Breastfeeding and your new baby

Most women, when given accurate information and education with adequate support and encouragement, can achieve successful lactation and breastfeeding.
The midwives caring for you will provide you with education, support,
encouragement and assistance to help you establish and maintain your lactation
and breastfeeding. Please do not hesitate to ask your midwife for advice, at any
time.
Small, preterm or sick babies may have additional special needs for their feeding.
 

Benefits of breast milk and breastfeeding

Breast milk is the nutritionally ideal food for babies and has a wide variety of
benefits for both mother and baby.

Breast milk

  • is a living fluid that changes to ensure your baby receives what they need at any given time
  • is easily digested and contains essential vitamins, minerals, fats, carbohydrates and proteins
  • contains hormones, growth factors, enzymes and antibodies and other living cells, which work to protect your baby from disease
  • is associated with enhanced brain and improved cognitive development
  • aids in the development of your baby’s immune system, and has been found to provide some protection against developing diabetes, Crohn’s disease, asthma, allergies, coeliac disease, ear, urinary tract and chest infections, diarrhoeal diseases, some childhood cancers, rheumatoid arthritis and obesity
  • enhances vaccine effectiveness.

Breastfeeding

  • provides optimal visual development
  • provides babies with optimal dental and jaw development
  • significantly decreases the risk of the mother developing breast and ovarian
    cancer and osteoporosis
  • helps a mother lose weight and helps her uterus shrink back to its prepregnant
    size more quickly after the birth of their baby
  • enhances bonding, as breastfeeding stimulates the release of the ‘love
    hormone’ oxytocin in both the mother and baby,
The World Health Organization recommends breastfeeding exclusively for the first
six months then continuing to breastfeed after the introduction of solids until the
second year of your baby’s life, or as long as mother and baby wish. For the first 12
months breast milk remains the primary source of nutrition for babies.

How breastfeeding works

Breastfeeding works on supply and demand. Every time your baby feeds, your body starts to make the next feed. The more your baby feeds, the more milk you make. You do not have to wait a specific amount of time for your breasts to fill up before feeding your baby again.

Rooming-in

At Mater Mothers’ Hospitals you will room-in with your baby during your hospital stay. A mother who is rooming in is able to attend to her baby when feeding cues are displayed, helping her establish a good milk flow by promoting milk let-down.

This means you are less likely to have hard sore breasts and breastfeeding will get off to a good start. Rooming-in helps mothers bond with their babies and gain confidence in their care. Research shows that mothers and babies who room-in together actually get more sleep.

Feeding cues—how to know when your baby is ready to feed

Look for, and respond to, early feeding cues that your baby displays to indicate
they are ready to feed. These feeding cues include:

  • rapid eye movement
  • clicking or tongue sucking
  • rooting—opening their mouth and searching to suck on contact
  • hand movements to their mouth and sucking on hands
  • moving other extremities
  • general increased alertness or activity.

Crying is a late sign of hunger. Avoid waiting for this sign as a crying baby can be more difficult to attach.

The first breastfeed

The first step towards successful breastfeeding is early skin-to-skin contact—if possible, allow uninterrupted skin-to-skin contact with your baby following their birth (skin-to-skin contact is beneficial at any time). This encourages licking, nuzzling, touching, sniffing and eventual feeding when your baby is ready, which is normally within the first after hour birth. Bathing and weighing should wait until after the first breastfeed.

Correct attachment and positioning of your baby to your breast is also important. Please ask your midwife to provide guidance when attaching your baby, until you feel confident managing this independently.
 

Positions for feeding

Before you start breastfeeding make yourself comfortable. Have a glass of water close by—many mothers find they become thirsty during a feed. If possible, sit upright in a chair to feed your baby. Using a rolled up towel behind your back and resting one foot on a low footstool provides back support while breastfeeding.

This is usually more supportive than sitting up in bed. If you cannot sit upright, or Mater Mothers’ Hospitals wish to rest while feeding, it is best to lie on your side. Placing a pillow under your head and a pillow between your knees can also help you to be comfortable while feeding in this position. If you have had a caesarean birth you could try feeding lying on your side or sitting upright with your baby tucked under your arm.

Holding your baby

You may choose to hold your baby in one of three ways while breastfeeding:

  1. Support your baby with your opposite arm to the breast you are feeding from. Use your forearm to hold your baby close to you. Position the heel of the palm of your hand in between the baby’s shoulder blades and your outstretched hand behind the baby’s shoulders (no higher than the base of the baby’s skull). This allows the baby’s head to tilt back slightly. Remember to support your baby’s bottom so your baby does not drag on your breast. In the early days of breastfeeding many mothers prefer this hold as they can guide the baby towards the breast more easily.
  2. Cradle your baby inside your arm on the same side you are feeding from.
  3. Hold your baby under your arm in a ‘football’ or ‘rugby’ hold. This hold may be suitable after a caesarean birth. A pillow may be useful to position your baby correctly. Whichever way you choose to hold your baby, the following useful tips will help.

Attaching your baby to your breast

  • Take your time—rushing only causes stress for you and your baby.
  • Ensure your breast is free of clothing and your baby is unwrapped and preferably has skin to skin contact with you.
  • Hold your baby close to you with their chest facing yours and their lower arm wrapped around your body.
  • If necessary, you can support and shape the breast in a U hold, (i.e. with your fingers opposite your baby’s lips), with most of your hand underneath the breast and fingers well back from the areola (the darkened area around the nipple).
  • Your baby’s nose should be level with your nipple.
  • Bring your baby to your breast when their mouth gapes wide. Take your baby to the breast not your breast to the baby. They need to take a larger amount of the areola into the mouth on the side nearest to their chin and lower jaw. Direct the nipple to the baby’s nose when latching and then ‘plant’ the lower rim of the baby’s mouth well below the nipple and fold the breast into the baby’s mouth.
  • If your baby is attached to the breast properly only their chin and cheek
    should touch your breast and you should not feel any pain. There should be
    no stinging, burning or pinching of the nipple during the feed. At the start of
    the feed you may feel uncomfortable for 10–15 seconds. If the pain persists,
    take your baby off the breast by inserting your little finger into the corner of
    Mater Mothers’ Hospitals your baby’s mouth to release the suction or gently pull down on their jaw, and reattach.
  • Your baby’s chin and cheek should be against the breast with their nose
    free—it should not be necessary to hold your breast away from your baby’s
    nose.
    • Allow sucking to continue until your baby detaches from the breast or falls
    asleep.
  • Please ask for help if you have any problems.
Signs of correct attachment
  • Your baby has a wide open mouth like a yawn when latching.
  • Once attached only your baby’s chin and cheek touch your breast, and their nose should be away from the breast.
  • You may experience a painless drawing sensation while your baby is sucking and you will see full movement of your baby’s lower jaw.
  • After the feed your nipple should appear as it did before your baby attached; just softer around the areola.
  • Your nipple should not be white, squashed, ridged or damaged when it comes out of your baby’s mouth.
What to avoid when attaching your baby to the breast
  • Pushing your breast across your body or chasing your baby with your breast—always bring your baby to the breast.
  • Holding the breast with a scissor grip—the ‘U’ hold is preferred.
  • Twisting your body towards your baby—you should turn slightly away.
  • Aiming your nipple to the centre of your baby’s mouth—your nipple should be level with your baby’s nose.
  • Pulling your baby’s chin down to open their mouth—this will not encourage your baby to have a wide gape.
  • Flexing your baby’s head when bringing them to your breast—this will not allow your baby to lead with their chin and will result in incorrect attachment.
  • Moving your baby to the breast without a proper gape—your baby will attach to the nipple only, resulting in nipple damage.
  • Not moving your baby quickly enough onto the breast during their widest gape—your baby will not maintain that wide gape and will attach incorrectly resulting in nipple damage.
  • Holding your breast away from your baby’s nose—this should not be necessary if your baby is well attached as their nose will be away from the breast. Constant pressure of this type could lead to a blocked duct which may then develop into mastitis.
Sore or damaged nipples

A certain amount of nipple sensitivity in the early days of breastfeeding is normal. However, damaged or grazed nipples are not normal and usually mean your baby has not attached properly. If you have grazed or cracked nipples, ask your midwife to guide you when you are attaching your baby to the breast.

The nipple area produces its own natural oils, and nipple creams can block openings from the ducts on your nipples, increasing the possibility of mastitis. As breast milk contains special skin healing properties, expressed breast milk is the ideal treatment for sore nipples. Gently rub expressed breast milk onto the nipple after feeds and allow the milk to dry before replacing your bra. To prevent infection always wash your hands before you handle your breasts. Once you are home, if nipple damage or soreness becomes worse please seek help, as soon as possible, from any of the organisations listed under Breastfeeding support after discharge from hospital.

Feeding to need or baby led feeding

Breastfed babies feed according to hunger. Allow your baby to stay on the breast until they have had enough and fall asleep or come off your breast. You may notice that your baby may wish to suck more often in the early days until your milk comes in, which is usually on the second or third day following birth. This is normal infant behaviour and should be encouraged.

Allow your baby to feed as often as they wish, and remember that sucking time may vary from feed to feed. Allow your baby to feed on the first breast until their rhythmic or nutritive sucking stops. They may then flutter suck at the end of the feed. This is normal and helps your baby to have the fat-rich milk which comes towards the end of the feed. Babies settle for longer periods and gain more weight when allowed to flutter suck at the end of a feed.

Babies will generally feed between eight to 12 times each day. If they have a longer break between feeds they often have several feeds in close succession, which is referred to as cluster feeding.

Some babies may not display these feeding cues as distinctly and it is recommended that babies are fed at least six times in the first few days following birth. If you are having difficulty waking and feeding your baby please speak to your midwife.
 

Complementary feeds

Mater does not routinely give formula or boiled water to breastfed babies, unless medically indicated, for the following reasons:

  • Both soy and cows’ milk formula can cause allergies.
  • Your breasts make less milk if breastfeeds are missed or replaced by a formula feed.
  • Your breasts may become overfull and painful (engorged) if the milk in your
    breasts is not removed often.
  • A baby sucks differently on a breast and a bottle teat. A breastfed baby can become confused between the two and may have difficulty latching correctly onto the breast.

Nipple shields

Nipple shields are made of soft silicone and may be used to help mothers with flat or inverted nipples to continue breastfeeding. However, it is imperative that a nipple shield not be used until your milk comes in (usually around day three), and then only in appropriate situations.

Nipple shields have been found to decrease the amount of stimulation to the breast and may decrease your supply. There is also evidence that nipple shields can cause rubbing between the shield and the nipple, causing more nipple damage. They can also confuse your baby’s sucking action and make it hard for them to suck directly on the breast. It is recommended to try alternatives first.

If your breasts are very full and your baby is unable to attach, it may be necessary to express some milk to soften the breast. It may also help to stimulate the nipple with your thumb and forefinger to make the nipple erect prior to attaching your baby. Good positioning of your baby at the breast and the ‘U’ shape breast hold will also assist in correct attachment.

Your midwife or lactation consultant will be able to advise you on the use of a nipple shield, if required. Follow-up with a lactation consultant or child health nurse is recommended if you are discharged home using a nipple shield.

To clean your nipple shield:

  • rinse in cold water
  • wash in hot soapy water
  • rinse with clean water
  • air dry or pat dry with clean paper towel
  • store in a clean airtight container
Please note: the storage container should be washed daily as per above instructions.

Dummies/pacifiers

The early use of pacifiers can interfere with the natural process of breastfeeding. Pacifiers can contribute to slow weight gain, early weaning and thrush infections of your baby’s mouth and your nipples. The routine use of pacifiers for breastfed babies is not recommended.
 

How fathers can help

Supporting your partner’s decision to breastfeed and encouraging her throughout provides her with invaluable support. Fathers may be concerned that they will not bond as closely with their baby if their partner chooses to breastfeed. However, there are many ways in which you can support your partner and still form a close bond with your baby.

Spending time with your baby, doing other important things such as bathing, burping, changing nappies and cuddling help you to get to know your baby. For example, put your baby in a sling and go for a walk while your partner has a rest—your baby will enjoy the closeness with you and your partner will be grateful for some time to catch up on sleep.
 

Continuing breastfeeding following discharge from hospital

During the early stages of breastfeeding, your baby’s feeding pattern will vary significantly. Remember, the amount of breast milk you produce depends on the amount of sucking stimulation your breasts receive so continue to feed as often as your baby wishes.

It is normal for your baby to have some unsettled periods throughout the day. The most common time is in the late afternoon and early evening when your baby’s feeds may be close together, which is called cluster feeding. This is normal infant behaviour and should be encouraged.
 

Signs that your baby is getting enough breast milk
Breast milk contains all the nutrients and fluid that your baby needs in the first six months of life. No other fluids are needed. Be confident in knowing that your baby is receiving enough breast milk if they have five to six wet disposable nappies per day (or six to eight wet cloth nappies) and their urine is pale in colour. Breastfed babies are rarely constipated. You can expect there may be two to three loose bowel movements per day that are yellow or mustard in colour. After six weeks of age your baby’s bowel motions may decrease, but this is not a concern if weight gain and the number of wet nappies are adequate. Your baby should also be settled following most feeds. Your baby should look alert when awake and their mouth should be moist. In the early weeks at home, it is normal for your breasts to become soft as they adjust to your baby’s needs.

 

Growth spurts

As your baby grows they may have times where they will want to feed more often.Growth spurts or periods of increased breastfeeds commonly occur at around three and six weeks and three months of age. More frequent feeding is your baby’s way of building your milk supply to meet their growing needs. Continue to feed on demand and your baby’s feeding patterns should return to normal after two to three days.

 

Breastfeeding and nutrition

Breastfeeding helps you lose weight after your baby is born but now is not the time to diet. You may become hungrier when you are breastfeeding and it is best to satisfy your hunger with nutritious foods. Eat a generous amount of fruits and vegetables, wholegrain breads and cereals, calcium and protein rich foods—do not skip meals.

No one food has been proven to upset babies or cause wind. The best advice is to eat all foods in moderation, unless there is a family history of food allergies or intolerance. The natural variation in your diet will change the flavour of the breast milk for your baby, which may better prepare your baby for solids after six months of age. Breastfeeding mothers need enough fluids to stay hydrated. Drink to satisfy your thirst only. Increasing the amount of fluid you drink does little to increase your milk supply.
 

Alcohol

Alcohol in your bloodstream passes into your breast milk and reaches concentrations similar to that in your blood. The level of alcohol in your breast milk will decrease as you metabolise the alcohol in your blood stream. Your baby will metabolise and excrete alcohol more slowly than you will.1 Even relatively low levels of alcohol intake may reduce your milk supply and possibly cause irritability, poor feeding and sleep disturbances in your baby.


The current Australian guidelines recommend that, for women who are breastfeeding, not drinking alcohol is the safest option.

You should avoid alcohol in the first month after birth until breastfeeding is well established. After that:

  • your alcohol intake should be limited to no more than two standard drinks a day
  • you should avoid drinking alcohol immediately before breastfeeding
  • if you wish to drink alcohol you should consider expressing in advance. It is not necessary to express and discard breast milk, except for your comfort when you are not feeding for an extended time.
It takes approximately two hours for the average woman to completely eliminate one standard alcoholic drink, four hours for two drinks, six hours for three drinks, and so on.

Caffeine

The younger your baby is the longer it will take any caffeine to be metabolised by their body. Excessive caffeine intake may make your baby wakeful and fussy. Remember, caffeine can be found in tea, coffee, soft drinks, energy drinks, some medications, herbal preparations, as well as foods containing coffee or chocolate.

Working and breastfeeding

Breastfeed when you are not at work. Express after breastfeeds when you are at home if you require more expressed milk for when you are at work. While you are at work express milk for each feed you will miss. The number of feeds you need to express for will depend on the age and needs of your baby and how many hours you are at work. If extra milk is required express when your supply is greatest. This is usually first thing in the morning, so express after feeding your baby and prior to leaving for work. When you are on days off breastfeed your baby and express only if you require a stock of breast milk for work days.

Engorgement

Full, painful, hard or shiny breasts, commonly referred to as engorgement, will rarely occur if your baby is able to breastfeed at any time of the day or night. Correct positioning and attachment will also help to prevent engorgement.

If your breasts do become overfull and uncomfortable:

  • continue to feed your baby when they’re hungry
  • remove your bra when your baby is feeding
  • hand express a little milk before a feed, softening the areola to assist your baby to latch well
  • continue allowing your baby to soften one breast first before offering the second breast. Express the second breast to a comfort level if it is uncomfortable after the feed
  • wear a supporting bra between feeds e.g. a nursing bra or crop top. Make sure that your bra is not too tight
  • apply covered cold packs for 10–15 minutes after feeds for comfort (only while your breasts are engorged).

Mastitis

Mastitis is a hot, red, painful inflammation of the breast tissue, usually caused by
a blocked duct in the breast. It is a good idea to check your breasts regularly, and
note any lumps and flushed or tender areas as quick treatment of a blocked duct
can actually prevent mastitis.

Factors which can lead to mastitis include:

  • sudden, strict timing of breastfeeds
  • being overtired, skipping meals and not looking after yourself
  • sudden changes in feeding patterns
  • nipple damage including cracks or grazes
  • poor attachment resulting in the breast not draining well
  • untreated engorgement.
Symptoms of mastitis include soreness, redness and a hot area on the breast, together with flu-like symptoms such as fever, tiredness, aching joints, lower back pain and sometimes nausea and vomiting.


To treat blocked ducts and mastitis it is extremely important to empty the sore, tender breast as much as possible and feeding your baby is the best way to do this—now is not the time to wean. Apply moist heat, such as a warm face washer, to the affected area before you feed. When attaching your baby to the breast, point their chin towards the flushed area for better drainage. You may need to use the football or rugby hold if the flushed area is on the side of your armpit.

Start feeding on the affected side for two feeds and do not limit the sucking time on this breast. Gently massage the affected area with the pads of your fingers while feeding or expressing. You may need to express the other breast for comfort. If you cannot feed your baby, express your breast milk.

You also need to get plenty of rest and maintain a healthy diet.

You should seek medical advice if symptoms continue for 12 to 24 hours; you have a temperature above 37.5 degrees Celsius or feel unwell. Your doctor will start you on an antibiotic which treats mastitis and will not harm your baby. Ensure you take the entire course of the antibiotic tablets (you may need two courses of antibiotics) to prevent mastitis returning.
 

Expressing breast milk

When will I need to express milk for my baby?

There may be times when you need to express breast milk for your baby. This may be if you are going out, returning to work, if your baby is sick, preterm or unable to suck at the breast. If your baby is preterm or unwell and is not able to suck at the breast it is important to commence expressing as soon as possible after the birth to provide colostrum for your baby.

Midwives are able to assist you to hand express or use an electric breast pump to express your colostrum. Do not expect a large quantity of colostrum as it is very concentrated, and has a small volume initially. Regular expressing acts as breast stimulation to assist the breasts as they build milk volume over the next few days.

You should express each breast for 10 minutes, at least eight times per day, with no longer than a five hour break at any one time (usually overnight). Prolactin levels (the hormone responsible for milk production) are higher overnight so expressing at least once during the night is encouraged.

Electric breast pumps can be bought or hired.

How do I express?

You can either express by hand, or use a hand operated, battery operated or electric pump, available from Australian Breastfeeding Association group, some chemists, or baby equipment hire companies.

  • Always wash your hands well before handling your breasts.
  • A warm face washer on the breasts may help the milk to let-down. Gentle massage of the breast towards the nipple is also helpful.
  • If possible, it is best to feed your baby before expressing. This way you can express at the end of a feed taking advantage of the flow of milk your baby has started. Remember not to aim to express large amounts at once (unless your baby is not going to the breast at all). Express small amounts at one sitting several times over the day.
  • Your midwife can assist you to work out how much breast milk you will need to express for your baby.

How do I hand express?

  • Position your thumb and first two fingers about 2.5–4 cm behind the nipple. Place your thumb pad above the nipple and the finger pads below the nipple forming the letter "C" with the hand as shown below.
  • Push straight into chest wall.
  • Press thumb and fingers together gently (to meet) and then release. Repeat step two and three to establish a milk flow.
  • Repeat rhythmically to drain the breast. Position, push, roll, position, push, roll…
  • Rotate your thumb and finger position to milk the other ducts.
  • Any handling of your breast should be gentle and non-painful. If discomfort occurs, move your fingers further behind the areola which should increase comfort as well as milk flow. Ask your midwife to assist you if difficulties occur.

Avoid:

  • squeezing the breast—this may cause bruising
  • pulling out the nipple—this can cause tissue damage
  • sliding on the breast—this can cause skin burns.

Storing expressed breast milk safely

Never heat breast milk in a microwave as the milk heats unevenly and hot spots in the milk can burn your baby's mouth.Microwaving also destroys some of breast milk's important properties.  

Breast milk Room temperature Refrigerator Freezer
Freshly expressed into closed container Six to eight hours at less than 26 degrees Celsius Three to  five days at 4 degrees

Store in back of refrigerator where it is coldest

For the hospitalised baby—three days

Two weeks in freezer compartment inside a refrigerator

Three months in freezer section of refrigerator with separate door

Six to 12 months in deep freeze 18 degrees Celsius
Previously frozen and thawed in refrigerator but not warmed Four hours or less i.e. next feed  Store in refrigerator 24 hours—if milk has not been warmed  Do not refreeze
Thawed outside refrigerator in warm water For completion of feed Hold for four hours or until next feeding  Do not refreeze
Infant has begun feeding Only for completion of feed then discard  Discard  Do not refreeze

Cleaning expressing equipment

Expressing equipment may include bottles, caps, containers for hand expressingand attachments for hand, battery operated or electric breast pumps.

General cleaning

  • Wash your hands.
  • Rinse all equipment in cold water immediately after use.
  • Wash all equipment in hot water and detergent.
  • Rinse all equipment with clean hot water so that no soap remains.
  • Drain any water from the equipment and air dry on a clean paper towel.
  • Seal bottles and storage containers.
  • Store in a clean container in the fridge for 24 hours.
  • If not used in 24 hours repeat cleaning.

Note: It is important that equipment is dry before sealing bottles and storing in the container.

If someone who lives in your home is unwell general cleaning as well as boiling or steam disinfection is recommended.

Heat disinfection

Boiling

  • Put all equipment into a large saucepan and cover with water making sure that all air bubbles are removed from the equipment.
  • Place a lid on the saucepan and bring to the boil.
  • Boil for five minutes.
  • Allow the equipment to cool in the saucepan, with the lid on, until it is just hand-hot before removing it.
  • Drain any water from the equipment and air dry on a clean paper towel.
  • Seal bottles and storage containers.
  • Store in a clean container in the fridge for 24 hours.
  • If not used within 24 hours repeat cleaning.
Dishwasher

Bottles, storage containers and other equipment may also be placed in the dishwasher for heat disinfection, after general cleaning, if the dishwasher has a final high temperature rinse program. Then follow the steps for drying and storing as above.

Steam
Units using steam to disinfect are automatic and raise the temperature quickly to the range which kills germs. Follow manufacturer’s instructions carefully. Then follow steps for drying and storing as above.

Breastfeeding support after discharge from hospital

Support, advice, and assistance on breastfeeding following discharge from hospital are available from a variety of sources:
 

  • Mater Mothers’ Hospital Breastfeeding Support Centre, level 7, Mater Mothers’ Hospitals. Please telephone 07 3163 8200 to arrange an appointment.
  • The Australian Breastfeeding Association 1800 686 2 686 or www.breastfeeding.asn.au
  • Child health help line 13 43 25 84
  • Private lactation consultants—to find an International Board Certified Lactation Consultant near you visit www.ilca.org and look under ‘find a consultant’.
     

The ten steps to successful breastfeeding

Mater Health Services supports the World Health Organization’s Ten Steps to Successful Breastfeeding which state that every facility providing maternity services and care for newborn infants should:

  1. have a written breastfeeding policy that is routinely communicated to all health care staff
  2. train all health care staff in skills necessary to implement this policy
  3. inform all pregnant women about the benefits and management of breastfeeding
  4. place babies in skin-to-skin contact with their mothers, immediately following birth, for at least an hour and encourage mothers to recognise when their babies are ready to breastfeed; offering help if needed
  5. show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants
  6. give newborn infants no food or drink other than breast milk, unless medically indicated
  7. practise rooming-in—that is, allow mothers and infants to remain together—24 hours a day
  8. encourage breastfeeding on demand
  9. give no artificial teats or dummies to breastfeeding infants
  10. foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

References

  • Centre for Addiction and Mental Health. Exposure to psychotropic medications and other substances during pregnancy and lactation. A Handbook for health care providers, 2007.
  • Alcohol and women’s health. Australian alcohol guidelines. Fact sheet. Accessed February 3 2011 http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/F985CDA718F63E46CA25718E0081F1D8/$File/fswomen.pdf
  • National Health and Medical Research Council. If you are breastfeeding, the safest option is not to drink alcohol. 2009. Accessed February 3 2011 http://www.health.gov.au/internet/alcohol/publishing.nsf/content/guidelines
  • National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. 2009. Accessed February 3 2011
    http://www.nhmrc.gov.au/guidelines/publications/ds10
  • Lactmed: Drug and lactation database. National Library of Medicine. Available at http://toxnet.nlm.nih.gov/ Accessed February 3 2011.
  • Giglia RC and Binns CW. Alcohol and Lactation: a systematic reviewNutrition and dietetics 2006; 63:103–16.
  • Brodribb W. Breastfeeding management in Australia. East Malvern: NMAA, 2004.
  • Burby L. 101 reasons to breastfeed your child. http://www.notmilk.com/101.html. 2005.
  • Glover R. Hold tight—feed right. The promise of positional adaptability. Paper presented at ILCA International Conference, Sydney, 2003.
  • Hale TW. Medications and mothers’ milk (10th ed.) Amarillo: Pharmasoft
    Publishing, 200212 McCauley L. Nipple shields. A survey of the literature. Topics in breastfeeding. Lactation Resource Centre: Victoria, 1991.24
  • Lawrence RA & Lawrence RM. Breastfeeding—a guide for the medical profession.5th Ed. St. Louis: Mosby,1999.
  • Marmet C. Manual expression of breast milk: Marmet Technique. Retrieved February 10, 2002 from http://www.medelabreastfeedingus.com/tips-and-solutions/130/how-to-manually-express-breastmilk---the-marmet-technique.
  • Mohrbacher N & Stock J. The breastfeeding answer book. Illinois: La Leche League International, 2003.
  • National Health and Medical Research Council. Infant Feeding Guidelines for Health Workers. Canberra NHMRC, 1996.
  • Newman J. (1990) Breastfeeding problems associated with the early introduction of bottles and pacifiers. Journal of Human Lactation 1990; 6:59–63.
  • Perez-Escamilla R, Pollitt E, Lonnerdalo B & Dewey K. Infant feeding policies
    in maternity wards and their effect on breastfeeding success: an analytical
    overview. American Journal of Public Health 1994; 84 89–97.
  • Righard L & Alade M. Sucking technique and its effect on success of breastfeeding. BIRTH 1992; 19 185–89.
  • Royal Women’s’ Hospital. Breastfeeding: best practice guidelines. Royal Women’s’ Hospital, Melbourne 2004.
  • Victorian breastfeeding guidelines. Promoting breastfeeding. Health and Community Services: Victoria. 1994.
  • Walker M. Mastitis in Lactating Women. La Leche League International: Lactation Consultant Series, Unit 2.
  • World Health Organisation Evidence for the Ten Steps to Successful
    Breastfeeding. WHO Health Organisation, Geneva. 1998. Newman J. When latching. 2009. http://www.breastfeedinginc.ca/content.php?pagename=doc-WL

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