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Breastfeeding challenges 

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Prego Power
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Breastfeeding can be challenging enough at first, but some women experience special challenges, such as breastfeeding multiples or breastfeeding during a breast infection. 
Common breastfeeding challenges. 
Breastfeeding can be challenging, especially in the early days. But remember that you are not alone. Lactation consultants can help you find ways to make breastfeeding work for you and your baby. Some women face many different problems while breastfeeding, while others do not. Also, many women may have certain problems with one baby that they don't have with their second or third baby. 

Challenge: Sore nipples 
Many moms say that their nipples feel tender when they first start breastfeeding. Breastfeeding should feel comfortable once you and your baby have found a good latch and some positions that work. 

What you can do 
•    Your baby should not be suckling from just the nipple. The baby should be nursing from most of the areola (the darker colored area around the nipple) and the nipple. 
•    A good latch is key, so visit the Getting a good latch section for detailed instructions. If your baby sucks only on the nipple, gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth. Then try again to get your baby to latch on. (Your nipple should not look flat or compressed when it comes out of your baby's mouth. It should look round and long or the same shape as it was before the feeding.) 
•    If you find yourself putting off feedings because breastfeeding is painful, get help from a lactation consultant. Delaying feedings can cause more pain and harm your milk supply. 
•    Try changing positions each time you breastfeed. The Breastfeeding holds section describes the various positions you can try. 
•    Help cracked nipples stay moist so you can continue breastfeeding. Try one or all of these tips: 
•    After breastfeeding, express a few drops of milk and gently rub the milk on your nipples with clean hands. Human milk has natural healing properties and contains oils that soothe. 
•    Use purified lanolin cream or ointment that is especially made for breastfeeding. 
•    Let your nipples air dry after feeding or wear a soft cotton shirt. 
•    Get help from your doctor or lactation consultant before using creams, hydrogel pads (a moist covering for the nipple to help ease soreness), or a nipple shield (a plastic device that covers the nipple during breastfeeding). In some cases, you should not use these products. Your doctor or lactation consultant will help you make the choice that is best for you. 
•    Don't wear bras or clothes that are too tight and put pressure on your nipples. 
•    Change nursing pads (washable or disposable pads you can place in your bra to absorb leaks) often to avoid trapping in moisture that can cause cracked nipples. 
•    Avoid harsh soaps or ointments that contain astringents (like a toner) on your nipples. Washing with clean water is all that is needed to keep your nipples and breasts clean. 
If you have very sore nipples, you can ask your doctor about using non-aspirin pain relievers. 
 
Challenge: Low milk supply 
Most mothers make plenty of milk for their babies. But many mothers worry about having enough milk. This video suggests that checking your baby's weight and growth is the best way to make sure he or she gets enough milk. Let your baby's doctor know if you are concerned. 
For more ways to tell if your baby is getting enough milk, visit the How do I know if my baby is getting enough breastmilk? section. 
There may be times when you think your supply is low, but it is actually just fine: 
•    When your baby is around 6 weeks to 2 months old, your breasts may no longer feel full. This is normal. At the same time, your baby may nurse for only five minutes at a time. This can mean that you and your baby are just getting used to breastfeeding — and getting good at it! 
•    Growth spurts can make your baby nurse longer and more often. These growth spurts often happen around 2 to 3 weeks, 6 weeks, and 3 months of age. Growth spurts can also happen at any time. Don't be worried that your supply is too low to satisfy your baby. Follow your baby's lead. Nursing more and more often will help increase your milk supply. Once your supply increases, you will probably be back to your usual routine. 

What you can do 
•    Make sure your baby is latched on and positioned well. 
•    Breastfeed often and let your baby decide when to end the feeding. 
•    Offer both breasts at each feeding. Have your baby stay at the first breast as long as he or she is still sucking and swallowing. Offer the second breast when the baby slows down or stops. 
•    Avoid giving your baby formula or cereal in addition to your breastmilk, especially in the first 6 months of life. Your baby may lose interest in your breastmilk, and your milk supply will decrease. If you need to supplement your baby's feedings with more milk, try using a spoon, cup, or a dropper filled with pumped breastmilk. 
Check with your doctor for health issues, such as hormonal issues or primary breast insufficiency, if the above steps don't help. 
 

Challenge: Oversupply of milk 
An overfull breast can make breastfeeding stressful and uncomfortable for you and your baby. 

What you can do 
•    Breastfeed on one side for each feeding. Continue to offer that same breast for at least two hours until the next full feeding, gradually increasing the length of time per feeding. 
•    If the other breast feels unbearably full before you are ready to breastfeed on it, hand express for a few moments to relieve some of the pressure. You can also use a cold compress or washcloth to reduce discomfort and swelling. 
•    Feed your baby before he or she becomes overly hungry to prevent aggressive sucking. (Learn about hunger signs in the Tips for breastfeeding success section.) 
•    Burp your baby often if he or she is gassy so there is more room in baby's tummy for milk. 

Challenge: Strong let-down reflex 
Some women have a strong milk ejection reflex or let-down. This can happen along with an oversupply of milk. 

What you can do 
•    Hold your nipple between your first and middle fingers or with the side of your hand. Lightly press on milk ducts to reduce the force of the milk ejection. 
•    If your baby chokes or sputters when breastfeeding, unlatch him or her and let the extra milk spray into a towel or cloth. 
•    Allow your baby to latch and unlatch from the breast whenever he or she wants to. 
•    Try positions that reduce the force of gravity, which can make milk spray worse. These positions include the side-lying position and the football hold. (See the Breastfeeding holds section for illustrations of these positions.) 

Challenge: Engorgement 
It is normal for your breasts to become larger, heavier, and a little tender when they begin making milk. Sometimes, this fullness may turn into engorgement, when your breasts feel very hard and painful. Engorgement is the result of the milk building up. It usually happens during the third to fifth day after giving birth. But it can happen at any time, especially if you have an oversupply of milk or are not feeding your baby or expressing your milk often. 
Engorgement can also cause: 
•    Breast swelling 
•    Breast tenderness 
•    Warmth 
•    Redness 
•    Throbbing 
•    Flattening of the nipple 
•    Low-grade fever 
Engorgement can lead to plugged ducts or a breast infection, so it is important to try to prevent it before this happens. 
What you can do 
•    Breastfeed often after giving birth. As long as your baby is latched on and sucking well, allow your baby to feed for as long as he or she likes. 
•    Work with a lactation consultant to improve your baby's latch so that your baby can remove more milk from your breast. 
•    Breastfeed often on the engorged side to remove the milk, keep the milk moving freely, and prevent your breast from becoming too full. 
•    Do not use pacifiers or bottles to supplement feedings in the beginning. Try to wait to introduce pacifiers until your baby is 3 or 4 weeks old. 
•    Hand express or pump a little milk to soften the breast, areola, and nipple before breastfeeding. 
•    Massage the breast. 
•    Use cold compresses on your breast in between feedings to help ease the pain. 
•    If you are returning to work, try to pump your milk on the same schedule that your baby breastfed at home. Pump at least every four hours, or more often. 
•    Get enough rest, proper nutrition, and fluids. 
•    Wear a well-fitting, supportive bra that is not too tight. 
Try reverse pressure softening to make the areola soft around the base of the nipple and help your baby latch. Try one of the holds in the illustrations below. Press inward toward the chest wall and count slowly to 50. Use steady and firm pressure, but gentle enough to avoid pain. You may need to repeat each time you breastfeed for a few days. 
1.    One-handed "flower hold." Works best if your fingernails are short. Curve your fingertips in toward your body and place them where baby's tongue will go. 
2.    Two-handed, one-step method. Works best if your fingernails are short. Curve your fingertips in toward your body and place them on each side of the nipple. 
3.    Two-handed, one-step method. You may ask someone to help press by placing fingers or thumbs on top of yours. 
4.    Two-handed, two-step method. Using two or three fingers on each side, place your first knuckles on either side of the nipple and move them 1/4 turn. Repeat above and below the nipple. 
5.    Two-handed, two-step method. Using straight thumbs, place your thumbnails evenly on either side of the nipple. Move 1/4 turn and repeat above and below the nipple. 
6.    Soft-ring method. Cut off the bottom half of an artificial nipple and place it on the areola. Press with your fingers. 
 
Challenge: Plugged ducts 
Plugged ducts are common in breastfeeding mothers. A plugged milk duct feels like a tender and sore lump in the breast. If you have a fever or other symptoms, then you probably have a breast infection rather than plugged ducts. 
A plugged duct happens when a milk duct does not drain properly. Pressure then builds up behind the plug, and surrounding tissue gets inflamed. A plugged duct usually happens in only one breast at a time. 

What you can do 
•    Breastfeed on the side with a plugged duct as often as every two hours. This will help loosen the plug and keep your milk moving freely. 
•    Aim your baby's chin at the plug. This will focus his or her suck on the duct that is affected. 
•    Massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple. Use a warm compress on the sore area. 
•    Rely on others to help you get extra sleep, or relax with your feet up to help speed healing. Often a plugged duct is a sign that you are doing too much. 
•    Wear a well-fitting, supportive bra that is not too tight, since a tight bra can constrict milk ducts. Consider trying a bra without an underwire. 
•    If you have plugged ducts that keep coming back, get help from a lactation consultant. 

Challenge: Breast infection (mastitis) 
Mastitis (mast-EYE-tiss) is soreness or a lump in the breast. It can cause symptoms such as: 
•    Fever and/or flu-like symptoms, such as feeling run down or very achy 
•    Nausea 
•    Vomiting 
•    Yellowish discharge from the nipple that looks like colostrum 
•    Breasts that feel warm or hot to the touch and appear pink or red 
A breast infection can happen when other family members have a cold or the flu. It usually happens in only one breast. It is not always easy to tell the difference between a breast infection and a plugged duct, because both have similar symptoms and can get better within 24 to 48 hours. Some breast infections that do not get better on their own need to be treated with prescription medicine from a doctor. (Learn more about medicines and breastfeeding in the Breastfeeding fact sheet.) 

What you can do 
•    Breastfeed on the infected side every two hours or more often. This will keep the milk moving freely and your breast from becoming too full. 
•    Massage the area, starting behind the sore spot. Move your fingers in a circular motion and massage toward the nipple. 
•    Apply heat to the sore area with a warm, wet cloth. 
•    Rely on others to help you get extra sleep, or relax with your feet up to help speed healing. Often a breast infection is a sign that you are doing too much and becoming overly tired. 
•    Wear a well-fitting, supportive bra that is not too tight, since a tight bra can constrict milk ducts. 
Ask your doctor for help if you do not feel better within 24 hours of trying these tips, if you have a fever, or if your symptoms get worse. You might need medicine. See your doctor right away if: 
•    You have a breast infection in which both breasts look affected 
•    There is pus or blood in your breastmilk 
•    You have red streaks near the affected area of the breast 
•    Your symptoms came on severely and suddenly 

Challenge: Fungal infections 
A fungal infection, also called a yeast infection or thrush, can form on your nipples or in your breast. This type of infection thrives on milk and is an overgrowth of the Candida organism. Candida lives in our bodies and is kept healthy and at the correct levels by the natural bacteria in our bodies. When the natural balance of bacteria is upset, Candida can overgrow, causing an infection. 
A key sign of a fungal infection is sore nipples that last more than a few days, even after your baby has a good latch. Or you may suddenly get sore nipples after several weeks of pain-free breastfeeding. Other signs are pink, flaky, shiny, itchy, or cracked nipples or deep pink and blistered nipples. You could also have achy breasts or shooting pains deep in the breast during or after feedings. 
Causes of fungal infection include: 
•    Thrush in your baby's mouth, which can pass to you 
•    Nipples that are sore or cracked 
•    Receiving or taking antibiotics or steroids (often given to mothers during labor) 
•    A chronic illness like HIV, diabetes, or anemia 

What you can do 
Fungal infections are treated with a medicine you rub on your breasts several times a day for about a week. It may take several weeks to clear up, so it is important to follow these tips to avoid spreading the infection: 
•    Change disposable nursing pads often. 
•    Wash any towels or clothing that comes in contact with the yeast in very hot water (above 122°F). 
•    Wear a clean bra every day. 
•    Wash your hands often. 
•    Wash your baby's hands often, especially if he or she sucks on his or her fingers. 
•    Boil every day all pacifiers, bottle nipples, or toys your baby puts in his or her mouth. (To boil them, place them in a pot of water and heat the water to a rolling boil. Boil the items for about 10 minutes.) 
•    After one week of treatment, throw away all pacifiers and nipples and buy new ones. 
•    Every day boil all breast pump parts that touch your milk. 
•    Make sure other family members do not have thrush or other fungal infections. If they have symptoms, do not let them care for you or your baby until they get treated. 

Challenge: Inverted, flat, or very large nipples 
Some women have nipples that turn inward instead of pointing outward or are flat and do not protrude. Nipples can also sometimes flatten for a short time because of engorgement or swelling from breastfeeding. Inverted or flat nipples can sometimes make it harder to breastfeed. For breastfeeding to work your baby must latch on to both the nipple and the breast, so even inverted nipples can work just fine. Often, flat and inverted nipples will protrude more over time as the baby sucks more. 
Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk. 

What you can do 
•    Talk to your doctor or a lactation consultant if you are concerned about your nipples. 
•    You can use your fingers to try to pull your nipples out. You can also talk to your doctor or nurse about using a device that gently suctions or pulls out inverted or temporarily flattened nipples. 
•    The latch for babies of mothers with very large nipples will improve with time as the baby grows. It might take several weeks to get the baby to latch well. But if you have a good milk supply, your baby will get enough milk even with a latch that isn't perfect. 

Challenge: Nursing strike 
A nursing "strike" is when your baby has been breastfeeding well for months and then suddenly begins to refuse the breast. A nursing strike can mean that your baby is trying to let you know that something is wrong. This usually does not mean that the baby is ready to wean (stop breastfeeding totally). 
Not all babies will react the same way to the different things that can cause a nursing strike. Some babies will continue to breastfeed without a problem. Other babies may just become fussy at the breast. And other babies will refuse the breast entirely. 
Some of the major causes of a nursing strike include: 
•    Having mouth pain from teething, a fungal infection like thrush, or a cold sore 
•    Having an ear infection, which causes pain while sucking or pressure while lying on one side 
•    Feeling pain from a certain breastfeeding position, perhaps from an injury on the baby's body or from soreness from an immunization 
•    Being upset about a long separation from the mother or a major change in routine 
•    Being distracted while breastfeeding, such as becoming interested in other things going on around the baby 
•    Having a cold or stuffy nose that makes breathing while breastfeeding difficult 
•    Getting less milk from the mother after supplementing breastmilk with bottles or overuse of a pacifier 
•    Responding to the mother's strong reaction if the baby has bitten her while breastfeeding 
•    Being upset by hearing arguing or people talking in a harsh voice while breastfeeding 
•    Reacting to stress, overstimulation, or having been repeatedly put off when wanting to breastfeed 
If your baby is on a nursing strike, it is normal to feel frustrated and upset, especially if your baby is unhappy. Be patient with your baby and keep trying to offer your breasts. You may also want to pump your breastmilk to offer during the strike and to make sure you do not get engorged. 

What you can do 
•    Try to hand express or pump your milk as often as the baby used to breastfeed, to prevent engorgement and plugged ducts. 
•    Try another feeding method temporarily to give your baby your breastmilk, such as using a cup, dropper, or spoon. 
•    Keep track of your baby's wet and dirty diapers to make sure he or she is getting enough milk. 
•    Keep offering your breast to your baby. If your baby is frustrated, stop and try again later. You can also try offering your breast when your baby is very sleepy or is sleeping. 
•    Try breastfeeding positions where your bare skin is pressed next to your baby's bare skin. 
•    Focus on your baby, and comfort him or her with extra touching and cuddling. 
•    Try breastfeeding while rocking your baby in a quiet room without distractions. 
 
Breastfeeding a baby with a health problem 
Some health problems can make it harder for babies to breastfeed. But breastmilk provides the healthy start your baby needs, which is even more important if your baby is premature or sick. Even if your baby cannot breastfeed directly from you, you can hand express or pump your milk and give it to your baby with a dropper, spoon, or cup, or bottle as your baby gets older. 
 
Jaundice 
Jaundice is caused by an excess of bilirubin, which is found in the blood but usually only in very small amounts. In the newborn period, bilirubin can build up faster than it can be removed from the intestinal tract. Jaundice can appear as a yellowing of the skin and eyes. The jaundice usually clears up by 2 weeks of age and usually is not harmful. 
Some breastfed babies develop jaundice when they do not get enough breastmilk, either because of breastfeeding challenges or because the mother's milk hasn't come in. This type of jaundice usually clears up quickly by breastfeeding more often or feeding of expressed breastmilk or after the mother's milk comes in. 
Your baby's doctor may monitor his or her bilirubin level with blood tests. Some babies with jaundice may need treatment with a special light (called phototherapy). This light helps break down bilirubin into a form that can be removed from the body easily. 
Breastfeeding is best for your baby. Even if your baby gets jaundice, this is not something that you caused. Your doctor can help you make sure that your baby is eating well and that the jaundice goes away. 


Reflux disease 
Some babies develop gastroesophageal (GASS-troh-uh-SOF-uh-JEE-uhl) reflux disease (GERD). GERD happens when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to come back up into the esophagus, the tube in the throat. 
Some symptoms of GERD include: 
•    Severe spitting up or spitting up after every feeding or hours after eating 
•    Projectile vomiting, where the milk shoots out of the mouth 
•    Inconsolable crying, as if in discomfort 
•    Arching of the back, as if in severe pain 
•    Refusal to eat or pulling away from the breast during feeding 
•    Waking up often at night 
•    Slow weight gain 
•    Gagging or choking or having problems swallowing 
Many healthy babies might have some of these symptoms and not have GERD. Also, some babies with only a few of these symptoms have a severe case of GERD. Not all babies with GERD spit up or vomit. GERD may need to be treated with medicine if the baby refuses to nurse, gains only a small amount of weight or is losing weight, or has periods of gagging or choking. 
See your baby's doctor if your baby spits up after every feeding and has any of the other symptoms listed in this section. If your baby has GERD, continue breastfeeding. Infant formula is harder to digest than breastmilk. 

Premature birth or low birth weight 
Premature birth (also called preterm birth) is when a baby is born before 37 weeks. Premature babies often have a low birth weight (less than 5½ pounds). Both of these can make it challenging to breastfeed, especially if the baby has to stay in the hospital for extra care. But breastmilk helps premature babies grow and stay healthy. 
Some babies can breastfeed right away. This may be true if your baby was born at a low birth weight but after 37 weeks. These babies will need more skin-to-skin contact to help keep warm. These smaller babies may also need to be fed more often because their stomachs are smaller, and they may get sleepier during those feedings. 
If your baby is born prematurely and you are not able to breastfeed at first, you can: 
•    Hand express or pump colostrum in the hospital as soon as you are able 
•    Talk to the hospital staff about renting an electric pump. Call your insurance company or the local Women, Infants and Children (WIC) office to find out whether insurance will pay for rental of this type of pump. Most insurance plans must cover the cost of a breast pump, but different insurance plans will cover different types of pumps. 
•    Pump milk as often as you would normally breastfeed — about eight times in a 24-hour period (every 3 hours). 
•    Give your baby skin-to-skin contact once your baby is ready to breastfeed directly. This can be very calming and a great start to your first feeding. Be sure to work with a lactation consultant on proper latch and positioning. It may take some time for you and your baby to get into a good routine. 

Colic 
Many infants are fussy in the evenings, but if the crying does not stop and gets worse throughout the day or night, it may be caused by colic (KOL-ik). Colic usually starts between 2 and 4 weeks of age. A baby may cry inconsolably or scream, extend or pull up his or her legs, and pass gas. The baby's stomach may be enlarged. Crying can happen at any time, although it often gets worse in the early evening. 
Colic will probably get better or disappear by the age of 3 or 4 months. Doctors don't know why some babies get colic. Some breastfed babies may be sensitive to certain foods their mother eats, like caffeine, chocolate, dairy, or nuts. Colic could be a sign of a medical problem, such as a hernia or some type of illness. 
If your infant shows signs of colic, talk to your doctor. Sometimes changing what you eat can help. Some infants seem to be soothed by being held, "worn" with a baby wrap or sling, rocked, or swaddled (wrapped snugly in a blanket). 
 
Breastfeeding and special situations 
Will you make enough milk to breastfeed twins, triplets, or more? Want to know if you can breastfeed your adopted baby? Learn the answers to these questions and get tips to help you breastfeed in any situation. 
 
What do I need to know about breastfeeding twins or multiples? 
The benefits of breastfeeding for mothers of multiples and their babies are the same as for all mothers and babies — possibly greater, since many multiples are born early. The idea of breastfeeding more than one baby may seem overwhelming at first! But many moms of multiples find breastfeeding easier than other feeding methods, because there is nothing to prepare. Many mothers successfully breastfeed more than one baby even after going back to work. 

Being prepared 
It will help to learn as much as you can about breastfeeding during your pregnancy. Before the babies are born, you can: 
•    Take a breastfeeding class 
•    Find internet and print resources for parents of multiples 
•    Join a support group for parents of multiples through your doctor, hospital, local breastfeeding center, or La Leche League International 
•    Let your doctor and family members know that you plan to breastfeed 
•    Find a lactation consultant who has experience with multiples before your babies are born so that you know where to get help 
Many twin and multiple babies are smaller or born premature. Get tips on caring for these babies. 

Making enough milk 
Most mothers can make plenty of milk for twins. Many mothers exclusively breastfeed or express their milk for triplets or quadruplets. Keep these tips in mind: 
•    Breastfeeding soon and often after birth is helpful for multiples the same way it is for one baby. The more milk that is removed from your breasts, the more milk your body will make. 
•    If your babies are born early, double pumping (pumping both breasts at the same time) can help you make more milk. 
•    The doctor's weight checks can tell you whether your babies are getting enough breastmilk. Learn other signs that your babies are getting enough milk. 
•    It helps to have each baby feed from both breasts. You can "assign" a breast to each baby for a feeding and switch at the next feeding. Or you can assign a breast to each baby for a day and switch the next day. Switching sides helps keep milk production up if one baby isn't eating as well as the other baby. It also gives babies a different view to stimulate their eyes. 

Can I still breastfeed if I'm pregnant? 
Breastfeeding during your next pregnancy is not usually dangerous to you, your breastfeeding child, or your new developing baby. Your child may decide to wean (stop breastfeeding) on his or her own because of changes in the amount and flavor of your milk. Your doctor also may advise you, or you may want, to wean your baby if: 
•    You have any problems in your pregnancy, such as uterine pain or bleeding 
•    You have a history of preterm labor 
•    Pregnancy hormones make breastfeeding uncomfortable 
•    Your growing belly makes breastfeeding difficult 
Your child will need additional food and drink, especially if he or she stops breastfeeding. You will probably make less milk during pregnancy, especially after your 20th week. 
If you keep nursing your child after your baby is born, feed your newborn first to make sure he or she gets the colostrum. Once you are making more milk, you can decide how you can best meet everyone's needs but stay aware of your new baby's needs for you and your milk. 
You may want to ask your partner to help you by taking care of one child while you are breastfeeding. Also, you will need more fluids, healthy foods, and rest, because you are taking care of yourself and two small children. 

Can I breastfeed after breast surgery? 
Yes, but the amount of milk your breasts will make will depend on how your surgery was done, where your incisions were, and the reasons for your surgery. Women who had incisions in the fold under the breast are less likely to have problems making milk than women who had incisions around or across the areola, which can cut into milk ducts and nerves. Women who have had breast implants usually are able to breastfeed. 
If you ever had surgery on your breasts for any reason, talk with a lactation consultant. If you are planning to have breast surgery, talk with your surgeon about ways he or she can save as much of the breast tissue and milk ducts as possible. 

Can I breastfeed my adopted baby? 
Maybe. Many mothers who adopt can breastfeed their babies with some help. You may need to supplement your breastmilk with donated breastmilk from a milk bank or with infant formula. But some adoptive mothers can breastfeed exclusively, especially if they have been pregnant in the past. 
If you plan to adopt and want to breastfeed, talk with your doctor and a lactation consultant. They can help you decide the best way to try to establish a milk supply for your new baby. Options include: 
•    Pumping every three hours around the clock for two to three weeks before your baby arrives 
•    Waiting until the baby arrives and starting to breastfeed 
•    Using devices such as a supplemental nursing system or a lactation aid. This can help make sure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time. 


Can I breastfeed later if I didn't when my baby was first born? 
Maybe. You can try breastfeeding (or returning to breastfeeding) after your baby is older. This process is called relactation. It may take weeks or even longer to get a full supply of milk, so you will need to continue to supplement your baby's diet with formula. 
Talk with your doctor and a lactation consultant. They can help you decide the best way to try to rebuild your milk supply. Options include:1 
•    Pumping every three hours to stimulate your milk supply. 
•    Give your baby skin-to-skin time to encourage the transition from the bottle to the breast. 
•    Using devices such as a supplemental nursing system or a lactation aid. This can help ensure that your baby gets enough nutrition and that your breasts are stimulated to make milk at the same time. 

What do I need to know about using breastmilk from donor banks? 
If you can't breastfeed and still want to give your baby human milk, you may want to consider a human milk bank. A human milk bank can give you fresh donor human milk if you have a prescription from your doctor. Many steps are taken to make sure the milk is safe. 
Some reasons you may want or need a human milk bank include: 
•    You are unable to breastfeed because: 
o    Your baby was born premature (before 37 weeks of pregnancy) 
o    Your baby has other health problems 
o    You take certain medicines that are dangerous for babies and can be passed to your baby in your breastmilk, such as anxiety medicine, birth control with estrogen, or certain migraine medicines 
o    You have a specific illness (such as HIV or active tuberculosis) that means you should not breastfeed 
o    You get radiation therapy, though some therapies may mean only a brief pause in breastfeeding 
•    Your baby isn't doing well on formula because of allergies or intolerance 
Some mothers give extra breastmilk directly to parents of babies in need. This is called "casual sharing." But this milk has not been tested in a lab like milk at a human milk bank has. The Food and Drug Administration recommends against feeding your baby breastmilk that you get either directly from other women or through the Internet. 
You can find a human milk bank through the Human Milk Banking Association of North America (HMBANA) To find out whether your insurance will cover the cost of the milk, call your insurance company or ask your doctor. If your insurance company does not cover the cost of the milk, talk with the milk bank to find out whether payment can be made later on or how to get help with the payments. 
 

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