During World Breastfeeding Week, MUSC Women’s Health experts answer questions they hear a lot

Breastfeeding can feel like the most beautiful bonding moment and, at the same time, a really confusing experience. During World Breastfeeding Week, the Lactation Services team at MUSC Women’s Health is answering some of the questions it hears most frequently. Every participant in this Q&A is both a nurse and an international board-certified lactation consultant.

How do you know if a baby is getting enough to eat?

Ellen Linder said there are several ways.

“First and foremost, your baby should be latched well to the breast. Your baby should eat eight to 12 times every 24 hours, with the exception of the first 24 hours, where a baby may only eat six times. 

Counting wet and dirty diapers is another way to monitor your baby's intake. Once mom's milk is in, by day four or five, a baby should have six to eight wet diapers a day and three to four dirty diapers. The dirty diapers will change in color from black to green to brown and yellow once mom’s milk is in. 

The final way to know that your baby is getting enough to eat is to monitor their weight. It is expected that all babies will lose weight for the first couple of days. Your pediatrician will follow up and monitor your baby's weight.”

Should breastfeeding be painful?

Lactation services program manager Molly Gros said that beyond minor discomfort, the answer is no.

“Nipple pain with breastfeeding, although a lot of women think is normal, really isn't beyond the first minute of your baby latching to your breast. Most often the cause is incorrect attachment to the breast. Because of the way we position our babies, it's usually a pretty easy fix. 

However, it can also be caused by an oral tethering, such as a tongue tie or a baby not opening its mouth enough, if you get cracks, blisters, bleeding, bruising. All of this is very abnormal, and you should not have to suffer through it. 

Please seek the help from a qualified breastfeeding specialist such as an international board-certified lactation consultant. Now, some mild nipple tenderness when you're learning how to breastfeed and your body's getting used to all of this action because we're not used to that. It can be normal to be tender and between feeds, but painful attaching to the breast is abnormal.”

When should you start including other people in feeding the baby?

Gros said mothers should wait until breastfeeding is well-established.

“To introduce your baby to another way to feed, this is typically between four and six weeks after birth. So when you're ready, pick one feed a day, pump your breasts and allow somebody else to feed your baby that bottle so they continue to associate you with direct breastfeeding.”

When can parents start sleep training the baby?

Sarah Brunson fields a lot of questions about when babies can sleep through the night.

“It makes sense. Parenting is exhausting. Lactation consultants want parents to be well-rested also; however, we know biologically speaking, mothers need to empty their breasts frequently. If mothers are spending eight to 12 hours at night sleeping and not feeding their baby, it may compromise their milk supply. 

Infants, too, often cannot go eight to 12 hours without eating. It may compromise their growth. Babies are little, and they need small, frequent meals. How about some tips to help? Well, dad can get baby and bring baby to mom in the middle of the night. Naps are wonderful before going back to work. And a small dream feed right before mom goes to bed can help,” referring to feeding the baby while they're semi-awake.

Can I use a pacifier if I’m breastfeeding?

Dorothy Winters said it’s not bad to use a pacifier.

“We just need to know when it's okay to introduce it, and that we're not going to do anything that's going to harm your milk supply. Most people have an established breastfeeding with their child around two to three weeks, and then you can use a pacifier when you need to. 

The other thing is making sure you're not offering the pacifier when the baby needs to be going to the breast, which could in turn make your milk supply a little bit lower. Also, some babies might not latch as easily if you introduce that pacifier too soon, but before they have really learned how to breastfeed well.”

For a video version of this Q&A, check out MUSC Women's Health Instagram posts for World Breastfeeding Week and visit the Breastfeeding Services team’s web page for more resources. The MUSC Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion is a Baby Friendly Designated hospital, a certification that means it offers the best care for baby feeding.