Breastfeeding: it's all in the latch

Experts answer 8 common questions about breastfeeding - read and take heart.

Q How do I know if my baby's getting enough milk when I'm breastfeeding?

Watch and listen to your baby's sucking and swallowing patterns. A baby who is getting adequate amounts of breastmilk takes long, drawing sucks (as opposed to short and choppy ones), and you can hear her swallowing. Another way to gauge whether your baby's milk intake is sufficient is to monitor her nappies: she should have at least six to eight wet nappies and two or more bowel movements a day.

Q How often should I nurse my baby?

While every baby is different, in general, a newborn up to about three months of age should nurse between eight and 12 times a day. But rather than keeping a tally or trying to get your baby on a feeding schedule, the most important thing you can do is pay attention to her signals and feed her whenever she seems hungry. Her hunger cues might include "rooting" at the breast, opening her mouth, turning her head, making fussing noises and, of course, crying.

Q Is it normal to feel pain during breastfeeding?

"Some women do feel tenderness or discomfort when the baby latches on," says Corky Harvey, registered nurse and lactation consultant. "But it shouldn't last for more than 20 seconds." Shooting pain, Harvey adds, is a sign that something isn't right. If you experience such pain, it probably means that your baby isn't latched on properly and is sucking only on the nipple, rather than the nipple plus at least 2cm of the areola. (See next question for tips on getting a good latch.)

Q I know how important it is to get the right latch. How do I do it?

As long as your baby has taken your entire nipple and a large portion of the areola into her mouth and her lower lip is flared out, she's latched on properly. Follow these steps to get there:

* Get comfortable Use a rolled-up blanket or towel to prop your baby up so you don't have to lean over her. Or try a specially designed breastfeeding pillow.
* Get in the right position Place your baby so she is lying on her side, her tummy tight against yours.
* Support her head and neck Place one hand behind your baby's neck; your thumb should be near her ear, your middle finger on her jaw. Lift her head so that her nose is about level with your nipple. Use the opposite hand of the side you're nursing on; if you're nursing with your left breast, use your right hand to support her head.
* Get her to open wide Use your other hand to grasp the nursing breast. Brush her lips with your nipple until she opens her mouth wide, then quickly place her mouth on your breast. Don't stretch your breast out to reach her.
* Do a quick check When she begins to suck, make sure you can see her tongue between her lower lip and your breast. If you can't, she may be sucking her tongue and your nipple. If necessary, use your finger to break the suction, remove her from your breast and try again.

Q I've heard breastfed babies need to wake more often to eat. Is this true?

While every baby is different, some breastfed babies sleep through the night by three months of age; others don't until about nine months. Until then, you might consider sleeping with the baby next to your bed and nursing from the side-lying position; doing so will help you get more rest. If you do this, take precautions to protect your baby from suffocation: remove pillows and padding, make sure your duvet doesn't cover the baby and there are no gaps between the wall and bed where she could become lodged and so on. Remember: do not sleep with your baby if you or your partner are overly tired, are intoxicated, obese, or have taken any drug or medication that impairs your judgment or makes you sleep more deeply than usual.

Q My baby seems fussy. Do I need to change my diet while I'm nursing?

Eating certain foods may seem to upset your baby's digestion, but there is no evidence that you should make drastic changes to your diet while breastfeeding. In fact, most experts simply recommend following the same basic guidelines and precautions as when you were pregnant. In other words, make sure you're eating a healthy, well-rounded diet and drinking plenty of fluids – at least eight glasses a day. Also talk to your doctor about continuing to take your prenatal vitamin.
It is advisable that nursing mothers avoid eating shark, tilefish, swordfish or king mackerel (not commonly eaten in South Africa, let's face it) because these fish may contain dangerous levels of mercury. You can safely eat other fish, such as tinned light tuna, salmon and shellfish.

Q If I give my baby an occasional bottle of formula, will she not want to nurse?

As long as you wait until your baby is approximately four weeks old and breastfeeding well, giving her an occasional bottle of formula probably won't necessarily cause "nipple confusion" or affect her willingness to breastfeed or take breastmilk from a bottle. However, feeding your baby bottles of pumped breastmilk instead of formula will increase her ability to fight off certain diseases. "The baby's gut is an open structure, like a honeycomb, until approximately five months of age," Harvey explains. "Breastmilk creates good bacteria that help close up the open walls of the intestines, in turn preventing the large molecules of some harmful bacteria and viruses from passing through."

Q Will it harm my baby if I have a glass of wine or a beer once in a while?
"Most experts say that an occasional glass of beer or wine is acceptable," Harvey says. "But the earlier in your baby's life you drink alcohol, the greater the potential risk." One study suggests that the breastfed babies of mothers who have one or two alcoholic beverages per day score lower on motor-skills tests at one year of age than the babies of moms who don't drink.

"We don't want to make life so miserable for breastfeeding moms that they don't want to nurse," Harvey adds. "If you want to have a drink on occasion, then have one; but try to limit your intake to one drink every other day." Other experts advise that breastfeeding women who choose to drink do so slowly and on a full stomach, and that they forgo nursing for several hours after having an alcoholic beverage. Others recommend that nursing women "pump and dump" their breastmilk two hours after drinking alcohol.

Tips for beginners:

* Cut yourself some slack. It's normal to feel awkward and sore when learning to breastfeed. Have faith that your breasts and your baby will adapt in a couple of weeks.
* Relax! Infants can sense tension. Sip some water and relax your neck and shoulders.
* How do I know if she's getting enough milk? Your baby will let you know when she's full by letting go or nodding off. Plenty of wet nappies will reassure you she's feeding well.
* Ignore the clock: rather than keeping a tally or trying to get your baby on a strict feeding schedule, the most important thing you can do is pay attention to her signals and feed her whenever she seems hungry