This document provides information and advice about breastfeeding for new mothers. It discusses the benefits of breastfeeding, common concerns mothers have about breastfeeding, and solutions to common breastfeeding problems. The key topics covered include the nutritional and emotional benefits of breastfeeding, how to determine if a baby is getting enough milk, introducing bottles or pacifiers, diet and lifestyle considerations for breastfeeding mothers, establishing and maintaining a sufficient milk supply, and treating issues like engorgement, sore nipples, and mastitis. The document aims to equip mothers with knowledge to initiate and continue successful breastfeeding.

1. Choosing to Breastfeed
Ann Douglas, Author; President, Mom Media

2. Overview
I. What Mothers Need to Know About Breastfeeding
II. Mothers' Top Worries and Concerns About
Breastfeeding
III. Helping Mothers to Deal With Common Breastfeeding
Problems
IV. Breastfeeding Promotion: What Works and What
Doesn't Work—Summarizing the Results from Some
Key Studies
V. Communicating Effectively with Mothers About Breastfeeding
VI. Recommended Resources

3. I. What Mothers Need to Know
About Breastfeeding
• Breastfeeding offers
tremendous health
benefits to mothers and
babies. Two years and
beyond.
• The quantity and the
specific composition of
breast milk changes in
order to meet baby's
need at any given time.

4. • A baby may breastfeed
more frequently in hot
weather or during a
growth spurt. Growth
spurts typically occur at
around two to three
weeks, six weeks, three
months, and six months
of age.
• Breastfeeding doesn't
come naturally or easily
to every mother and
baby. There can be a
learning curve for one
or both; and the
problems to be
overcome during the
early weeks can range
from the easy-to-
troubleshoot to the
much more challenging
to resolve.
Breastfeeding
is worth it

5. • The pressure to
breastfeed can be
considerable—
something that can be
either motivating or
overwhelming,
depending on both the
amount of pressure and
the individual mother's
reaction to the pressure
that is being exerted.
“I feel really strongly that new
moms should not be pressured
into breastfeeding or made to
feel guilty if they choose not to
breastfeed or it simply doesn’t
work out. I get very angry at
those who say that at all costs
every mother can breastfeed.
It’s like saying that every woman
with a working uterus can be a
good mother! This is not the
case. I have friends who tried
very hard to breastfeed, and
even with extra pumping and
fees, their breasts simply would
not produce enough milk. That
doesn’t make them ‘bad
mothers.’”
- Judith, 31, mother of oneQuotes from mothers are excerpted from
The Mother of All Baby Books
By Ann Douglas (Wiley Canada, 2001).

6. Breastfeeding is much
more than a form of
nutrition. It is a special
way to bond with your
child: to learn how to be a
mother.”
- Elisa, 27, mother of two
• Once you reach "the
reward period" of
breastfeeding,
breastfeeding can be a
wonderful way to
snuggle up to baby, a
source of feel-good
mothering hormones,
and a powerful
mothering tool.

7. • Breastfeeding may be
the healthiest and most
natural way of feeding a
baby, but breastfeeding
isn't necessarily the
right choice for every
mother and baby.

8. • Learning about
breastfeeding before
your baby is born,
setting a breastfeeding
goal for yourself, and
connecting with sources
of breastfeeding support
and information after
the birth can increase
your odds of being able
to breastfeed over the
long-term.
“Enter into breastfeeding
with an open mind. You may
feel now that you only want
to breastfeed for six weeks
or so, but you may be
shocked by your pull to keep
going.”
- Jennifer, 26, pregnant with
her second child

9. • Babies may not be able
to talk, but they have
ways of communicating
their desire to
breastfeed: rooting,
clicking their tongues,
and sucking on their
fingers or their hands.
“Breastfeeding is the most
natural way of nourishing
your baby and it makes
mothering easier.”
- Jennifer, 26, pregnant with
her second child
• They can also tell you
when they've had
enough to eat: they may
stop nursing and turn
their head away, relax
in your arms, and
stretch out their arms
and legs and their
fingers.

10. • The milk tide ebbs and
flows. Your milk supply
is more abundant in the
morning than it is at
night. That said, you
can be caught off guard
by leaks, squirts, and
spurts. Breast pads and
a sense of humor are a
breastfeeding mother's
best friends.
• There also peaks and
valleys in your energy
cycle. These are tied to
your sleep-wake cycle,
the last time you ate,
and your baby's sleep-
wake-feeding cycle.
• Life is easier as a
breastfeeding mom if
you learn to "go with the
flow."

11. II. Mothers' Top Worries and
Concerns About Breastfeeding
"I can't tell how much milk
my baby is getting."
Swallowing signs,
breastfeeding at least 8
times/day, having 3 to 4
bowel movements every
24 hours after Day 4
(although some babies
may go a week or longer
without a bowel movement
starting at around Week 6),
gaining weight (after the
initial post-birth weight loss
of 5 to 8% of birth weight,
which is normal).

12. "My milk hasn't come in
yet. I'm worried he's
starving to death.”
Ideally baby should regain
his birth weight by age two
weeks and to continue to
gain four to eight ounces
(120 to 240 grams) per
week during the first three
months of life.
Newborns only need tiny
quantities of colostrum (the
nutrient-rich first food).
Transitional milk comes in
(around day 4): about 2
ounces of milk per feeding.
Up to about 2 to 2 ½
ounces of breast milk by
the time your actual breast
milk comes in the following
day (around day 5).

13. Breast Milk - Best Milk (2003)
Colostrum, foremilk,
and hindmilk
A breastfeeding poster
published by Britain’s
National Childbirth Trust
www.nctms.co.uk

14. "Is breast milk supposed to
look like that?"
Breast milk is supposed to
look like a whitish-bluish
version of the most
watered down skim milk
you've ever seen. That's
normal.

15. "How often should my
newborn be nursing?”
Resist the temptation to
schedule feedings, to time
feedings, or to limit time at
the breast. Your baby will
let you know when he's
hungry and when he's had
enough to eat.
Up to 6 weeks of age: Up
to 12 times/day.
6 weeks of age: Up to 10
times/day.
3 months: approximately 8
times/day.
You'll probably notice that
your baby "cluster feeds"
(has a couple of feedings
that are closely spaced
together). This is normal.

16. "What foods should I
eliminate from my diet in
order to reduce my baby's
fussiness?"
Foods that have been blamed
for making babies edgy, cranky,
or colicky include caffeine, dairy
products, eggs, gluten, corn,
fish, nuts, soy, gassy
vegetables, spicy foods.
Try to figure out what food
might have triggered your
baby's fussiness and then
try to eliminate that food or
food group for two weeks.
Then gradually re-
introduce the food and see
if you notice a difference in
your baby's symptoms.

17. "What's the earliest I
should introduce a bottle or
a pacifier?"
Opinions vary. It's easier to
get milk out of a bottle than
a breast. Time spent
sucking on an artificial
nipple is time that isn't
spent at the breast
stimulating milk production.
On the other hand, if mom
is feeling like she's turned
into a human pacifier 24/7,
and nursing is well
established, it may be
worthwhile weighing the
pros/cons of pacifier use.

18. "Is it okay to offer a
breastfed baby the
occasional bottle of
formula?"
Exclusive breastfeeding is
the preferred option
because infant formula is
very different from breast
milk.

19. "Is it okay to drink alcohol
while you're nursing?"
Most health authorities
advise limiting yourself to
one alcoholic beverage per
day and timing that drink
so that you have it right
after a feeding.
Alcohol can make
breastfeeding babies extra
drowsy, which can interfere
with breastfeeding.

20. "I've heard that smoking
affects breastfeeding, too."
Smoking decreases milk
production, interferes with
milk ejection, lowers
prolactin levels and fat
levels in milk, and
increases the incidence of
infant colic. What's more,
exposure to second-hand
smoke increases a baby's
risk for Sudden Infant
Death Syndrome,
respiratory infections, and
cancer.

21. Nutrition for Healthy Term
Infants states that
breastfeeding mothers
should be encouraged to
stop or reduce smoking, but
adds, "Even if smoking is
continued, breastfeeding
is still the best choice."
(Revision: 12/08/05).

22. La Leche League
International offers this
sensible advice:
• Smoke away from the baby,
outdoors, or in a separate
room.
• Smoke right after nursing
sessions.
• Smoke as few cigarettes as
possible.

23. "Is it safe to take this
medication or herbal
product?"
Medications and herbal
products pass through
breast milk to babies.
Some products are known
to be harmful to babies.
Contact the Motherisk
Clinic www.motherisk.org;
1-877-327-4636.

24. "Which position should I
use?”
See So That's What They're For by
Janet Tamaro for mom-friendly
explanations of these particular
breastfeeding positions or download
this document from the La Leche
League website:
www.lalecheleague.org/FAQ/
positioning.html
The position that works for
you and your baby—and
there are a smorgasbord of
choices to choose from:
the cradle position, the
transition position, the
clutch or football position,
the cradle lying down
position, the alternate lying
down position, the cross-
cradle position, etc.

25. “Because I’m big-breasted, the regular football or
cradle hold just wouldn’t work for me. I placed a
rolled-up face cloth under by breast to raise it up and
give me more support.”
- Tammy, 32, mother of one

26. "When should I start my
breastfed baby on solid
foods?”
You don't need to give babies
anything other than Vitamin D
drops during that time. Water,
juice, sugar water, and formula
are not necessary for breastfed
babies.
Encourage exclusive
breastfeeding for the first 6
months of life, as breast
milk is the best food for
optimal growth.
Breastfeeding may
continue for up to 2 years
and beyond.
- Nutrition for Healthy Term
Infants (Ottawa: The Canadian
Paediatric Society Nutrition
Committee, Dietitians of Canada
and Health Canada, Rev. 2005)

27. "Is it okay to diet when I'm
breastfeeding?”
While some women lose
weight while they're
breastfeeding, dieting is
not recommended. Talk to
your healthcare provider if
you are concerned about
your weight.
Healthy nutrition is
important for breastfeeding
mothers. Structure your
meals and snacks around
Canada's Food Guide. You
will probably find that you
want to have a snack and
a drink handy while you're
feeding your baby.

28. III. Helping Mothers to Deal With
Common Breastfeeding Problems
Baby is too sleepy to
nurse
Following a period of
initial alertness, most
newborns become
quite sleepy. Babies
with jaundice are
extra sleepy.
Attempt to rouse
baby during periods
of active sleep (when
baby's eyes are
moving and he's
"nursing" in his
sleep). Do "baby sit-
ups" while supporting
baby's head.
Undress baby, but
don't allow baby to
become chilled.
This table is modified from a more detailed chart which can be found on pages 22 t o 33 of
Mealtime Solutions for Your Baby, Toddler, and Preschooler: The Ultimate No-Worry Guide for
Each Age and Stage by Ann Douglas (John Wiley and Sons Canada Ltd: Toronto, 2006). All
material © Ann Douglas and John Wiley and Sons Canada Ltd.

29. Baby doesn't want to
nurse
If a newborn refuses
the breast, it's called
"breast refusal";
when an older baby
refuses the breast,
it's called a "nursing
strike."
Figure out what's at
the root of the
problem. Is baby
frustrated with
breastfeeding? in
pain? (sore mouth,
sore teeth, sore
throat, ear infection)
picking up on stress
in the family?
Soothe and reassure
your baby and offer
the breast when
baby is sleepy.
Offer pumped breast
milk via alternative
means, ideally
avoiding a bottle.

30. Breast engorgement Your baby can't
extract milk from
your overly firm
breasts; and baby's
poor latch leaves you
susceptible to sore
nipples.
Apply warm
compresses right
before feedings to
encourage milk flow
and apply cold
compresses (frozen
peas) in between
feedings to reduce
swelling. Nurse
frequently (at least 8
to 12 times/day) and
watch for signs of a
breast infection
(fever, redness,
breast soreness).

31. Inadequate milk
supply
Most women
produce enough milk
for their babies. In
general, if your baby
is producing one wet
diaper on Day 1, two
wet diapers on Day
2, and so on until
Day 5 (at which point
you want to see five
to six wet diapers per
day and a couple of
yellowish stools), you
should feel
reassured. If you are
still worried, have
your healthcare
provider check your
baby's weight, latch,
and overall health.
To build up your milk
supply
• check baby's latch
• ensure baby nurses
actively for at least
10 minutes at each
breast
• breastfeed at least
8 times per day
• offer each breast at
each feeding and
express milk (or
pump) after each
feeding to further
stimulate milk
production
• ask if a prescription
or herbal product
would help

32. Overabundant milk
supply
Your baby chokes,
gulps, or pulls away
from the breast
because he can't
manage the flow of
milk. Some babies
simply refuse to
nurse.
Offer one breast per
feeding.
Pump or hand-
express some milk
before you offer the
breast to your baby
so that the milk flow
won't be quite so
overpowering.
Nurse in the side-
lying position so that
baby can let any
extra milk dribble out
of his mouth.

33. Flat or inverted
nipples
It is more difficult
for a baby to latch
on to flat or
inverted nipples
and the nipple is
more susceptible
to injury.
Use a breast pump
immediately prior to
each nursing
session. This will
encourage the nipple
to protrude long
enough for baby to
get a good latch.
Positioning
problems
Baby is latching
on to the nipple
itself rather than
the areola
(shallow latch).
This leads to sore
nipples, poor
letdown, poor milk
flow, and reduced
milk production.
Check baby's
position.

34. Nipple trauma Overuse or improper
use of a breast
pump; pulling the
baby off the breast
without breaking the
suction with your
baby finger.
If your breast pump
is causing you pain
or discomfort, stop
pumping. Break the
suction in your
baby's mouth before
you remove your
baby from the breast.

35. Breast infection Your nipples can
become cracked and
infected with bacteria
or yeast.
You will require
treatment with oral
antibiotics (for a
bacterial breast
infection) or anti-
fungal medication
(for a yeast-based
breast infection).

36. Mastitis If a plugged milk duct
becomes infected,
you can develop a
fever that is
accompanied by
symptoms of a
breast infection (red
streaks on your
breast, a cracked
nipple that oozes
pus, and pus or
blood in your milk).
• Keep nursing to
avoid engorgement.
• Apply warm water
(shower, bath, basin)
and massage your
breasts in a circular
motion (armpit to
nipple) before
nursing to encourage
milk flow. Cabbage
leaf compresses
work well, too.
• If baby refuses to
nurse on the affected
side, pump from that
side and continue to
offer the other
breast.

37. “With my two boys, I developed
mastitis. My body started
aching, and there was this hard
lump in my breast. I started
running a fever and having chills
and generally feeling the most ill
I’d ever felt in my life. If you
develop mastitits, it really helps
to breastfeed often, especially
on the infected side. You should
also make sure you keep your
breasts dry and that you change
your breast pads often. Try
massaging the hard lump in a
warm bath and applying warm
compresses and see if that
helps, and call your doctor to
see if an antibiotic is in order.”
- Christina, 25, mother of two

38. • Avoid tight clothing,
particularly tight bras.
• Take a pain medication as
needed.
• Get plenty of rest.

39. Thrust/yeast
infections
You may notice
white patches inside
your baby's mouth, a
white tongue (thrust),
or a fiery-red yeast-
based diaper rash.
Your baby may seem
like he's in pain when
he's nursing. You
may feel sharp,
burning pains in your
nipple. The skin of
the areola may or
may not be affected.
(If it is, it may be
itchy and scaly or red
and shiny).
Seek treatment for
yourself, your baby,
and your partner.
(Yeast infections can
be transmitted during
sex.) Treatment
options include
nystatin cream or
ointment, gentian
violet, or anti-fungal
creams.

40. Baby with reflux Gastroesophageal
reflux disease
(GERD) occurs when
stomach acids back
up into the
esophagus, causing
extreme distress
during and after
feedings and when
baby is lying down
after a feeding.
Positions that keep
your baby's head
elevated during a
feeding work best for
babies with GERD.
Keep baby upright
for at least half an
hour after each
feeding. Talk to your
healthcare provider
about the advisability
of modified sleeping
positions for babies
with GERD.

41. Babies with special
feeding issues
Babies who are
premature may not be
capable of feeding at
the breast or staying
awake for a full feeding
at the breast initially.
Babies who are tongue-
tied (frenulum is
unusually short), or
who have a physical
condition or structural
problem that makes
breastfeeding more
difficult (e.g., Down
syndrome, cleft lip, or
cleft palate) may
require modified
breastfeeding holds or
surgery in order to
breastfeed.
Consult with a lactation
consultant to find out
how to make
breastfeeding and
breast pumping work
for your baby. There
are special feeding
devices that can be
helpful to babies with
cleft palate; for
example, a palatal
obturator: a mouth
appliance that provides
a firm surface at the
roof of the mouth; and
a Haberman feeder (a
bottle that can be
adjusted for slower or
faster flow and that is
compression rather
than sucking driven).

42. Breastfeeding Tricks of the Trade:
Practical Strategies to Share with Mothers
• Stay as calm and relaxed as possible, even if you're having a
tough time. If you become stressed, baby will pick up your
stress signals and become stressed, too. That will make
breastfeeding more challenging for both of you.
• Read your baby's feeding cues so that you can offer the breast
at a time when baby is most likely to be responsive.
• Help your baby to achieve a good latch. Aim for what
Mohrbacher and Kendall-Tackett describe as "the comfort
zone"—a deep latch that is comfortable for mom and that
provides a steady milk flow for baby.

43. Watch for these
common positioning problems
• Baby's body is twisted.
• Baby's feet are pushing against the arm of a chair or other
surface, so baby is able to push herself off the breast.
• Baby's chin is pressed down against her chest, which makes
swallowing difficult and which tends to press her nose into the
breast, which makes breathing more difficult for baby.

44. IV. Breastfeeding promotion: What works
and what doesn't work—summarizing the
results from some key studies
Sciacca, JP, DA Dube, BL Phipps, MI Ratliff. "A breastfeeding
education and promotion program: effects on knowledge,
attitudes, and support for breastfeeding." J Community
Health. 1995: Dec;20(6):473-90.
Prizes can work really well in promoting breastfeeding.
Special incentives (prizes) were offered to women and their
partners for participating in several breastfeeding education and
promotion activities. Special incentives (prizes) for women and
their partners to participate in several breastfeeding education
and promotion activities. Researchers concluded that offering
prizes can produce positive changes in breastfeeding
knowledge, attitudes, and support, and can have a dramatic
effect in promoting breastfeeding.

45. Guise, Jeanne-Marie, MD, MPH; Valerie Palda, MD, MPH;
Carolyn Westhoff, MD, MSc; Benjamin K. S. Chan, MS; Mark
Helfand, MD, MS; and Tracy A. Lieu, MD, MPH. "The
Effectiveness of Primary Care-Based Interventions to
Promote Breastfeeding: Systematic Evidence Review and
Meta-Analysis for the US Preventive Services Task Force."
Annals of Family Medicine 1:70-78 (2003).
Telephone support is more effective than written materials
like pamphlets: Support programs conducted by telephone, in
person, or both increased short-term and long-term duration. In
contrast, written materials such as pamphlets did not
significantly increase breastfeeding.

46. "The effect of peer support on breast-feeding duration among
primiparous women: a randomized controlled trial.” Dennis,
Cindy-Lee, Ellen Hodnett, Ruth Gallop and Beverley
Chalmers.CMAJ, January 8, 2002; 166 (1).
Mother-to-mother telephone support is extremely effective
and mothers love it: The telephone-based peer support
intervention was effective in maintaining breast-feeding to 3
months post partum and improving satisfaction with the infant
feeding experience. Of 130 mothers, 81.6% were satisfied with
their peer volunteer experience and 100% felt that all new
breast-feeding mothers should be offered this peer support
intervention.

47. "The Impact of a New Universal Postpartum Program on
Breastfeeding Outcomes." Debbie Sheehan, RN, MSW;
Susan Watt, DSW, RSW; Paul Krueger, PhD; Wendy Sword,
RN, PhD. Journal of Human Lactation, Vol. 22, No. 4, 398-
408 (2006).
Postpartum visits and phone calls from a public health worker
don't affect a mother's decision to breastfeed longer:
Extended length of stay, a postpartum phone call from a public
health worker, or a postpartum in-home visit did not affect a
mother's decision to continue breastfeeding until 4 weeks.
Maternal attitudes toward breastfeeding, formula feeding or
supplementation in hospital, infant readmission, and use of
walk-in clinics for infant care were associated with breastfeeding
discontinuation before four weeks post-discharge.

48. Canada Prenatal Nutrition Program
Guiding Principles
• Mothers and Babies First The health and well-being of the mother
and baby are most important in planning, developing and carrying out
every project.
• Strengthening and Supporting Families Families have the main
responsibility for the care and development of their children. However
all parts of Canadian Society, governments, agencies, employers,
organized labour, educators and voluntary community organizations
share the responsibility for children by supporting parents and families.
• Equity and Accessibility Projects must meet the social, cultural and
language needs of pregnant women in the community and must be
available in all parts of the country, particularly isolated areas or those
with poor access to services, to women with disabilities, to Aboriginal
women, and to recent immigrants and refugees.
• Partnerships Partnerships and cooperative activities at the
community level are the key to developing effective programs. Projects
must work in partnership with other services in the community.

49. • Community based Decision making and action must be community
based. Pregnant women, new mothers, families and community groups
must have an active role in planning, designing, operating and
evaluating projects. New projects and changes to existing projects must
be based on what participants need and want, and be appropriate to
the culture and language of the women.
• Flexibility Projects must be flexible to respond to the different needs
in each community and to the changing needs and conditions of women
in these communities.
Source: Canada Prenatal Nutrition Program: A Practical Workbook to
Protect,Promote and Support Breastfeeding in Community Based
Projects. Minister of Public Works and Government Services Canada,
2002.
www.phac-aspc.gc.ca/dca-dea/publications/pdf/bf_workbook_e.pdf

50. V. Communicating Effectively with Mothers
About Breastfeeding
When you're talking
to mothers about
breastfeeding,
don't forget
your CAMERA.

51. • Clear: Aim for messages that are clear and concise. Remember
that you're dealing with a sleep-deprived mom who may be
distracted by her baby and possibly other children, so it doesn't
hurt to make your key point(s) a couple of different ways.
• Accurate: Stay on top of new developments in your field so that
you can provide relevant, accurate, and up-to-date information.
This will allow you to dispel breastfeeding myths in a credible
manner.
• Memorable: Provide new moms with pamphlets, tip sheets,
wallet cards, checklists, and other helpful breastfeeding
resources that will make it easier for them to remember the
information that you conveyed during your visit. Also strive to
make the visit memorable in other ways—by establishing a
warm and caring connection and, in some cases, giving moms
concrete reasons for wanting to remember your messages
(incentives such as donated prizes and giveaways: see Journal
of Community Health, 1995 Dec; 20(6):473-90).

52. • Empathetic: Be empathetic and non-judgmental. Breastfeeding
is a very emotional issue for mothers. Moms who are
experiencing breastfeeding difficulties often struggle with
feelings of guilt and self-doubt. A negative breastfeeding
experience can stay with a mother for a very long time.
• Reassuring: Mothers need to hear what a great job they are
doing. They also need to be reassured that it's normal to feel
like they've been transported to another planet (Planet Mom!)
and that they still haven't regained their bearings quite yet.
Being truly heard by someone who cares and who reassures
her that her feelings are normal can make a huge difference in
the life of a new mom.

53. • Accessible: Ensure that the service that you are providing is as
accessible as possible: financially accessible, physically
accessible, accessible in terms of language and literacy level,
accessible in other practical terms (hours of operation, childcare
needs, location, etc.) Here's something to ask yourself: Can
mothers obtain your services (or do they have access to a
similar service) at those times when their need for breastfeeding
answers and support is particularly pressing? Do they know
where they can call for information and support at 3 am?

54. VI. Recommended Resources
• Canada Prenatal
Nutrition Programme
(CAPC/ CPNP)
resources on Public
Health Agency of
Canada website.
• List of books, videos,
and online resources in
workshop materials.
For further inspiration, consider what others in the field
of breastfeeding promotion are doing elsewhere -- in
other communities; in other parts of the world.

55. New Zealand
Aboriginal breastfeeding campaign poster from New Zealand.
www.womens-health.org.nz/breastfeed/downloads/Breastfeed.Rarawa.pdf

58. Mothers’ Milk Marketing Board, UK

59. Posters from Sri Lanka and France;
Statue from Brazil

60. Health Canada and
INFACT Canada

61. www.geocities.com/HotSprings/Spa/3156/stamps.htm
Ted Greiner’s
Breastfeeding
Website