and crush with a rolling pin (or similar). They can be used refrigerated or at room temperature. Drape leaves directly over breasts, inside the bra. Change when the leaves become wilted, or every two hours. Discontinue use if rash or other signs of allergy occur. Some reports suggest that overuse of cabbage compresses can reduce milk production, therefore discontinue the compresses when the swelling goes down. Source: La Leche League International, http://www.llli.org/faq/engorgement.html

Contact your doctor if your symptoms do not improve after trying the above relief methods, if you have symptoms of mastitis (fever of more than 38.1°C), if your baby is unable to latch, or if he does not have enough dirty diapers.

Source: Marchofdimes

Oversupply

Sometimes a mother produces more milk than her baby needs and this can result in a forceful ejection of milk from her overfull breast. This can be upsetting for babies during and between feedings. Typical symptoms of oversupply include:

• Baby cries a lot, and is often very irritable and/or restless
• Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
• Baby may seem to bite or clamp down on the nipple while feeding
• Milk sprays when baby comes off, especially at the beginning of a feeding
• Mother may have sore nipples
• Baby may arch and hold himself very stiffly, sometimes screaming
• Feedings often seem like battles, with baby nursing fitfully on and off
• Feedings may be short, lasting only 5 or 10 minutes total
• Baby may seem to have a “love-hate” relationship with the breast
• Baby may burp or pass gas frequently between feedings, tending to spit up a lot
• Baby may have green, watery or foamy, explosive stools
• Mother’s breasts feel very full most of the time
• Mother may have frequent plugged ducts, which can sometimes lead to mastitis

Source: La Leche League International, http://www.llli.org/faq/oversupply.html

To address this problem, try:

• Nursing your baby on only one breast per feeding. If needed, you can express the other breast to relieve pressure and freeze the excess milk for later. If your baby wants to nurse again within two hours, offer the same breast again.
• Expressing some milk before you start nursing to reduce the rate of milk ejection. Do not express too much as that will tell your breasts to produce more milk.
• Positioning your baby more upright during nursing and/or reclining yourself so that gravity helps slow the rate of milk ejection. The side-lying position is also good.
• Feeding your baby before he is too hungry, which means he will not suck as hard which will not stimulate your breasts as much.
• Stopping pumping, if you have been doing so to store milk, until your milk supply better matches your baby’s current needs.

If you are producing a lot of milk you can use breast pads to catch leaks, but remember to change them at least daily. Also, your baby will likely swallow more air, so frequently burp your baby to minimize the problem.

Low milk supply

This is a common concern, but oftentimes is a false alarm. Often women are concerned they don’t have enough milk if their:

• Breasts no longer feel full. False alarm! When your baby is between 6 weeks to 2 months old, your body has adjusted to how much milk he needs.
• Baby has fewer stools. False alarm! From six weeks old your baby will have fewer stools than before and can go days without one.
• Baby wants to nurse longer and more frequently. False alarm! Babies will experience several “growth spurts” in the first few months of life (often around 2-3 weeks, 6 weeks, and 3 months), but if you let him breastfeed as often and as long as he wants this will help bring up milk supply quickly.

Milk supply is very often a simple case of demand and supply, so the more you breastfeed, the more milk you will produce. The most important indicators baby is getting enough milk are the number of diapers and weight gain. If you are still concerned about your milk supply after considering this and ruling out the false alarms noted above, you should:

• Call us or visit your local Beba-ks Center (Women’s Health Resource Center) for free information and support.
• “Encourage your baby to breastfeed frequently and for as long as he will.
• Offer both breasts at each feeding. Allow the baby to stay at the first breast as long as he is actively sucking and swallowing. Offer the second breast when the baby slows down or stops. “Finish the first breast first,” is a good general rule. This technique gives the baby lots of the fatty “hindmilk.”
• The baby should end the feeding. He may do this by falling asleep and detaching from the breast after about 10 to 30 minutes of active sucking and swallowing.
• Be sure the baby is latched on and positioned correctly at the breast, that is, lips should be on the areola (the darker skin area), well behind the nipple. We can help fine-tune positioning as well as suggest ideas to ease soreness.
• A sleepy baby may benefit from “switch nursing” that is, switching breasts two or three times during each feeding. Switch breasts when the baby’s sucking slows down and he swallows less often.
• All of the baby’s sucking should be at the breast. Limit or stop pacifier use while encouraging the baby to nurse more effectively. If you are supplementing, even temporarily, you can give the supplement by spoon or cup.”
• Practice breast compressions; see how here.

“This may be a stressful time. Take care of yourself. Pay attention to your own need for rest, relaxation, proper diet, and enough fluids.”

Breastfeeding within an hour after birth will give you the best start.

This is because it will release hormones (oxytocin), which stimulate the production of milk. Extensive studies have shown that it leads to a longer and more successful experience with breastfeeding. Here is a step-by-step guide:

1. Lay your baby skin-to-skin as directed above (if possible). Research has shown that many babies immediately placed skin-to-skin after birth will latch on and start breastfeeding all by themselves.
2. Turn your baby’s whole body toward you, chest to chest.
3. Touch her upper lip with your nipple, and, when she opens her mouth wide, pull her onto your breast, holding your breast for support. Her mouth should cover not just the nipple but as much of the areola (the darker part surrounding it) as possible.
4. Don’t worry if your baby has trouble breastfeeding. It requires patience and lots of practice. Ask a nurse or friend with breastfeeding experience for help. You can also call one of our breastfeeding experts for free advice anytime.
5. Breastfeeding should not be painful. If it is, try fixing the latch that you have as best you can by pushing the baby’s bottom into your body with your forearm. This will tip the baby’s head back so her nose is in ‘sniffing position’. If necessary, try gently pulling down the baby’s chin and/or bottom lip so he has more of the areola in her mouth.

Yes, just by nursing often and getting a good latch. If you are worried there are ways to increase your milk supply.

Milk production is almost always a simple matter of supply and demand – the more your baby demands i.e. the more you breastfeed, the more milk you will produce. It is normal to worry as you can’t actually see how much milk your baby is taking. Here are some simple ways to be sure baby is getting enough:

1. Diaper output – your easiest clue, 4-6 wet diapers and 3-6 soiled diapers per day during weeks 1-6. Urine should be clear-to-pale yellow in color.
2. Weight gain – baby regains birth weight within two weeks, but keep in mind baby will lose 5-10% of their birth weight in their first 3-4 days of life.
3. Relaxed baby – baby seems relaxed and happy after a feed.
4. Softer breasts after a feed.
5. Swallowing – look or listen for swallowing during a feeding.

Milk removal is especially important in the first 2-3 weeks because that is when your milk production capacity is established. The more milk you remove in this time, the more you will have for your baby over the longer term. But don’t worry if you have trouble in those first few weeks, there are ways to improve your supply later on.

Once you start producing milk, it is always being made faster when the breast is less full, and slower when the breast is more full. This is why your milk production will slow if you wait until your breasts “fill up” to feed your baby, so don’t wait! It is also why your breasts are never truly empty, you can always get more out!

Ways to increase your milk supply:

• Call us or visit your local Beba-ks Center (Women’s Health Resource Center) for free information and support.
• “Encourage your baby to breastfeed frequently and for as long as he will.
• Offer both breasts at each feeding. Allow baby to stay at the first breast as long as he is actively sucking and swallowing. Offer the second breast when baby slows down or stops. “Finish the first breast first,” is a good general rule. This technique gives baby lots of the fatty “hindmilk.”
• Baby should end the feeding. He may do this by falling asleep and detaching from the breast after about 10 to 30 minutes of active sucking and swallowing.
• Be sure baby is latched on and positioned correctly at the breast, that is, lips should be on the areola (the darker skin area), well behind the nipple. We can help fine-tune positioning as well as suggest ideas to ease soreness.
• A sleepy baby may benefit from “switch nursing” that is, switching breasts two or three times during each feeding. Switch breasts when baby’s sucking slows down and he swallows less often.
• All of baby’s sucking should be at the breast. Limit or stop pacifier use while encouraging baby to nurse more effectively. If you are supplementing, even temporarily, you can give the supplement by spoon or cup.
• Practice breast compressions; see how here.

“This may be a stressful time. Take care of yourself. Pay attention to your own need for rest, relaxation, proper diet, and enough fluids.”

No, so you might have a problem with baby’s latch onto your breast. We can help.

Tender nipples are common at the start of a feed for the first week of breastfeeding. However, if nipples are very sore, or are cracked, bruised, or bleeding, there is something wrong. Almost always, sore nipples are caused by improper positioning of the baby at the breast. Click here to learn on how to get the best position and latch for breastfeeding.

Other causes of sore nipples include: 1) engorgement; 2) incorrect use of a pump; 3) pacifiers or bottles causing your baby to have nipple confusion and therefore breastfeeding incorrectly; 4) yeast infection; or 5) removing baby from breast without first breaking the seal by inserting your finger in the corner of her mouth.

Taking the baby off the breast is a last resort. There are lots of ways to treat sore nipples:

• Nurse on the least sore side first or only nurse from the least sore breast for part or all of the day if you are able (check diapers to be sure baby is getting enough milk).
• Experiment with different positions, some will be less painful than others.
• Try short, frequent feedings to encourage a less vigorous suck.
• Apply freshly expressed breastmilk to your nipples (if a yeast infection is not present).
• Expose your nipples to air as much as possible.
• Use a nipple ointment, like pure lanolin, after breastfeeding and do not wash it off.
• Do not wash your nipples frequently. Daily bathing is more than enough.
• Apply a warm, moist compress to your nipples (if a yeast infection is not present).

If you are unable to breastfeed at all because of pain, in spite of trying all the above methods, try taking a short (2-5 day) break from breastfeeding to allow the nipples to heal. During this time, it is best for you and the baby if the baby is fed your expressed milk. Click here for information about pumping and bottle feeding. That way you can keep your milk supply up and continue breastfeeding once your nipples have healed.