Tips For Breastfeeding Success

By: Marla Nichols, MSN, BSN, RN, CNE, IBCLC • Holly L. Thacker, MD • Kristi Tough DeSapri, MD • Posted on August 05, 2024

Breast is best! But breastfeeding is not for all moms or for all babies. The goal of this column is to help support and promote breastfeeding, but we understand that breastfeeding does not work for everyone.

August is National Breastfeeding Month

National Breastfeeding Month (NBM) is celebrated in August each year, and this year’s theme is ‘Nourish, Sustain, Thrive.’ The theme shines a light on why protecting, promoting, and supporting lactation is so important for the human life cycle.

I want to salute our Assistant Nurse Manager Marla Nichols who is a lactation consultant and co-author of this column. She has provided some excellent resources within this column that I think you will find really helpful. Nurse Marla Nichols has a teenage son and a newborn baby girl, and has experience with breastfeeding while working and teaching her older son how to drive. I was a breastfeeding mom of 3, including tandem nursing during pregnancy- while working full time!

Culture, family, work and health status can affect the ability and decision on how to give nutrition to your baby. Some babies with rare inborn errors of metabolism can not be breast fed. Some moms who have bipolar illness require certain medications or treatments. These examples and more are why some mom’s choose to use formula instead of breastmilk. Fathers and other family members can be big helpers with nighttime feedings especially if the baby is bottle fed - whether it is formula or breastmilk.

Tips for Storing Breastmilk

It’s a big commitment to pump your breast milk, especially if you are working out of the home. Have a plan on how to refrigerate and freeze your pumped breastmilk AKA “liquid gold” in case of electrical power outage, as many working moms who do not supplement and exclusively breastfed have had to deal with loss of pre-pumped milk which can be heartbreaking.

Freshly expressed pumped milk can stay at room temperature for 4 hours
Freshly expressed pumped milk can be refrigerated for 4 days
Freshly expressed pumped milk can be frozen for 6-12 months
Thawed milk from a freezer can be stored in a refrigerator for 24 hours
Thawed milk from a freezer can be left out for 1-2 hours
NEVER refreeze previously frozen breastmilk
If milk leftover from a feeding need to use within 2 hours after baby finished

Blood levels of lead, mercury and PCBs are a concern if you are breastfeeding. Please read the column, Your Unborn Baby and Breastfeeding – What You Need to Know About Environmental Pollutants written by SWH fellow graduate Dr. Foluke Alli. She is a mom of three, including a newborn while she was doing her Specialized Women’s Health fellowship training. A study done by Brown University, published in the Journal of Environmental Research measured blood levels of lead, mercury and Polychlorinated Biphenyl (PCBs) in women of childbearing age. This study showed that almost 1 in 4 American women of childbearing age met or exceeded the average blood levels for all three of these environmental chemical pollutants.

Another esteemed SWH graduate Dr. Kristi Tough DeSapri wrote a great column, New Mom’s Food Fight: Breast Milk vs Formula. Dr. DeSapri shared tips on choosing to breastfeed or use formula in the column, and we would like to highlight some of her most helpful tips in this column.

Breast Milk or Formula?

Along the same lines, the decision to breastfeed or formula feed your baby fuels many debates. The American Academy of Pediatrics (AAP) recommends breastfeeding exclusively for six months and continuing until 12 months with the addition of solid foods after six months of age. This affords the newborn natural immunity from respiratory infections and ear infections.

Research shows breast milk and its antibodies reduce the following later in life:

Allergies
Asthma
Diabetes

Breastfeeding allows for a quiet, rewarding bonding time. More breastfeeding benefits include:

Increased metabolic demand
Modest weight loss
Slightly higher IQ level

Some studies show breastfeeding reduces:

Cardiovascular risk
Breast cancer
Postpartum depression

Mothers should be sure to consume at least 1000 mg of calcium and adequate vitamin D in food or supplement form daily while nursing to prevent future osteoporosis or bone loss.

Tips to Overcome the Struggles of Breastfeeding

The truth is breastfeeding comes naturally for some while others struggle with latching or supply. If you are struggling with early nursing issues, don’t wait. Reach out to a trained lactation consultant or elicit advice from seasoned mamas. Often lactation groups in your neighborhood or local hospitals offer classes.

As nursing progresses and your baby finds the outside world more exciting than your breast or teeth appear (ouch!) allow more time and patience with nursing. I found the book The Nursing Mother’s companion, 6th edition by Kathleen Huggins, RN a great reference.

Supplements

Supplements such as fenugreek have anecdotally increased mother’s milk supply. However, there are no scientific studies to validate this claim and herbal supplements are not well regulated by the Federal Drug Administration (FDA.)

Pumping

I found adding in a pumping session at night before bed, staying hydrated and keeping stress at minimum allowed me to keep my milk supply adequate.

When you need to choose formula

If you cannot nurse or have no alternative, formula becomes your baby’s primary source of nutrition. “Breast is best” however, formula can be an excellent option or even a necessity for some moms. This was the case for a mother I met who carried the BRCA mutation for hereditary breast cancer and underwent a bilateral mastectomy at age 28 for stage 1 breast cancer.

If your baby isn’t meeting weight goals or has a lactose allergy, some pediatricians recommend supplementing with formula. Sometimes some medical conditions or medicines are contraindicated for breastfeeding. Some moms have to get uninterrupted sleep and need someone else to feed the baby with formula at night. Don’t criticize yourself for not fulfilling your ideal of 12 months of breastfeeding. Instead, focus on growing and bonding with your healthy baby.

Feeding Tips for Newborns

Feeding your newborn is a great opportunity to bond with your baby, and you should try to enjoy every mealtime. For the first few months, you should be feeding your baby infant formula or breast milk only.

Make sure that feeding is enjoyable for you and the baby. Pick a comfortable place to sit with the baby while you breastfeed or use a bottle. Be sure that you are holding your bottle-fed baby propped in your arms.
Breastfeeding moms might want to have a cup of water handy and a pillow on their laps to make positioning easy.
Remember that breastfeeding is comfort as well as food, so feeding often is normal for settling a baby that has already fed.

Below are some tips to make breastfeeding your baby as comfortable and enjoyable as possible.

Positioning while feeding your baby

If you are bottle-feeding, hold your baby and talk to him or her. Do not lay your baby down and prop the bottle in position. Infants need to be held and cuddled during feeding and should never be left propped with a bottle.
Breastfed babies can be held in your lap or in the "football" hold, with the baby’s legs at your side, perhaps on a pillow. Many breastfeeding mothers like feeding in bed with the infant rolled towards them.

Burping

Your baby will probably swallow some air while feeding. This could cause him or her to spit up or become fussy, so it is important to burp your child after every feeding.
To burp your baby, sit him or her up on your lap or hold him or her against your chest or shoulder, and pat gently on the back.

How do I know my baby is eating enough?

If your baby is wetting lots of diapers with diluted urine, then your infant is likely getting enough to eat.
If your baby is not gaining the proper weight, you might need to increase the amount of formula or breastfeed more often. The more you nurse, the more milk you will make. Breastfed infants often nurse every 2 to 2 ½ hours in the first weeks.

When can I give my baby solid food?

Solid foods are usually introduced into a baby’s diet between four and five months, depending on what your child's doctor recommends.
If you start your baby on solid foods too early, he or she has a greater chance of developing a food allergy and might not grow as well.

Follow the steps below when you introduce solid foods to your baby:

Give your baby one solid food at a time to help determine if he or she is allergic to any of the foods.
Start your baby on iron-fortified infant cereal, and then slowly add fruits, vegetables and meats.
Feed your baby small amounts of food at first.
Prepare mashed foods such as sweet potatoes, applesauce, carrots, bananas and peaches. It is always best to give your baby a variety of foods so he or she gets the proper nutrients.

What foods should I avoid giving my baby?

Until your baby is one year old, it is best to avoid certain foods like:

honey
nuts
plain cow’s milk
foods with seeds

During the month of August, we honor the incredible work that organizations are doing to make the world a little more friendly for new parents and families, and highlight how individuals, funders, and policymakers can contribute to a strong and sustainable lactation field.

Here at Cleveland Clinic, we have a vast variety of breastfeeding resources to meet our diverse family populations and their needs. Our current Main Campus Obstetric and Gynecologic Institute (OGI) Assistant Nurse Manager, Marla Nichols, is a practicing Internationally Board-Certified Lactation Consultant (IBCLC) that continues to support the CCF Lactation Department through her work with a Melanin Rich Breastfeeding Support Group.

To learn more about the CCF offerings that provide breastfeeding support to our community, please visit my.clevelandclinic.org.

Be Strong, Be Healthy, Be in Charge!

-Holly L. Thacker, MD, Marla Nichols, MSN and Kristi Tough DeSapri, MD

About Holly L. Thacker, MD, FACP

Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Her special interests are menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health. Dr. Thacker is the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause.

About Marla Nichols, MSN, BSN, RN, CNE, IBCLC

Marla is a Masters prepared Registered Nurse with over 22 years experience in Women’s Health Nursing. Marla has worked at Cleveland Clinic for four years, initially in the department of Outpatient Lactation Support and Breastfeeding Education. Her current role is Assistant Nurse Manager of the Obstetric and Gynecologic Institute at Main Campus, with a recent promotion to Akron General L&D Manager, which she will transition into as of September 1, 2024.

Marla is also the facilitator for CCF's Melanin Rich Breastfeeding Support Group, designed to increase breast feeding support for Black families in our community. In 2021 Marla was part of the research team that composed the AWHONN (Assoc. of Women's Health, Obstetric and Neonatal Nurses) Respectful Maternity Care Evidence -Based Clinical Practice Guidelines - aimed at improving the birth experience for people in maternity care settings. Marla is passionate about advocating for equitable and respectful care for families in all healthcare settings.

About Kristi Tough DeSapri, MD

Dr. Kristi Tough DeSapri is a board certified internist specializing in midlife women’s health. After fellowship training at the Cleveland Clinic, she has worked in private practice and academic medicine for over 13 years, including being director of the Northwestern Women’s Bone Health program at the Center for Sexual Medicine and Menopause at Northwestern Medicine in Chicago.

She started Bone and Body Women’s Health, LCC, a concierge midlife women’s health practice in Winnetka, IL, focused on consultation and management of perimenopause, menopause, osteoporosis, and sexual health. She is a national leader in the field of osteoporosis and menopause management. Follow Dr. DeSapri on Instagram @boneandbodywh.

breastfeeding, nursing, milk supply, pregnancy, newborn, breastfeeding tips, women's health, lactation, pumping milk, formula

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