What Should I Do? (Mother Edition)

Learn About Wonders Of Breastmilk

Nursing your baby on breastmilk is not just good for the baby, it's also great for the mother. How is breastmilk produced? What components in breastmilk are good for the baby, and why?...

See More..

Hints For Continuing To Breastfeed

For better breastfeeding, here are some helpful hints....

See More..

What Should I Do? (Mother Edition)

“I don’t think I have enough breastmilk…” “I’d like to go back to work.” We’ll answer these and others questions about the mother’s body and lifestyle....

See More..

What Should I Do? (Baby Edition)

“My baby doesn’t seem to be gaining enough weight…” “My baby bites my nipples…” We’ll answer these and other questions about the baby’s body and condition....

See More..

To First-Time Father

When your first child is born, your wife will be filled with anxiety about herself and about your baby....

See More..

To Medical Personnel

This information is about the various conditions that prevent babies from nursing directly from the breast. We introduce various products for low-birth-weight babies, babies with cleft palates, and baby...

See More..

Learn the signs that your baby is drinking breastmilk

The baby's appearance, how the baby drinks breastmilk, the amount and frequency of urine and stool output and the baby's body weight are indicators of whether enough breastmilk is being produced.

Baby's frequent crying and slight engorgement of the breast do not indicate that insufficient breastmilk is being produced. Breastmilk secretion increases and the amount of breastmilk produced stabilizes as you continue to breastfeed.

Baby's appearance and causes

There can be other causes of the symptoms that are making you think that your breastmilk is insufficient.

For example,

  • Your baby cries frequently, wakes up and cries while asleep
  • Even when your baby has consumed enough breastmilk, he can be in a bad mood or sleep only lightly for other reasons.
  • Your baby wants to nurse frequently
  • Because breastmilk is easily digested and doesn't produce a long-lasting feeling of satiety, breastfeeding intervals are often short.
  • Additionally, your baby's rate of growth will not always be the same. During periods when your baby is growing more quickly, your baby will want breastmilk frequently.
  • Your breasts don't become engorged
  • The mother's breasts often stop being engorged a few weeks after the baby's birth, but this doesn't mean that breastmilk production has decreased.
  • Your breasts grow smaller
  • TIt is said that breast size has nothing to do with breastmilk production.
  • The amount of breastmilk your baby takes in is small
  • The amount of intake differs from baby to baby. A more accurate indicator is whether your baby is gaining weight appropriately.
  • Only a little breastmilk is expressed
  • It is said that the amount of milk secreted and the amount the baby takes in are not the same.

Signs that a newborn is receiving sufficient breastmilk

  • He breastfeeds at least eight times in 24 hours.
  • During a feed, his suckling rhythm will slow down as milk is released, and swallowing or gulping may be heard.
  • He is alert, and has good muscle tone and healthy skin.
  • He is contented between feeds (though well-fed babies may be fussy for other reasons, leading mothers to believe they don't have enough milk).
  • He has six or more wet diapers in 24 hours; with pale, diluted urine.
  • He will have three to eight bowel movements in 24 hours. As babies grow older, stooling may be less frequent.
  • He shows a consistent weight gain, with an average of 18-30 grammes/day.
  • The mother's breasts may feel full before a breastfeed and softer afterward, though not all women experience a dramatic change.

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff", 1993, p. 68)

There may also be physiological reasons for breastmilk insufficiency

Signs that a baby is not gaining weight adequately

  • He grows less than 18 grammes/day.
  • He has not recovered his birth weight by three weeks.
  • His growth line is not rising appropriately on the growth curve.
  • He sleeps for long periods of time to conserve energy.
  • He seems lethargic and has a weak or high pitched cry.
  • His urine output may be low with concentrated urine; or urinary output may be normal. Urinary output alone is not a reliable measure of weight gain.
  • He has very few stools, or none at all.
  • He may stay at the breast consistently.
  • He may have a worried look on his face, with hanging folds of skin on his body.

(Source: UNICEF WHO, "UNICEF/WHO Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18-hour course for maternity staff", 1993, p. 69)

(Caution) Poor weight gain is not just caused by breastmilk insufficiency. Don't try to judge by yourself; consult an expert.

Lack of breastmilk intake and hyposecretion of breastmilk

There are two types of breastmilk insufficiency:

Lack of breastmilk intake and hyposecretion of breastmilk. Refer to the following coping strategies and consult an expert such as doctors, midwives, and lactation consultants.

1. Lack of breastmilk intake

Insufficiency of breastmilk intake because of inappropriate breastfeeding style and poor sucking of baby

2. Coping strategy

  • Check how to hold your baby (positioning) and how to help your baby suck on (latch on), and modify if necessary.
  • Don't limit the frequency or duration of breastfeeding; allow your baby to nurse as often and as much as he wants.

3. Hyposecretion of breastmilk

  • Actual insufficiency of the breastmilk produced by the mother
  • Sometimes caused by breastmilk intake insufficiency
  • Divided into 2 types:
  • Primary breastmilk hyposecretion, which occurs for medical reasons such as mammary gland hypoplasia, and secondary breastmilk hyposecretion, in which even though the ability to produce breastmilk is present, appropriate support is not provided and the amount of breastmilk secreted doesn't increase, and may decrease.

4. Coping strategy

If you have breastmilk hyposecretion caused by medical reasons, breastmilk production can often be insufficient and appropriate supplements are needed.

If one breast has secretion insufficiency, you still can get sufficient breastmilk secretion from the other breast only. Milk expression is also effective in increasing breastmilk secretion.

Supplementing breastfeeding when the amount lactated is insufficient, in order of priority

  • Freshly expressed mother's own milk
  • Chilled breastmilk
  • Frozen and thawed breastmilk
  • Infant formula

Take appropriate measures depending on the symptoms

For breastfeeding mothers, the most common nipple problem is sore nipple. This often occurs in the early postpartum period.

It is said that most sore nipple occurs because the mother isn't used to the appropriate way to hold the baby and let the baby suck on the nipple. In any case, it can be a challenge to continued breastfeeding. In this section, we'll show you how to prevent sore nipple and coping strategies.

How can you prevent and cope with your symptoms?

Symptoms Cause Prevention Coping strategies
Temporary nipple soreness that happens in the early postpartum period   Application of breastmilk
Inappropriate way to hold baby and let baby latch on Appropriate way to hold baby and let baby latch on
Baby's inappropriate sucking style Application of medicine
Use of nipple protector
Enforced removal of breast from baby's mouth Do not force baby away from the breast
Breastfeed or express milk before the breast engorges
Breast engorgement
  • Abraded wound
Candida (thrush infection) Treatment of baby's oral Candida, mother's colitis
Preventing wounds and cracks from getting worse
Consulting a specialized agency (doctors, midwives, and lactation consultantts)
Other nipple infections
Use creams or ointments Do not use inappropriate creams or ointments
Baby bites the nipple Paying attention to baby's sucking Consulting a specialized agency (doctors, midwives, and lactation consultantts)

Symptoms

Nipple irritation
  • The nipple is unusually sensitive because it isn't used to external stimuli.
  • There is nipple soreness with no visible damage, etc.
  • The pain can be an initial symptom of internal bleeding, blisters and cracking (rhagades).
Reddened skin
  • The surface skin of the nipple is thin.
  • The surface skin is partly peeling off, and the sub-epidermal layer is visibly inflamed.
Bleeding, internal bleeding

It is believed that there is edema or pooled blood in the nipple, and the negative pressure produced by the baby's sucking promotes anoxia in the papillary tissues, which increases capillary permeability and leads to burst capillaries and internal bleeding.

Crack

Created on the tip, sides and neck of the nipple; it resembles chapped skin and hurts when pressed or sucked.

Blisters

Often caused by shallow sucking and deficient milk discharge

Leucoderma
  • White blobs of about 1mm in diameter found on the tip of the breast duct; these cause intense pain during breastfeeding.
  • It is believed to be related to breast duct closure.
Bite wound
  • Occurs when the baby bites the nipple.
  • Found mainly in the neck region of nipple.

Cause

Transient nipple soreness in the early postpartum period
What kind of nipple soreness?
  • Temporary pain in the nipple occurs in the early postpartum period even when the baby sucks appropriately.
  • The pain goes away in 20-30 seconds.
  • The pain achieves its peak 3-6 days postpartum.
  • After reaching its peak, the pain goes away as breastmilk secretion increases.
Why?
  • The nipple is too sensitive in the early postpartum period.
  • The breastmilk secretion mechanism hasn't started to function completely.
Nipple soreness caused by holding the baby inappropriately and by the baby sucking inappropriately.
What kind of nipple soreness?
  • Many kinds of early postpartum nipple soreness are said to be caused by holding the baby inappropriately or by the baby sucking inappropriately.
  • Occurs rapidly when baby starts sucking.
  • Pain slowly goes away, but it continues during breastfeeding. The skin from the tip of the nipple to the whole areola hurts.
Why?
  • The baby doesn't latch firmly onto the areola, but shallowly.
  • The baby sucks on with pursed lips.
  • The baby's whole body isn't turned to face the mother.
  • The baby isn't held tightly to the mother, etc.

Example of baby not held to mother tightly.

Example of baby held appropriately while breastfeeding.

Nipple soreness caused by the baby sucks inappropriately
Why?
  • The baby is pressing nipple while sucking.
  • The baby sucks on with pursed lips.
  • The baby is sucking with her tongue pulled back behind the gum,etc.
Nipple soreness caused by enforced removal of breast from baby's mouth
Why?
  • Removing the baby from the breast before the baby is satisfied.
Nipple soreness caused by thrush infection
What kind of nipple soreness?
  • Stringing feeling with itching and a stabbing, burning pain in the whole breast or deep inside the breast, whether breastfeeding or not.
  • The breast and nipples shine pink or red, become swollen and the skin becomes so thin that it almost peels off.
  • The pain doesn't go away even when baby latches on appropriately.
Why?
  • Candida can occur anytime.
  • It is especially possible when the baby has an oral Candida infection or diaper rash or when the mother has colpitis.
Nipple soreness caused by other nipple infections
Why?
  • Caused by Staphylococcus aurous and hemolytic Streptococcus.
Nipple soreness caused by the use of creams and ointments
Why?
  • Pain can get worse by using the wrong ointment or cream.
Baby bites the nipple
Why?
  • The baby won't bite when latched on appropriately, but will sometimes bite not sucking.
Coping strategies
  • Application of breastmilk
    Nipple tissues are hydrated and healed by applying expressed breastmilk after breastfeeding.
  • Application of medical treatment
    Promotes the recovery of wounds by hydrating the affected area.
  • Use of nipple shield.

Be sure to choose the appropriate drugs during the breastfeeding period

When a mother takes drugs, most of them are transferred to the breastmilk and then more or less to the baby.

However, only a few drugs harm breastmilk, and most drugs are safe for mothers during the breastfeeding period.

Considering the baby's healthy growth, the advantages of breastfeeding are said to outweigh the risks of drugs, but you need to obtain the advice of a medical specialist and evaluate appropriately the detriments and danger of stopping breastfeeding with the amount of drugs that are transferred to the breastmilk, as the risks depend on the kind and amount of the drug.

Common symptoms of breast trouble are lumps or swelling that hurt, and mastitis. Please follow the instructions of an expert, such as doctors, midwives, and lactation consultants, as breast problems can lead to breastmilk insufficiency and poor weight gain in your baby.

Lumps and swelling

If you find lumps or swelling, try to breastfeed using the appropriate positioning and latch on, and breastfeed frequently. Another way to take care of lumps and swelling is to express breastmilk after and between breastfeedings. Expressing breastmilk often helps, even when the lump causes a burning pain. There is a possibility that a lump in the mammary gland will become mastitis if it is left untreated. Additionally, if your baby suddenly stops wanting breastmilk, it may be a warning of mastitis.

Mastitis

Mastitis is a breast disease accompanied by pain, fever (38.5 degrees C and above) and engorgement, chills, flu-like body pain and systemic symptoms.

Mastitis is said to be most common 2-3 weeks postpartum, but it can develop at any time during the breastfeeding period.

Mastitis is divided into 2 types, one with a bacterial infection and the other without.

1. Congestive mastitis

Stagnation mastitis (noninfectious mastitis) causes breast inflammation without bacterial infection. It is usually accompanied by redness, engorgement, lumps, a burning sensation in one breast, and sometimes a mild systemic fever. If you have these symptoms, try to breastfeed using the appropriate positioning and latch on to cope with the disruption of breastmilk.

Acute purulent mastitis

If symptoms don't improve within 24 hours of the start of the symptoms in (1) and you have flu-like symptoms such as fever, chills and body pain, you may be infected by this bacterial form of mastitis. If the symptoms are severe, a course of antibiotics may be recommended, but in any case, see a specialist and obtain advice.

It's a good idea to continue breastfeeding after returning to work

Continue breastfeeding after you return to work.

Breastmilk will keep the relationship between you and your baby close when you can't be with your baby.

Seek the understanding of your family, employer and child-care worker so that you can balance a career and raising your child.

Advantages of breastfeeding while working

  • Helps relieve the anxiety of mother and baby when they have to spend a long time away from each other, and makes child-rearing easier.
  • Provides happy feelings and bonding, which makes up for the long time apart.
  • Prolactin functions to relax a breastfeeding mother. The mother can relieve the fatigue of work by taking care of the baby.
  • Babies who spend time in nursery centers are more likely to develop infections, and it is said that the immune factors and infection prevention effects of breastmilk help prevent this.

Management after returning to work

You'll need a breast pump so that you can express breastmilk at the office.

It is best to freeze the breastmilk that you express during the day, and have it thawed and given to baby at the nursery center.

You can express breastmilk a little at a time during breaks. It helps relieve breast engorgement, and as you can easily breastfeed at night and on holidays, it helps to prevent decreases in the amount of breastmilk produced.

Make use of facilities such as nursing rooms, which enable mothers to express breastmilk.

Tips for returning to work during the breastfeeding period

  • Breastfeed directly before and after work.
  • Tell the child-care worker not to feed the baby very much just before the time you pick the baby up.
  • Express breastmilk at the office as necessary, even a little bit at a time.
  • It's a good idea to bring something that will relax you (such as your baby's photo) to look at while expressing breastmilk at the workplace.
  • Dress in clothes that enable you to breastfeed or express milk easily.
  • Breastfeed frequently at night and on weekends.

Preserve nutrient-rich breastmilk in an appropriate way

There are times when a mother can't breastfeed her baby for many reasons. Sometimes you just want to preserve excess breastmilk. In such cases, you can express breastmilk in an appropriate way and freeze or refrigerate to give it to your baby later.

Breastmilk can generally be preserved in a freezer (about -18oC) for about 3 weeks. It can be preserved in a refrigerator (5oC and below) for up to 24 hours. The antibodies and other components of breastmilk show little change during these periods. However, breastmilk produced by the mother's body changes in composition according to the baby's growth. It's better to use frozen or refrigerated breastmilk as soon as possible.

Other precautions for handling breastmilk are below:

  • Breastmilk that has been warmed once should not be refrigerated or frozen.
  • Breastmilk should not be microwaved, as much of the nutritive value will be lost.
  • Breastmilk should not be preserved at room temperature.
  • Use stored breastmilk as soon as possible,regardless of the storage life.

It's important to understand about pregnancy and breastfeeding while you are nursing

The possibility of pregnancy during the breastfeeding period

Breastfeeding decreases the possibility of getting pregnant, but you can get pregnant during the breastfeeding period.

The ability to get pregnant is greatly influenced by breastfeeding frequency. Infrequent breastfeeding increases the chance of ovulation, while even after your periods have started again, they may stop in the case of frequent breastfeeding. On average, periods start again one year and 3 months post partum.

Whether to keep breastfeeding or not

Decide whether to keep breastfeeding or not after considering carefully the baby's appearance and your own wishes. If you want to keep on breastfeeding, consult a medical expert. However, it is said that approximately 60-70% babies are weaned naturally.

Some reasons for this is that

  • The baby stops drinking because of changes in the amount and composition of breastmilk during pregnancy.
  • The mother decreases breastfeeding because of nipple pain and discomfort caused by hormones during pregnancy.
  • It is time for weaning regardless of pregnancy.

Additionally, the baby may start drinking breastmilk again after the new baby is born, even if he stopped drinking during pregnancy.

There are no rules for the timing of weaning. It varies among individuals.

Weaning means the overall situation in which the baby stops drinking breastmilk. The timing for this varies, depending on the mother's situation, the advice of those around her, and the baby's feelings.

You sometimes have to give up breastfeeding because of nipple problems, breast problems, breastmilk insufficiency or breastfeeding fatigue, but in most cases it is possible to keep on breastfeeding if you can get appropriate information and support. Additionally, when your baby is over one and a half years old, he begins to learn to speak and to make his wishes clear, which may help you decide to stop breastfeeding.

The World Health Organization (WHO) encourages mothers to keep breastfeeding until the baby is 2 years old or older, as breastmilk is effective in promoting the physical and mental development of the baby.

Breastfeeding methods vary among individuals.

There are many ways to tandem nurse. You can choose how to do it according to your preferences or the age of each child.

We will introduce 2 common breastfeeding methods in this section

Breastfeeding 2 children at the same time

The mother lets each child suck on a breast at the same time. You may think that it would be difficult to breastfeed 2 children at the same time, but it really isn't, as the older child adjusts her positioning so that she can latch on.

You can fix which breast each child sucks on when you breastfeed them, but the older child will drink breastmilk less frequently than the younger one, so you can let the younger child drink from the opposite breast when the older one is away or asleep. In consideration of eyesight development, it is better to let your baby drink from both breasts.

When you fix which breast each child sucks on, the size of each breast changes according to each child's requirements. This isn't really a problem, but if you wish to avoid it, it's better to switch the two babies from side to side.

Breastfeeding one child at a time

The mother breastfeeds one child at a time. One child has to wait while the other is being breastfed, but the advantage is that the mother can deal with each child one by one. The older child tends to be interested in other things while he is waiting to be breastfed. However, considering the establishment of a relationship of trust, it is important to breastfeed him even if she has forgotten

There are many places where you can breastfeed.

Breastfeeding when you are away from home

A lot of mothers think that it is hard to find places to breastfeed outside.

Some of them do research beforehand, go out by car and breastfeed in the car, or ask employees to let them use a private room or staff room. Others always bottle-feed the baby when they are outside.

Nowadays more and more public facilities, such as department stores, are equipped with nursing rooms, which you should try.

Breastfeeding in a public place

Breastfeeding in a public place is controversial. Unfortunately, what's happening now is that breastfeeding in public tends not to be accepted in some areas of the world.

Opinions differ from region to region, so please check the situation where you are.

In some communities, mothers demand their right to breastfeed in public places.

The sign above indicates that you can breastfeed in that area.

Recommendation for nursing clothes

It's not easy to pull up your clothes or stretch the neckline down to expose your breast. Doing so chills your neck and stomach, and doesn't shield the mother's privacy.

If you wish to meet the needs of your baby and care about yourself at the same time, breastfeeding clothes can be one solution. You can breastfeed without pulling your clothes up, and it also protects your privacy as it isn't too revealing.

You can also find nursing underwear, such as bras that allow you to breastfeed without taking them off.

Breastfeeding can cause many struggles, but there are various places where you can solve them.

Breastfeeding is always accompanied by struggles. It is natural for you to be worried and unsure of what to do. You don't have to be ashamed of this. Don't try to shoulder all of the problems yourself; get your husband, family, friends and people with experience in child-rearing to listen to you. It is also effective to rely on experts such as lactation consultants, midwives and healthcare nurses in your area.

Places where you can consult and exchange information about child-rearing

  • Experienced mothers
  • You can surely find other mothers who have the same struggles and worries as you do.
  • You can talk, exchange information and share it with them while you let your children play.
  • Bulletin boards on the Internet
  • You will find more child-rearing support sites than you might expect. Mothers who don't go out that much refer to these websites.
  • Experienced mothers who have solved the same questions or worries as yours will answer your questions.
  • Regional facilities and events
  • Try to participate in regional child-rearing support or child-rearing events.
  • You will gain not only specialist advice from nursery staff, but also advice from other mothers like you.
  • Where to get counseling
  • Hospitals and child-rearing support organizations provide counseling to relieve anxiety about breastfeeding.
  • Breastfeeding consultants and health nurses will listen to you and give you precise advice there.