What Are The Benefits of Breastfeeding?

With the upcoming arrival of your new baby, there are many decisions to be made. None more important than deciding which form of nutrition is best for you and your baby. Numerous government and private industry associations today recognize and promote the importance of exclusively providing breastmilk to babies in the first twelve months of life. Following are compelling, research-based facts about the importance of breastmilk that may help you to make an informed choice:

Mother breastfeeding baby and kissing baby’s hand

Best for Baby:

  • Research shows that breastfed infants have fewer and shorter episodes of illness.1,4,7,10
  • Breastfeeding is the most natural and nutritious way to encourage your baby’s optimal development.1,3,10, 21
  • Colostrum (the first milk) is a gentle, natural laxative that helps clear baby’s intestine, decreasing the chance for jaundice to occur.8
  • The superior nutrition provided by breast milk benefits your baby’s IQ.11,16
  • Breastfeeding is a gentle way for newborns to transition to the world outside the womb.14
  • The skin-to-skin contact encouraged by breastfeeding offers babies greater emotional security and enhances bonding.5,14
  • The activity of sucking at the breast enhances development of baby’s oral muscles, facial bones, and aids in optimal dental development.23
  • Breastfeeding appears to reduce the risk of obesity and hypertension later in life.22
  • Breastfeeding delays the onset of hereditary allergic disease, and lowers the risk of developing allergic disease.9,10
  • Breastfeeding helps the baby’s immune system mature, protecting the baby in the meantime from viral, bacteria, and parasitic infections.15
  • Breastfeeding increases the effectiveness of immunizations, increasing the protection against polio, tetanus, and diphtheria vaccines.1,7
  • Breastfeeding protects against developing chronic diseases such as: celiac disease, inflammatory bowel disease, asthma, and childhood cancers.2,13,19
  • The benefits of breastfeeding appear to last even after the baby has been weaned.1,11

Lack of Breastfeeding Increases the Risk to the Infant of:

  • Ear infections, childhood diabetes, obesity, gastrointestinal and diarrheal infections, urinary tract infection childhood cancers, SIDS, respiratory infections, allergies, NEC (necrotizing enterocolitis)1,6,9,10,16,17,20,22
Mother breastfeeding baby and holding baby’s hand

Best for Mom:

  •  Research shows that breastfeeding benefits the health of mothers.6, 9
  • Breast milk is always fresh, perfectly clean, just the right temperature, and is the healthy choice at the least cost!1,9
  • Increased levels of oxytocin stimulate postpartum uterine contractions, minimizing blood loss and encouraging rapid uterine toning.9,13
  • From 3 months to 12 months postpartum, breastfeeding increases the rate of weight loss in most nursing mothers.7,12
  • Breastfeeding offers some protection against the early return of fertility.10
  • Because breastfed babies are healthier, their mothers miss less work and spend less time and money on pediatric care.3
  • Breastfeeding women report psychological benefits such as increased self-confidence and a stronger sense of connection with their babies.9
  • Breastfeeding decreases risks of cardiovascular disease into postmenopausal age.5,11

Lack of Breastfeeding Increases the Risk to the Mother of:

  • Pre-and post-menopausal breast cancer, ovarian cancer, osteoporosis, rheumatoid arthritis, endometrial cancer2, 4, 8, 14, 15
Show References

How to Prepare

As an expectant mom, there are a number of things you should consider gathering prior to baby's arrival. The list below is specific for baby and breastfeeding.  There are a number of items you should consider to prepare properly for the arrival of baby.  Speak with your Child Birth Educator for a complete list of items.

Medela At Work

Welcome to Medela At Work, a resource dedicated to breastfeeding moms going back to work! Medela At Work makes it easy to find breastfeeding and back to work information that will arm you with helpful knowledge so you can preserve your breastfeeding relationship.

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Tips and Solutions

Whether it's your first latch or you have been breastfeeding successfully for months, Medela is here to support you with answers to many questions you may have.  Whether it's preparing to return to work or a specific complication, utilize these helpful solutions to keep you on the path of providing breastmilk for your baby.

If you have specific questions, please contact your healthcare provider or Ask the LC, Medela's board certified IBCLC.

How To Breastfeed

  • Before Baby Arrives

    Though breastfeeding is natural, technique is a learned skill. It is important to get started correctly, even before your baby is born. You need to know well in advance how to identify and avoid possible problems, and where to turn if difficulties do arise. Many breastfeeding problems may occur when you establish your nursing patterns. With proper and prompt attention, the majority of these problems disappear as quickly as they develop.
    Plan to learn as much as you can about breastfeeding. You will be making an important investment in your and your baby's continued good health. An abundance of valuable reference material is available to help you get started. Medela offers a complete line of breastfeeding books that covers all aspects of breastfeeding, as well as how to use a breastpump, with expert, thorough instruction.
    The most important contact before and during your breastfeeding experience is with certified lactation consultants and/or support organizations such as La Leche League International (LLL) and the Nursing Mothers' Council. By attending League meetings, for example, you will have the opportunity to meet and compare notes with other breastfeeding mothers. As your questions are answered, you will receive the helpful tips and reassurances you need to make your breastfeeding experience even more rewarding. To help connect you with a lactation consultant or breastfeeding specialist in your area, visit the Breastfeeding National Network (BNN).
    As with any skill, the keys to successful breastfeeding are practice and patience. Learn all you can and then surround yourself with people who will offer you the encouragement you need. Be easy on yourself. Relax and enjoy this special and wondrous experience.
  • A Simple Nipple Test

    Nipples come in all shapes and sizes, and most babies can handle these variations. Sometimes, if the mother's nipples lack elasticity or invert when compressed, a baby may have difficulty getting a good latch. This difficulty may temporarily worsen during engorgement, when the breasts get fuller and the breast tissue is even tighter and less elastic. Over time, these problems resolve, but mothers with inverted nipples may need extra help to get breastfeeding off to a good start. After birth, if baby still has difficulty attaching to your breast, contact a breastfeeding specialist, La Leche League leader, or Nursing Mothers Counsel.

    Simple Nipple Test Image 1Many mothers have everted nipples

    Some have inverted nipples.

    breastfeeding...nipple testWhile others may be flat.

    Breastfeeding..breastshellsMedela's Breast Shells can help draw out flat or inverted nipples.

  • How Your Breasts Produce Milk

    Milk is produced in the glandular tissue (alveoli) of the breasts. The smooth muscle tissue around each tiny milk-producing cell contracts when maternal hormones are released. This contraction propels milk down the milk ducts to the openings in the nipple. This process is called the milk ejection reflex or the letdown. Your baby's cry and touch, nipple stimulation, and sucking all can trigger this hormone release. The majority of milk obtained during breastfeeding, hand expression, or breast pumping occurs during milk ejections, each of which last about 1-2 minutes. Multiple letdowns appear to occur during most breastfeeding sessions.

    When the milk is actively ejecting, many women will notice a bit of tingling, especially during the first letdown of the feeding. The other letdowns may be less intense. The breastfeeding mother may simply notice the baby begin to gulp again after seeming to rest at the breast for a few minutes. A mother who is pumping may notice more milk sprays or an increase in the milk flow. When pumping, it is important to ensure that you pump long enough to trigger several letdowns.

  • How Breastfeeding Works

    Breastfeeding is the normal way to feed a baby. Babies are born with reflexes that help them find the breast and begin nursing. But for mother and baby both, breastfeeding is a learned art. In the past, little girls grew up watching experienced mothers putting babies to breast. Today, many women have never seen anyone breastfeed before being handed their own first baby. Without assistance, learning how to position and latch the baby can seem difficult. Mothers also need help interpreting feeding cues and in being able to tell whether their baby is feeding well. It doesn’t quite seem fair that mothers must learn these new skills during a time when they are tired and still recovering from childbirth! The first few weeks can be challenging, but with support, mothers can enjoy the special intimacy and vital health benefits provided by breastfeeding.

  • Collection and Storage of Breastmilk

    Many mothers find it convenient or even necessary to collect their breastmilk and store it to be used at a later time.  Such is the case for mothers who are returning to work or school or for mothers who may need to be separated from their infants.  The guidelines offered below may answer the many questions mothers have about safely storing their breastmilk.

    Collecting Breastmilk

    • Wash hands well with soap and water.
    • Wash all the collecting bottles and breastpump parts that touch your breasts or the milk.  Use hot, soapy water or a dishwasher.  Rinse carefully.  Air dry on a clean towel.  When soap and water are not available use Medela Quick Clean™ products.  If your baby is premature or ill, the hospital may ask you to sterilize your pump parts.
    • Read the instructions book that comes with your pump and follow the suggestions.  Sterilize your pump parts once a day as described.
    • Practice pumping when you are rested, relaxed and your breasts feel full.  Once a day try to breastfeed your baby only on one side and pump the other breast.  Or pump for a few minutes if your baby skips a feeding or breastfeeds for only a short while.  Read the Breastmilk Storage chart to learn how to store breastmilk.  Be sure to use the right size breastshield so that your nipple fits comfortably.  Medela makes different sizes of PersonalFit™ breastshields to fit all nipple sizes, from small to extra large.
    • Employed moms can help their baby learn to take a bottle once breastfeeding is going well.  It is best to wait for three (3) to four (4) weeks to introduce bottles.  If you are having problems breastfeeding, ask for help from a lactation consultant or health care provider.
    • Begin to pump to store milk one (1) to two (2) weeks before returning to work.  Many employed moms use the fresh milk they pump at work for feedings the next day.  They refrigerate Friday's milk for use on Monday.  Save your frozen milk for emergencies.
    • Pump three (3) times during an eight (8) hour work shift, or every three (3) hours you are away from your baby.  Ten minutes of pumping during breaks and 15 minutes of pumping during lunch with a good pump will help protect your milk supply.  If you can't pump three (3) times, pump as much as you can during each day. 
    • Breastfeeding in the evening and on days off helps maintain your milk supply and protects your special bond with your baby.

    Storing Breastmilk

    • It is normal for pumped milk to vary in color, consistency and scent depending on your diet.  Stored milk separates into layers.  Cream will rise to the top.  Gently swirl the warmed bottle to mix the milk layers.
    • You can continue to add small amounts of cooled breastmilk to the same refrigerated container throughout the day.  Avoid adding warm milk to already cooled milk.
    • Pumped milk may be added to frozen milk provided it is first chilled and the quantity is less than what is frozen.
    • Store your milk in Medela's breastmilk collection bottles or in disposable bags specifically designed for breastmilk, such as  Pump & Save™ Bags, by Medela.
    • Freeze milk in two (2) to five (5) oz portions.  Small amounts will thaw more quickly.  You will waste less milk this way and will avoid over-feeding.  Aqueous liquids expand when frozen.  Be sure to leave some extra room at the top of the container so the bottle or bag won't burst.
    • Seal containers tightly.  Write the date on a piece of tape on the bag or bottle.  Use the oldest milk first.

    Breastmilk Odor and Taste Changes

    • Causes of breastmilk odor and taste changes
      Changes in breastmilk odor and taste can be caused by medications, mother's diet, smoking and exposure of milk to light or cold temperatures during storage. In most cases, infants do not seem to mind odor/taste changes in breastmilk.
    • Odor due to lipase
      Some mothers produce milk that, when frozen, develops an off-odor and taste due to a normal breastmilk enzyme called lipase. When thawed, this milk is often described as smelling unpleasant, rancid or soapy. It is safe to use and many infants will accept it. However, some infants may refuse to drink it, either with their first taste or later as they develop taste preferences and volitional (non-reflexive feeding) feeding behaviors.
    • Test prior to freezing
      Before freezing large amounts of breastmilk, mothers can test their milk for odor and taste changes due to lipase. Collect and freeze 1-2 bags or small containers of breastmilk for at least 5 days. Then evaluate the odor and see if your infant will drink it.
    • To eliminate lipase-induced milk changes during freezing
      If milk changes smell and taste during test freezing, mothers can scald their fresh milk before they freeze it. Scalding milk after it has been frozen will not correct the odor/taste problem.
    • To scald fresh milk:
      - Heat it in a pot until tiny bubbles form around the edges of the pan (approximately 180° F).
      - Remove the milk from the stove and quickly chill it before freezing.

      Scalding milk reduces some of the beneficial components in breastmilk, so whenever possible, give your infant fresh breastmilk.

    Special Situations
    Mothers of neonatal intensive care (NICU) infants may need to pump and store milk for a long time. We know that in normal home freezers, liploysis increases with longer storage times. However, many NICU freezers store breastmilk at super-cold temperatures of -70° to -80° C. At these temperatures, milk odor and taste changes due to lipolysis do not occur.

    Mothers of NICU infants who have lipolysis-induced milk changes during freezing should consult with the NICU lactation consultant about milk storage temperatures in the hospital. Together they can develop a plan for her breastmilk storage while the baby is hospitalized.



    If your baby was born premature, these guidelines may differ slightly.  You should check with your health care provider for the recommended storage guidelines for your specific situation.

    Never microwave breastmilk.  Microwaving can cause severe burns to baby's mouth from hot spots that develop in the milk during microwaving.  Microwaving can also change the composition of breastmilk.

    Breastmilk Storage Guideline References:

    • Hamosh M, Ellis L, Pollock D, Henderson T, and Hamosh P: Pediatrics, Vol. 97, No. 4, April 1996. pp 492-497. (4 hours at 77° F/25° C).
    • The Academy of Breastfeeding Medicine Protocol Committee.  ABM Protocol #8: Human milk storage information for home use for healthy full-term infants. 2004.
    • Adeola, K.F., Otufowora, O.A. Effect of Storage Temperature of microbial quality of infant milk. J Tropical Peds 1998 Feb; 44(1): 54-55.
    • Hands, A. Safe Storage of expressed breast milk in the home. MIDIRS Midwifery Digest 2003: 13(3):378-85.
    • Jones, F. and Tully, M.R. Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings, Second Edition. The Human Milk Banking Association of North America, 2006.
    • Lawrence, R. and Lawrence, R.  Breastfeeding: A Guide for the Medical Profession, Sixth Edition. St. Louis; Mosby, 2005; 1018-20.
    • Martinez-Costa, C., Silvestre, M.D., and Lopez, M.C. et al  Effects of refrigeration on the bactericidal activity of human milk: A preliminary study. J Pediatr Gastroenterol Nutr 2007; 45:275-77.


    • Thaw milk overnight in the refrigerator, or hold the bottle under warm running water to quickly thaw.  You can also place the sealed container in a bowl of warm water for 20 minutes to bring it to body temperature.
    • Thawed milk is safe in the refrigerator for 24 hours.  DO NOT REFREEZE.

    Your Milk Supply and Your Baby's Needs

    • We used to think that mothers needed to make more and more milk as their babies grew.  Scientists now know that a healthy milk supply remains fairly constant over the six (6) months of exclusive breastfeeding.
    • During the early weeks, babies eat very frequently and grow very quickly.  By Day 10, babies should recover any lost birth weight.  For the next few months, little girls should gain about an ounce a day, and little boys slightly more than an ounce a day. 
    • Around three (3) to four (4) months, a breastfed baby's rate of growth begins to slow down.  Continuing to gain weight rapidly after this time may contribute to obesity later on.  This means that the milk supply established in the early days will continue to satisfy the baby until it is time to introduce solids at 6 months.
    • By the end of the first week of life, women who are breastfeeding one baby normally make between 19 to 30 oz of milk each day.  Infants between one (1) and six (6) months of age normally drink an average of 19 to 30 oz a day.*  An average size "meal" for a baby is between three (3) to five (5) oz of breastmilk.  Formula is harder to digest and less well absorbed.  Formula fed babies may need larger feeds.  Consult your doctor for advice.

    *Daly S, Owens R, Hartmann P:  The Short-Term Synthesis and Infant-Regulated Removal of Milk in Lactating Women, Experimental Physiol 1993; 78:209-220.


Problems & Solutions

  • Anthrax and Breastfeeding

    By Catherine Genna and Barbara Wilson-Clay
    Anthrax is an animal disease that can be transmitted to humans, but cannot be passed from person to person. Anthrax is not passed from mother to child during breastfeeding or through breast milk. There are safe medicines to treat breastfeeding mothers who have been exposed to anthrax.

    Exposure to a single spore will not usually cause the disease; usually thousands of spores must be breathed in, eaten, or enter a cut before a person becomes ill. Anthrax takes different forms, depending on how the bacteria entered the body. Inhalation (respiratory) anthrax is the most dangerous and cutaneous (skin) anthrax is the mildest. Gastrointestinal anthrax is usually contracted by eating undercooked contaminated meat. Anthrax spores on the hands can theoretically enter the mouth when eating. Washing hands with soap and water after opening mail, before eating or preparing food, and after handling raw meat can help prevent anthrax, whether the source is natural or not.

    Since anthrax is a bacterial disease, antibiotics can be used to control it if the disease is recognized and treated early. Most naturally occurring anthrax is susceptible to penicillin, but some laboratory created strains are not. Because of this fact, ciprofloxacin was initially chosen to treat victims of terrorism. However, further analysis indicated that the anthrax strain used in the 2001 US Postal Service attacks is also treatable using penicillin and doxycycline.

    Antibiotics are used when a person becomes ill with anthrax (treatment), or to prevent the illness in a person who is likely to have been exposed (prophylaxis). Antibiotics must be taken for 60 days, because anthrax spores can remain in the lungs for this long. In bioterrorist events, cutaneous (skin) anthrax is treated for 60 days as well, due to the risk that the person also breathed in spores. Persons who have not been exposed to anthrax should not use antibiotics “just in case” as overuse of antibiotics can cause common germs to become hard to treat.

    The CDC recommends that infants infected with anthrax be treated with ciprofloxacin or doxycycline, at least for the first 10-21 days of the 60 day treatment. No problems have been reported in breastfed infants of women treated with short-term use of doxycycline, and the AAP considers it to be a drug compatible with breastfeeding. Owing to the risk that long-term doxycycline use may cause dental staining in the infant, the CDC suggest that nursing infants or breastfeeding women infected with anthrax switch to other medications for the remainder of the 60-day course of treatment. The CDC maintains an on-line list of these alternative antibiotics.

    A cell free vaccine is available for those who are most likely to be exposed to anthrax (vets, farm workers, or soldiers). The anthrax vaccine used in the US is made from only part of the bacterium, and like all “killed” vaccines, is considered safe for breastfeeding mothers. The vaccine must be given in 6 doses over 18 months, and yearly booster shots are required to maintain full protection. Consult your MD with further questions.

    American Academy of Pediatrics Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776--89.

    CDC Notice to Readers: Update: Interim Recommendations for Antimicrobial Prophylaxis for Children and Breastfeeding Mothers and Treatment of Children with Anthrax. MMWR Weekly; November 16, 2001/50(45);1014-16.

    Hale, T. Medications and Mother’s Milk, 12 Edition (2006), Hale Publishing. Pg 61-2.
    Inglesby, et al, Working Group on Civilian Biodefense; Anthrax as a Biological Weapon, Medical and Public Health Management, JAMA 281(18), May 12, 1999.

    What everyone needs to know about the anthrax vaccine, Feb 2001, US Coast Guard. http://www.anthrax.osd.mil/Flash_interface/default.html
  • Breastfeeding and Breast Reduction Surgery

    By Barbara Wilson-Clay

    Today, thanks to better surgical techniques, many women who have had breast reductions find that they can breastfeed. It is hard to predict in advance whether a woman will make a full or a partial milk supply, but it is worth it to give breastfeeding a try.

    Tell your baby’s health care provider about your surgery so that your baby’s growth may be monitored. Medela 1-800-TELL YOU can help you locate the nearest IBCLC.

    Begin breastfeeding as soon as possible after giving birth. Frequent feedings will help bring in your milk quickly. Watch for plenty of wet and soiled diapers as a sign that the baby is getting enough to eat. Breastfed babies normally have 6 or more wet and 3 or more bowel movements every 24 hours. Let your doctor know if the baby goes 24 hours without having a bowel movement.
    Tell your LC or doctor if your breasts become engorged and the baby cannot soften them. Intense engorgement can be a sign that milk is not draining well.
    Weigh the baby often at first. If there is a problem with the baby getting enough milk, an SNS™ (Supplemental Nursing System™) can ensure that the baby gets plenty to eat and helps preserve that special closeness. It may take a while to see just exactly how much milk you will be able to make. Even if partial supplementation is required to protect the baby’s growth, just remember that every drop of milk you make is important to your baby’s health.


    D Brzozowski M Niessen, H Evans, et al. Breastfeeding after inferior pedicle reduction mammaplasty. Plast Reconstr Surg 2000, 105(2):530-4.
    N Powers. How to assess slow growth in the breastfed infant, Pediatric Clin North Am 2001; 48(2):345-363.

    D West, Defining Your Own Success: Breastfeeding After Breast Reduction Surgery,, La Leche League International, Schaumberg, Il, 2001.


  • Breastfeeding an Adopted Baby

    By Barbara Wilson-Clay, BS, IBCLC

    Yes, it’s true. Adopting mothers can breastfeed. Down through history, a traditional way of nurturing and nourishing orphans has been for another woman, often a relative, to put the baby to breast. Sometimes the adoptive mother already was lactating, but if not, the infant’s sucking would bring in a milk supply. The process of breastfeeding an adopted baby is called induced lactation. Research has shown that breastfeeding enhances bonding.  Parents are thrilled to learn that their “chosen” baby can receive some of the wonderful health benefits provided by human milk, including experiencing the interactions which foster attachment between mother and child.

    How does induced lactation work? Simply put, sucking stimulation causes the breasts to make milk.  In the non-developed world, most women who are inducing lactation simply put the infant to breast and practice very frequent breastfeeding and baby-wearing (holding the infant almost constantly in a sling or carrier). 

    In developed countries, where adoption is more likely to be a planned event, the process of induced lactation ideally begins before the baby arrives. The mother starts by manually and mechanically stimulating her breasts and nipples using a combination of gentle massage and a rental grade electric breast pump. The stimulation schedule typically starts with several minutes of massage and pumping several times a day. Gradually, the woman increases the amount of stimulation until she is pumping for 10 minutes 8-10 times during each 24-hour period. (Pumping on a dry breast may pull some. Try lubricating the pump flange with a thin coat of cooking oil to make it more comfortable.)

    After massage and pumping are begun, medications may help stimulate the breasts to further increase milk production. Some induced lactation efforts begin with physician-prescribed hormones (estrogen and progesterone) that imitate the hormone levels of pregnancy. These medications are withdrawn after a short while, tricking the body into sensing that a baby has been born. The woman may then begin taking another prescribed drug called a galactagogue (a term that means ‘a milk stimulating substance’). Although there is no research to confirm effectiveness, some women who don’t want to use hormones may use herbal galactagogues such as fenugreek in addition to pumping and breast massage to help establish milk production.

    Within a week of beginning the process most women are very excited to discover that they are producing drops of milk! They may notice other changes. Their breasts may feel heavier and the areolae (the skin around the nipple) may darken. Some woman will eventually stop menstruating.

    While the milk supply typically builds over time, it is hard to tell how much milk an adoptive mother will make. Some women eventually make enough milk that they can wean their babies off of supplements. Other women have health issues that may affect their ability to make a full supply of milk. No matter. Any amount of milk is of great value to the baby, but the focus should be on the nurturing experience.

    Adoptions are unpredictable. Sometimes parents have plenty of time to prepare. Other parents greet the arrival of their baby before the milk supply is well developed. The Medela Supplemental Nursing System™ (SNS) protects the option to breastfeed because it allows mother to supplement the baby directly at the breast. The SNS™ is filled with formula and worn suspended from a necklace device. Thin silicone feeding tubes are taped to the nipple, and the baby drinks formula while breastfeeding. This device provides sucking stimulation for the breasts while ensuring that the baby gets enough to eat. Fathers can tape the feeding tube to a finger, and many fathers share that this experience is far more intimate than feeding a bottle.

    Be sure to talk with your baby’s doctor about your plans to induce lactation. Contact your local LC, La Leche League Leader, or Nursing Mothers Counselor for guidance, and for help answering your additional questions about nursing your adopted baby.


    Bryant CA. Nursing the adopted infant. J Am Board Fam Med 2006; 19(4):374-9.

    Britton  JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics 2006; 118(5)e1436-43.

    Cheales-Siebenaler NJ: Induced lactation in an adoptive mother. J Hum Lact 199l ; 15(1):41-3.

    Gabay MP. Galactogogues: medicines that induce lactation. J Hum Lact 2002; 18(3):274-9.

    Gribble KD: The influence of context on the success of adoptive breastfeeding: developing countries and the 
    west. Breastfeed Rev 2004; 12(1):5-13.

    Gribble KD. Mental health, attachment and breastfeeding: implications for adopted children and their mothers. Int Breastfeed J 2006; 9(1):5.

  • Tips on Biting

    By Catherine Watson Genna, BS, IBCLC

    Mothers sometimes worry about breastfeeding when their baby has teeth. Most babies do not bite, but a few do. There are things moms can do to stop baby from biting.
    It helps to know a little about how breastfeeding works. In order to suck, a baby needs to keep his tongue over his lower gum. This places the tongue between the teeth and the breast. Having the tongue over the gum stops the bite reflex. If the baby is latched properly, the nipple is deep in the mouth and protected from baby’s teeth. However, sometimes a baby may release the normal, deep latch and clamp down on the mother’s breast.
    •    Some babies bite to reduce the flow of milk if it is too fast for them. Try leaning back while feeding. Putting the baby in more upright feeding position helps manage a fast milk flow. Avoid pressing on the baby’s head. This allows him to let go of the breast if he needs to take a breath.

    •    Some older babies bite because their gums are sore from teething. Keep the gums clean with a soft baby toothbrush and plain water, or gauze moistened with cold water. This can reduce swelling and make baby feel better. Allow the baby to chew on a teething ring.

    •    Sometimes babies bite because they are not really interested in feeding at that moment. Older babies sometimes bite at the end of the feeding when they get distracted or want to play. Wait until the baby really wants to eat and don’t encourage the baby to stay on if he grows restless.
    •    Occasionally, a baby will bite if they are teething and receiving bottles…as they can bite on an artificial nipple without causing pain. When they try to do this with mother, her reaction may be surprising and confusing. Switching the baby to a sippee cup instead of a bottle may help.

    Try to teach the baby not to clamp down on the breast before the teeth come in. If baby closes his gums on the breast, remove him from the breast and end the feeding for at least a few minutes. In a firm tone, say: “Don’t bite.” Some mothers also follow, in a gentler tone, with “Gentle with mom.” or “Open wide.” Babies are smart. They learn from the consequences of their actions. If clamping down on the breast means it is taken away, most babies will stop clamping. If your baby bites, keep a finger ready to remove baby if he clamps down on the breast. Some mothers briefly pull the baby in close to block his nose. This will cause him to open his mouth to breathe, allowing mom to safely unlatch him.

    If baby does bite, and mom reacts strongly, some sensitive babies might refuse to breastfeed for a little while. This ‘nursing strike’ can be overcome with patience. .
    An IBCLC or LLL Leader can help determine the reason a baby is biting and help you teach your baby not to bite.
    Barbara Wilson Clay, BSEd, IBCLC
    Last edited 06/07
    Mohrbacher N, Stock J.  The Breastfeeding Answer Book 3rd Edition, La Leche League Int. Shaumburg, Il. 2003. Pg.478-480.

  • Colitis

    By Mary Bibb, BA, IBCLC

    Occasionally a breastfed baby will have little streaks of blood in the stool. This is often caused by a tiny tear in the inside skin of the anus called an anal fissure. Sometimes the bleeding is from an irritated intestine (colitis). Colitis can cause mucous and blood in the mucousy and bloody stools. The most common cause of colitis in young babies is allergy. Giving the baby ONLY breastmilk and nothing else for 6 months is the best way to reduce the risk of colitis. If your baby is bleeding rectally for any reason, it is important to have the baby examined by a physician. Colitis can be caused by viral and bacterial infections.  Rarely, rectal bleeding can indicate a more serious health problem.

    Occasionally, babies will react to food proteins from their mother’s milk react to something that their mothers have eaten.  If an exclusively breastfed baby gets colitis, the best thing to do is for the mother to stop drinking cow milk, and eating cheese, yogurt, and anything made with cows’ milk, whey, or casein. In one study, some breastfed babies with streaks of blood in the stool all got better when the mother eliminated eggs and cow milk products from her diet and continued to breastfeed. (Kumagai). Cow’s milk protein allergy has been linked with colitis in some infants.  However, new research suggests that cow milk allergy is less common than previously believed.  Trial removal of dairy products for 2-3 weeks to see if symptoms improve should be followed by a cow milk challenge (where dairy is re-introduced into the mother's diet).  This should be medically supervised and will tell whether improvements have occurred because of the elimination diet. Putting mothers on food eliminations diets is stressful and should be avoided unless clearly required.

    The most common allergy-causing foods are cow’s milk, eggs, wheat, and peanuts. Elimination diets can help mothers of allergic babies continue breastfeeding.  If you decide to wean to formula, it would be wise to pump frequently for 3-4 weeks so you have the option of resuming breastfeeding if baby's colic worsens. It can take this long for a formula allergy to become apparent.

    Tests showed these babies had signs of allergic reactions in their intestines. In the United States, the three most common foods that babies may be allergic to are cows’ milk, soy, and egg whites. Soy and cows’ milk are commonly used in infant formula.

    Mother’s milk helps to heal colitis in most cases. Human milk has been used to help babies with damaged intestines heal faster. Breastfeeding also reduces babies’ chance of getting colitis later in life, an important health benefit bonus .
    Occasionally, non-allergic babies can have mucous in the stools.  This is not a harmful condition. Letting the baby finish the first breast before switching helps baby get more of the fat from the “hind milk.” This coats the infant gut, helping the irritated intestine heal. A professional lactation consultant, along with your doctor, can help you with any breastfeeding and food-related issues so that your baby thrives on your milk.
    There is a registry of IBCLC’s at http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

    The baby’s overall health is the best way to tell if colitis is serious or not. If baby is gaining well and is happy, the colitis is usually very mild. If a baby with colitis is not gaining weight and is unhappy, talk to your doctor. Rarely, a breastfed baby with colitis has a severe case, and needs to have a special formula for a short period of time. Mom should express her milk with a hospital grade pump to keep her milk supply, because some babies with colitis cannot tolerate even the least allergenic formula. Many babies are able to go back to breastfeeding after a short time (1-2 weeks) on hypoallergenic formula. The best way to prevent colitis is to breastfeed exclusively for 6 months, without cows’ milk or cows’-milk-based supplements.

    Reviewed by:
    Barbara Wilson-Clay BSEd, IBCLC

    Arvola T. et al. Rectal Bleeding in Infancy:  Clinical, Allergological,and Microbiological Examination, Pediatrics 2006; 117(4):e760-768.
    Brink S. The successful use of human breast milk in a premature
    infant with the surgical short gut syndrome. Am J Dis Child. 1977 Apr;131(4):471.

    Corrao G, Tragnone A, Caprilli R, Trallori G, Papi C, Andreoli A, Di Paolo M, Riegler G, Rigo GP, Ferrau O, Mansi C, Ingrosso M, Valpiani D. Risk of inflammatory bowel disease attributable to smoking, oral contraception and breastfeeding in Italy: a nationwide case-control study. Cooperative Investigators of the Italian Group for the Study of the Colon and the Rectum (GISC). Int J Epidemiol. 1998 Jun;27(3):397-404.
    Giacoia GP, Williams GP. Rectal bleeding due to nonspecific colitis in premature infants. South Med J. 1995 Jul;88(7):789-91.

    Grazioso CF, Werner AL, Alling DW, Bishop PR, Buescher ES. Antiinflammatory effects of human milk on chemically induced colitis in rats. Pediatr Res. 1997 Nov;42(5):639-43.

    Kumagai H, Masuda T, Maisawa S, Chida S. Apoptotic epithelial cells in biopsy specimens from infants with streaked rectal bleeding. J Pediatr Gastroenterol Nutr. 2001 Apr;32(4):428-33.

    Lake AM, Whitington PF, Hamilton SR. Dietary protein-induced colitis in breast-fed infants. J Pediatr. 1982 Dec;101(6):906-10.

    Lentze MJ. Food allergies. Ther Umsch. 1989 Sep;46(9):645-53.

    Strauss RS, Koniaris S. Allergic colitis in two infants fed with an amino acid formula. J Pediatr Gastroenterol Nutr. 1998 Sep;27(3):362-365.

    Vonlanthen M, Lactose Intolerance, Diarrhea and Allergy Breastfeeding Abstracts 1998 Feb; 18(2):11-12.


  • Medela FAQs

    Medela has compiled a variety of FAQs to assist you when customer service is either unavailable or you are simply looking for a quick answer. 

  • Flat or Inverted Nipples

    By Barbara Wilson-Clay, BSEd, IBCLC

    During breastfeeding, the baby draws in nipple, a good portion of the areola, and underlying breast tissue. This drawing in and shaping of the breast can only be done if this tissue is capable of stretching. About 10 percent of first time mothers have nipples that are described as flat or inverted. (Alexander, 1992)

    breastfeeding...nipple test
    A erect nipple. An inverted nipple. A flat nipple.

    These terms describe the lack of elasticity of the muscle tissue that makes up the nipple. It is impossible to judge how the nipple will function just by looking at it. Mothers or care providers can compress the area just behind the nipple. If the nipple protrudes, it is everted. If it flattens or retreats, telescoping in like a navel, then some babies will have difficulty drawing it up to breastfeed. If a baby is premature, small, weak, or ill, a flat or inverted nipple can be especially challenging. (Neifert, 1996)

    The nipple is an important stimulator of sucking behavior in the infant. The reflex that triggers sucking involves stroking the palate. (Woolridge, 1986) Some parents may notice that the baby will suck strongly on a finger, pacifier or bottle nipple, but appear apathetic, disinterested or frustrated by the breast. This may be because the nipple is not elastic or everted enough to reach back to stroke the palate. When this happens the baby doesn’t know what to do next. The baby may bob back and forth and seem unable to “locate” the nipple, may pull away and cry, or may fall asleep each time the breast is offered. Skilled help from an IBCLC and close follow-up from the physician will make it easier to overcome this challenge. Making sure that latch technique is correct is the first and most important intervention to try.

    Flat and inverting nipples may become even more difficult for the baby to manage during the engorgement phase, when swollen breasts further reduce the elasticity of the breast tissue. Even normally everting nipples temporarily may flatten if engorgement is severe.

    While flat and inverted nipples are rather common – especially in first time mothers – they typically respond and improve over time. Some women will choose to wear breast shells during pregnancy to try to draw out the nipples . After the birth, when the breasts are hormonally primed to undergo dramatic changes, breast pumping can help increase elasticity, and can make initial breastfeeding easier.

    Nipple shields are devices that extend the length of the nipple to stimulate the palate, triggering the reflex to suck. Nipple shields can be used to encourage the baby to accept the breast. Direct sucking by the baby through the shield will help pull out the nipples. If you are using a shield, we recommend frequent pumping with a hospital grade double pump during the learning period, to protect milk supply. Pumping and the use of shields usually can be discontinued as the nipple elasticity improves and the baby gains strength and improved breastfeeding technique. This process can take varying lengths of time depending on how severely the nipple tissue is restricted. It is advisable to obtain frequent weight checks during this time to make sure the baby is breastfeeding adequately. Nipple shields are not meant as a substitute for skilled breastfeeding help. If a mother suspects she may have flat or inverting nipples, or if a previous breastfeeding relationship has been disrupted by this condition, she should seek help from anIBCLC, midwife, or informed health care provider.


    Kathleen B. Bruce, BSN, IBCLC
    Catherine Watson Genna, BS, IBCLC
    Mary Bibb BA, IBCLC


    J. Alexander, A Grant, M Campbell, Randomised controlled trial of breast shells and Hoffman’s exercises for inverted and non-protractile nipples, British Medical Journal 1992; 304:1030-1034.

    M Neifert, Clinical Aspects of Lactation, Clinics In Perinatology 1999; 26(2):281-306.

    M Woolridge, The ‘anatomy’ of infant sucking, Midwifery 1986; 2:164-7.

    B. Wilson-Clay, Clinical Uses of Nipple Shields, Journal of Human Lactation 1996, 12(4):279-285.

  • Nipple Confusion

    Breastfeeding with Nipple Confusion

    By Barbara Wilson Clay, BSEd, IBCLC

    Experts agree that it is best to wait several weeks before offering bottles to the breastfed baby. Because breastfeeding is learned behavior, most babies do better mastering one thing at a time. Normal, term infants generally get plenty of milk directly from mother’s breast. Besides, pumping and bottle-feeding create unnecessary, extra work for the mother as she recovers from childbirth.

    Occasionally a baby will have difficulty breastfeeding normally. The reasons for this may include:

    • The infant is small, or born before the due date
    • A difficult or complicated birth
    • The infant or mother is ill, or recovering from illness
    • Structural abnormality of the baby’s face or mouth
    • Structural abnormality of the breast or nipple

    When poorly feeding infants are offered a bottle, they then may appear to reject the breast. This is not nipple confusion, but an indication that the infant needs help to breastfeed successfully. In these cases, the baby’s refusal to breastfeed stems from inability rather than preference.

    The term nipple confusion most appropriately refers to an otherwise normal infant who has had too many bottles before breastfeeding has been well established.

    Sometimes nipple confusion occurs in an older baby, previously nursing well, whose mother has returned to work or school. If the mother’s milk supply is low due to lack of stimulation during separations, the baby may begin to prefer the quick, easy flow of the bottle. The key to reversing this situation is to re-stimulate the mother’s milk supply. Mothers also can gently re-focus on the breastfeeding relationship by nursing more often when at home with the baby and cutting back on the number of optional bottles.

    Another type of nipple confusion refers to a baby who refuses to accept a bottle! Breastfed babies love to breastfeed. In such situations, offer the bottle in a low-key manner. Keep practice sessions playful. Reassure the baby often, and stop whenever baby seems stressed. By continuing to offer tastes from the bottle, baby will soon get the idea.Some babies will not accept a bottle from the mother, but will accept a bottle from a father or a babysitter.

    Some older babies prefer to drink pumped milk from a cup, or mixed with solids from a spoon. They may never need to use a bottle.

    Pointers: If Your Baby Seems Nipple Confused:

    • Seek local help via the Breastfeeding National Network (BNN), call 1 800 TELL YOU, ILCA, LLLI, or consult Medela’s Ask an LC .
    • Increase skin-to-skin contact to calm baby
    • Use of a nipple shield can help coax these infants back to the breast.
    • Use of a feeding tube device such as the SNS can provide an increased milk flow allowing supplementation at breast
    • Protect breastmilk supply by increased breastfeeding/pumping


    1. Hill, P, Humenick, S, Brennan,M, et al: Does early supplementation affect long-term breastfeeding? Clin Pediatr 1997, 36:345-9.

    2. Chapman, D and Perez-Escamilla: Identification of risk factors for delayed onset of lactation, J Am Diet Assoc 1999, 99(4):450-54.

    3. Chen,D. Nommsen-Rivers,L. Dewey,K. Lonnerdal.B: Stress during labor and delivery and early lactation performance, Am J Clin Nutr 1998, 68:335-45

    4. Cronenwett,L: Single daily bottle use in the early weeks postpartum and breastfeeding outcome, Pediatrics 1992, 90:760-66.

    5. Neifert,M. Lawrence,R. Seacat,J: Nipple Confusion: Toward a Formal Definition, J Peds 1995, 12(6):125-129.

  • Nipple Shields

    breastfeedingBy Barbara Wilson Clay, BSEd, IBCLC

    Early latch-on problems are not unusual. For most mothers, breastfeeding takes a bit of practice! Most of the time, a little coaching from a skilled helper is all that is needed to get things going.

    For difficult or persistent latch-on problems, many breastfeeding experts suggest the temporary use of a nipple shield. Made of thin, soft, silicone that doesn’t interfere with nipple stimulation, the Medela nipple shield is worn during breastfeeding. Holes at the tip allow milk to flow to the baby. A nipple shield may help protect breastfeeding when:

    • The baby is premature, ill, or small. A nipple shield may make feeding easier for a small or weak baby. Because suction inside the nipple shield holds the nipple in an extended position, the baby can pause without ‘losing’ the nipple. Milk pools in the tip of the shield, and provides an immediate reward when the baby resumes suckling. Research shows that the milk intake of premature infants increases when a nipple shield is used. As the baby gains weight and matures, the shield becomes unnecessary.

    • The mother has flat or inverted nipples. Some new mothers have nipple tissue that is not very stretchable. If it is difficult for the baby to draw in the mother’s nipple, the baby may pull away, cry, or simply fall asleep. The Medela nipple shield provides sensation deep in the mouth that stimulates the baby to keep sucking. As the milk begins to flow, the baby discovers that breastfeeding works! Over time, the mother’s nipples will become more pliable, and the shield is no longer needed to trigger the sucking reflex.

    • The baby has had many bottles and now refuses the breast. Because the nipple shield feels similar to a bottle nipple, it can be used to coax a reluctant baby to accept the breast. Try this trick when the baby is not very hungry and the mother’s breasts are full. Drip a little expressed milk onto the top of the shield to moisten it. Drip milk into the corner of the baby’s mouth to reward the baby for trying. If the milk supply is low, an SNS™ taped under the shield can help provide an encouraging milk flow. Some babies need only a few sessions with a shield to return to full breastfeeding. Other will need more practice, or perhaps brief use of the shield at the beginning of each feed. Bottles can be decreased or discontinued as the baby becomes comfortable with nursing.


    Correct latch is important.

    Correct latch
    Poor latch
    Latch On series

    A good latch is especially important when the mother is using a shield. The baby’s jaws must close on the breast, not out on the shaft of the nipple shield. Sucking only on the nipple pinches off the milk flow and fails to stimulate the milk supply. The baby will not get enough milk, and growth may be affected. It helps to have the baby’s latch evaluated by a trained Breastfeeding Specialist.

    Cleaning the shield is important.

    It is necessary to keep the nipple shield clean. Wash in hot soapy water and rinse in lots of hot water after each use. Boil once daily.

    Choosing the correct size shield is important.

    Chose the right size shield for the size of the baby’s mouth. If a shield is too big, the baby cannot adequately draw up the mother’s nipple, or may gag on the shield. The Newborn Small size shield is best for most small babies.. Medela makes several types of nipple shields, the Newborn Small, Newborn Regular, and Contact™ Nipple Shields in two sizes.

    Protection of the milk supply is important.

    Milk supply is controlled by how much milk the baby takes. A small, weak or poorly suckling baby may under-stimulate the milk supply. When using a nipple shield, it is important to pump after nursing to make sure the breasts are well emptied. Pumped milk can be used to supplement the baby. Pumping after feeding is necessary until it is clear that the milk supply is stable and the baby is growing well. We suggest a hospital quality pump such as the rented Symphony® or Lactina® breastpumps.

    Nipple shields are devices that are used to help babies who are not yet breastfeeding normally. Medela, Inc. suggests that mothers using nipple shields seek advice from a lactation consultant or other trained individual, as well as their physicians. Babies should have weight checks frequently to ensure baby’s health and good growth.

    Helpful Hints:
    Sit the shield on the nipple with the brim turned up like a hat. Then smooth down the edges. This will help the shield stick better. Moistening the edges will also hold it in place. Some mothers have larger nipples than the small shield can accommodate. Try the next largest size. However, observe carefully to see if this size works for the baby. A shield will not solve all problems, and sometimes other equipment may be appropriate.


    The nipple shield is a tool to help solve a specific latch problems. They are not a subsitute for experienced breastfeeding assistance. If you are using a nipple shield, we suggest that you keep in touch with your lactation professional and your physician as you work to breastfeed comfortably and effectively. The goal is to return to full breastfeeding with no need for special equipment. As the baby’s breastfeeding ability improves, remove the shield at various times during each feeding. If the baby seems unable to nurse without the shield, this means the problem is not yet resolved. Just keep practicing. So long as the baby is growing well, the continued use of the shield is not a major problem. If it appears that the baby could manage without the shield and is using it from habit, some mothers try spending a day in bed with the baby. Quiet time with increased skin-to-skin contact and frequent practicing will reassure the baby that he or she doesn’t really need the shield any more. Cutting away the tip of a silicone is not advised. The cut edges may irritate the baby’s mouth.


    P Meier, LP Brown, NM Hurst, D Spatz, JL Engstrom, et al: Nipple shields for preterm infants: effect on
    milk intake and duration of breastfeeding. J Hum Lact 2000, 16(2):115-120.

    Neifert,M: Clinical Aspects of Lactation, in Clinics in Perinatology 1999, ed. by C. Wagner and D. Purohit, 26(2):281-306.

    B Wilson-Clay: Clinical Use of Silicone Nipple Shields, J Hum Lact 1996, 12(4):279-285.

    M Woolridge, J Baum, R Drewett: Effects of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Human Dev 1980, 4:357-64.

  • Nipple Blebs/Blisters

    By Catherine Genna Watson, BS, IBCLC

    A bleb is a small white spot on the tip of the nipple that looks like a tiny, milk-filled blister. The bleb only seems to cover one nipple opening or pore. It can be very painful to the touch and while breastfeeding or pumping. A sucking blister is usually larger and is caused by the baby taking only the nipple into his mouth during sucking, putting too much pressure on the tip of the nipple. Sucking blisters usually go away by themselves within a day or two when baby is latched on better. Blebs often need to be treated before they disappear. Professional help with latch-on technique from an IBCLC can often help solve these problems.

    You can try to open up or remove the bleb at home. First, soak the nipple in warm water to soften the bleb. Then try rubbing it gently with a clean, damp washcloth until it opens or loosens. Next, feed the baby or express some milk to make sure any thickened milk is removed. You may see a small strand of hardened milk come out from the tiny duct opening. This is normal, and will help the healing. Finally, some antibiotic ointment can be used on the sore area until it heals. Ask your doctor to recommend an ointment that will let you keep breastfeeding. Avoid any over-the-counter ointment that contains neomycin. Usually feeding is more comfortable as soon as the bleb is broken.

    If the bleb does not break easily, your doctor or midwife can break it with a sterile needle. This usually works better right after feeding the baby, when the blister is larger. You should continue to breastfeed often to drain the breast and let any thickened milk come out. If breastfeeding is too painful, using a hospital grade rental breast pump for 10 minutes at each feeding time will help maintain your milk supply and prevent mastitis.

    Better positioning should prevent both blisters and blebs. An IBCLC and your doctor can help if you have either problem, or if they come back after treatment.


    Kathleen B. Bruce BSN IBCLC
    Barbara Wilson Clay, BSEd, IBCLC
    Mary Bibb BA, IBCLC

    Lawrence R and Lawrence R. Breastfeeding A Guide for the Medical Profession, 5th edition. Mosby, 1999.

    Newman, J and Pitman, T. The Ultimate Breastfeeding Book of Answers, Prima Publishing, 2000.

    Riordan, J and Auerbach, K. Breastfeeding and Human Lactation, 2nd edition. Jones and Bartlett, 1999.

  • Mastitis

    By Barbara Wilson Clay, BSEd, IBCLC

    Mastitis, or inflammation of the breast, is a relatively common problem for breastfeeding mothers. An area of the nipple or breast becomes painful, red, hard, and may be followed by fever and flu-like symptoms. Experts cannot agree on whether all cases of mastitis represent a true infection. Sometimes, mastitis may be caused by the breast becoming over-full, or blocked because of milk over-supply, ineffective breastfeeding, missed feeds, restrictive clothing, or bruising. The pooled milk that is trapped in the breast can trigger chemical changes that cause pain and redness. This inflammation responds well to extra rest for the mother, and thorough emptying of the affected breast. Some experts suggest using heat and others suggest cold compresses during mastitis. Use of heat should be brief, perhaps just before pumping or breastfeeding in order to prevent more inflammation. Cold may help reduce swelling.

    Mastitis is most common in the first few weeks postpartum, although it can happen at any time, especially if a mother is over-tired, or if she smokes. Cracked nipples put a woman more at risk for infective mastitis. When the skin is broken, germs from the hospital environment, from the mother’s skin, or from the baby’s mouth may penetrate the breast. A woman should call the doctor if she experiences intense pain or fever. (Occasionally women who already are taking ibuprofen or Tylenol don’t realize they have a fever.) Some experts advise rest, hot or cold compresses, and breast emptying for 12 hours. Then, if the symptoms don’t resolve, antibiotics are prescribed. Others begin antibiotic at the first sign of mastitis. Your doctor can guide you, and he or she will chose medications that are considered compatible with breastfeeding. If you begin antibiotic therapy, it is very important to complete your full prescription in order to prevent recurrences. Please note that some mothers who are on antibiotics may develop yeast infections, and will need to be treated for this.

    The most important thing to do if you get mastitis is to continue to breastfeed. Emptying the breast is the best way to obtain relief and help the healing process. Abrupt weaning may cause complications such as breast abscesses. Consider speaking to a breastfeeding support person, such as an IBCLC if you develop mastitis in order to find out about simple ways to prevent it in the future.

    In rare cases, mastitis may result from a more serious type of underlying breast problem. Because women often are treated over the phone for this condition, it is important to see the doctor if you have repeated episodes of mastitis that are always located in the same area of the breast, or if lumps, pain, and redness don’t resolve after treatment. Ultrasound is a safe and effective method to identify abscesses or tumors in the lactating breast. Breastfeeding can continue during treatment for abscesses.

    Kathleen B. Bruce, BSN, IBCLC
    Catherine Watson Genna, BS, IBCLC
    Mary Bibb BA, IBCLC


    L. Amir, Mastitis: Are We Overprescribing Antibiotics? Current Therapeutics, April 2000, 24-29.

    S. Dahlbeck, J. Donnelly, R. Theriault: Differentiating Inflammatory Breast Cancer from Acute Mastitis, American Family Physician 1995; 52(3): 929-934.

    C. Fetherston: Mastitis in lactating women: physiology or pathology? Breastfeeding Review 2001; 9(1):5-12.

    B. Foxman, K. Schwartz, S. Looman: Breastfeeding Practices and Lactation Mastitis, Social Science Medicine 1994; 38(5): 755-761.

    A. Furlong, L. Al-Nakib, W. Knox, A. Parry, N. Bundred: Periductal Inflammation and Cigarette Smoke, Journal of the American College of Surgeons 1994; 179:417-420.

    R. Hayes, M. Michell, and H. Nunnerly: Acute Inflammation of the Breast – The Role of Breast Ultrasound in Diagnosis and Management, Clinical Radiology 1991; 44:253-256.

    V. Livingston, L Stringer: The treatment of Staphylococcus aureus infected sore nipples: A randomized comparative study, Journal of Human Lactation 1999; 15:241-6.

    P. Thomassen, V. Johansson, C. Wassberg, B. Petrini: Breast-feeding, Pain and Infection, Gynecologic and Obstetric Investigation 1998; 46:73-74.

  • Sore Nipple Management

    By Barbara Wilson Clay, BSed, IBCLC

    Multiple Language PDFs

    Breastfeeding is meant to be a comfortable and pleasant experience. During the first week or two, however, many mothers notice nipple tenderness. This may be related to normal postpartum skin changes or to inexperience with latching on. Tenderness of this kind soon disappears. In the meantime, USP modified lanolin such as Medela’s Tender Care™ Lanolin and Hydrogel pads are safe and soothing.

    Nipple pain that occurs between feedings or that continues during the entire feeding is not a normal part of the breastfeeding experience. Tell your lactation consultant, La Leche League or Nursing Mothers’ Council helper, or your health care provider if your nipples become cracked or blistered. Breastfeeding assistance from a knowledgeable breastfeeding professional can often correct these problems.

    Most nipple injury results from a poor latch. Effective latch on insures that the most sensitive part of the nipple tissue is pulled deeply into the baby’s mouth. The tongue is forward over the lower gum to help cushion the compression.

    When a baby is incorrectly latched, the baby grasps just the nipple shaft rather than locating the gum compressions on the breast itself. Mothers can identify a shallow, improper latch by removing the baby and checking the shape of the nipple. If the nipple looks creased, or drawn into a point (like a new lipstick), this is a sign that the baby is compressing the nipple shaft. Cuts can form across the crease line, as well as at the base or junction of the nipple and areola.

    If the milk flow is pinched off due to a nipple latch, if the milk supply is low, or the breast is hard to draw in because of engorgement, the baby will suck harder to get milk. This extra strong suction applied to such a small surface area can cause blistering.


    Seek help to correct the latch-on and positioning problems that cause sore nipples. Often, simple positioning changes can fix the problem.

    Manage engorgement or low milk supply problems.

    Gentle cleansing is good first aid for any cut in the skin surface. Wash your nipples with a mild, non-antibacterial soap during your daily shower. Rinse well.

    Your own milk feels soothing to sore nipples.

    If the nipples become too painful to allow breastfeeding, hand expression or a gentle, effective breast pump will protect your milk supply and provide milk for your baby until healing takes place.

    Broken skin can become infected. Your health care provider may recommend a safe, topical medication to resolve the problem. If mastitis (breast infection) occurs, oral antibiotics can be prescribed that are safe for use by breastfeeding moms.

    Other suggestions for preventing sore nipples:

    Avoid early use of bottles and pacifiers.

    Frequent breastfeeding (8-12 feeds per 24 hours) will prevent the baby from sucking too vigorously due to hunger.

    Soften engorged breasts with hand expression or pumping to help baby latch on. A brief warm shower before expression might be soothing to some moms.

    Express a little milk first to stimulate the let down reflex before latching.

    Use relaxation techniques before and during feedings.

    Check the baby for conditions such as tongue-tie that can contribute to sore nipples.

    Breastfeed on the least sore side first. Limit feeding time on the sore nipple if necessary. (Finish emptying the breast with hand expression or a breast pump).

    To remove the baby from the breast, place a clean finger between the baby’s gums. This will prevent the baby from clamping down on the nipple.

    Avoid synthetic bras and plastic-lined pads.

    Use care when applying herbal preparations. Some can be toxic to the baby, or have strong odors that lead to breast refusal, or can trigger allergic reactions.
    -Avoid the use of Vitamin E on the nipples. This can be toxic to the baby.
    -Many ointments or creams can cause allergic reaction when applied to broken skin. Consult your health care provider or lactation consultant.

    Keep pads and bras dry. Drop bra flaps and allow air to circulate.

    Multiple-hole breast shells hold fabric off of sore nipples and allow air circulation.


    Centuori S, Burmaz T, Ronfani L, Fragiacomo M, et al: Nipple Care, Sore Nipples, and Breastfeeding: A Randomized Trial, J Human Lact 1999; 15(2):125-130.

    Fetherston C: Mastitis in lactating women: physiology or pathology? Breastfeeding Review 2001, 9(1):5-12.

    Lawrence R and Lawrence R: Breastfeeding: A guide for the medical profession, Fifth Ed. Mosby, St. Louis.1999. Pg. 259-261.

    Livingston V and Stringer J: The Treatment of Staphyloccocus Aureus Infected Sore Nipples: A Randomized Comparative Study, J Human Lact 1999, 15(3):241-246.

    Riordan J: The effectiveness of topical agents in reducing nipple soreness of breastfeeding mothers, J Human Lact 1985;1(3):36-41.

    Spangler A and Hildebrandt E: The effect of modified lanolin on nipple pain/damage during the first ten days of breastfeeding, Int J Childbirth Ed 1993; 8(3):15-19.

    Woolridge M: Aetiology of sore nipples, Midwifery 1986; 2:172-176.

    Wilson-Clay B and Hoover K: The Breastfeeding Atlas 1999, Lactnews Press, Austin, Tx. Pg. 10-12, 17-21.

    Zeimer M, Paone J, Schupay J, and Cole E: Methods to Prevent and Manage Nipple Pain in Breastfeeding Women, West J Nurs Research 1990; 12(6):732-744.

    Zeimer M and Pigeon J: Skin Changes and Pain in the Nipple During the 1st Week of Lactation, JOGNN 1993; 22(3):247-256.

  • Fenugreek - An Herb to Increase Milk Supply

    Mothers who wish to build their milk supplies may consider using Fenugreek. Fenugreek is an herb that has long been used by healers as medicine, and as a galactogogue (to boost milk supply). Historically, fenugreek is an herb, trigonella foenum-graecum L, and is grown in various countries around the world including Argentina, France, India, and North Africa, and in the Mediterranean countries. The dried ripe seed of the plant is used, with one active ingredient being diosgenin. Fenugreek is used as a ground seed (high in fiber) in capsule form, or in tea, to increase milk production. The tea is weaker than the capsule form.
    The dose is 2-3 capsules (580-610 mg each), taken by mouth 3 times/day. Taking a lesser dose may not increase supply. Results are often noticed in 1-3 days, although some mothers report no improvement. A bottle of 100 capsules can cost between $6-8 US, and it is available in health food stores and natural food stores. There is no reliable clinical research that supports the use of this herb, although many practitioners do use it with breastfeeding mothers with good success. Fenugreek is used in artificial maple flavorings, and also has a food product. If used to build milk supply, Fenugreek can generally be discontinued after milk supply is increased, as long as a mother can regularly breastfeed or pump.

     The use of Fenugreek may cause a maple-syrup odor in a mother or baby’s sweat. It can have effects such as lowering blood sugar, and may cause allergy in some sensitive people with a history of asthma. Diabetic or asthmatic or allergic mothers should consult health care providers before using Fenugreek. Use of this herb may cause diarrhea. The FDA generally regards fenugreek as safe, but should not be used by pregnant mothers. 





    • Use brand name herbal preparations with expiration dates and capsule strength printed on the label.
    • Consult your doctor and lactation consultant (BNN) if you have milk supply issues. Herbs will not solve all milk supply problems.
    • Check with your doctor before taking any herbal remedy, especially if you have other health concerns.
    • Consult your doctor if you notice side effects of herbal remedies.
    • Check the label, making sure that no other substances are combined with the chosen herb.
    • Watch for diarrhea, aggravation in asthmatic or diabetic conditions.
    • Do not exceed recommended dose, as serious side effects may occur.


    1.Review of Natural Products. Facts and Comparisons, St. Louis, Mo. 1996
    2. Sauvaire Y. Baccou JC. Extraction of diosgenin, (25R)-spirost-5-ene-3beta-ol; problems of the hydrolysis of the saponins. Lloydia 41:247, 1978
    3. Valette G, et al. Hypocholesterolaemic effect of fenugreek seeds in dogs. Atherosclerosis 50(1):105, 1984.
    4. Ribes G. et.al.Effects of fenugreek seeds on endocrine pancreatic secretions in dogs. Ann Nutr Metab 28(1):37, 1984
    5. Dugue P, Bel J, Figueredo M. Fenugreek causing a new type of occupational asthma. Presse Medicale 22(19):922, 1993."
    6. Huggins, K. Fenugreek: One Remedy for Low Milk Production
    7. Lawrence, RA, Lawrence RM, Breastfeeding: A Guide for the Medical Profession, 2000.376.
    8. Hale, T. Medications and Mothers’ Milk. 2000. 260-261

  • Breastfeeding Your Premature Baby Using a Nipple Shield

    Nipple shields are often recommended to help premature babies breastfeed during the final part of the hospital stay and the first weeks at home. If your baby’s doctor, nurse, or lactation specialist has suggested that you try a nipple shield, you probably have several questions about how the shield helps your baby breastfeed, and how to use it correctly. Answers to the following questions will give you the basic facts about nipple shields for premature babies. Then, your baby’s nurse or lactation specialist can help you breastfeed with the nipple shield, so that you can be sure that it is working effectively for you.

    What is a nipple shield?
    A nipple shield is a small, ultra-thin silicone device that fits over the nipple and areola (the darkened part of the breast), and is used during breastfeeding. It is not the same thing as a breast shell, which is worn during pregnancy or between breastfeedings in order to gradually make the nipple longer and easier for babies to grasp. Mothers have used nipple shields for centuries, but until very recently, nipple shields were thicker, and often complicated breastfeeding problems instead of helping them. Newer model, silicone nipple shields have been tested with premature babies, and the results show that the babies take more milk with the shields than without them during the early weeks of breastfeeding.

    Why does my premature baby need a nipple shield?
    Several studies have shown that breathing rates and oxygen levels of premature babies are better during breastfeeding than during bottle-feeding. However, these same studies indicate that premature babies often tend to drink less milk from the breast than from the bottle. Mothers describe these differences in drinking by saying that their premature babies “slip off” of the maternal nipple while they rest between sucks or that they fall asleep within minutes of being placed at the breast. Researchers think that these feeding behaviors occur because premature babies have lower suction pressures than full-term babies. Suction is an important part of breastfeeding, because it allows the baby to pull or draw the mother’s nipple into the mouth, and thereby “stay attached” throughout the feeding. Researchers think that nipple shields help make up for these lower suction pressures in premature infants, because the shields create the suction that the babies cannot produce at this time. As a result, the babies drink much more milk from the breast than they could if the shield were not used. Because suction pressures increase as premature babies approach their expected birth dates, nipple shields are necessary only until about that time.

    How should I use the nipple shield?
    The newer model ultra-thin nipple shields are easy to use, but all mothers need someone to help them use the shield for the first few times. The shield should be placed over the breast so that your nipple fits into the nipple chamber of the shield. Position the shield so that the cut-out area is over the part of the breast where your baby’s nose will be. You can use a little sterile water to help the shield stay against your skin. Then, place your baby in the football position, with one hand supporting your breast. Tickle the side of your baby’s mouth with the nipple portion of the shield. Wait until your baby opens his mouth widely and then gently guide the shield upward over the tongue. It is not necessary to push or force the shield into your baby’s mouth. Then, use the hand holding your baby’s head to guide your baby onto the shield. As your baby starts to suck in response to feeling the shield, continue to guide the head toward you so that your baby’s nose is almost touching your breast. As you move your baby closer to the breast, you will gradually feel stronger suction pressures, a clue that your baby is using the shield effectively.

    Mothers often say that they feel their babies won’t be able to breathe if they are positioned so close to the breast. However, the nipple shield cannot work correctly unless your baby has his lips over the base of the nipple shield. In this position, your baby can squeeze the milk from the breast with each suck, and you will feel a different, stronger type of suction than if your baby has his lips over the elongated chamber of the shield only. Remember, to be effective, the tip of the shield must be in the back part of your baby’s mouth, and the shield should not move in and out of your baby’s mouth during sucking. With a little practice, you will be able to feel when your baby is sucking correctly with the shield.

    How do I know that my baby is drinking enough milk with the shield?
    When a mother has an abundant milk supply and her premature baby sucks effectively with the shield, the milk usually flows rapidly through the shield to the baby. You may notice milk dripping from the opposite breast or a tingling sensation in the breasts, both of which are signs of the let-down reflex, meaning that your milk is being released from the breasts. Most babies respond to this rapid milk flow by sucking more slowly and regularly. You may hear your baby swallowing or see milk dripping around your baby’s mouth. When you remove your baby from the breast, you’ll see that milk has collected in the chamber of the shield. These are signs that the shield is working effectively to help your baby drink milk. However, the only way to really know for sure that your baby drinks enough milk is to have the nurse show you how to measure the amount of milk your baby drinks by weighing your baby before and after the feeding. This procedure, called test-weighing, is a very accurate measure of milk intake when performed with an electronic scale.

    How long do I need to use the shield with my premature baby?
    Researchers who studied the nipple shield found that mothers of premature babies used the shield, at least for some feedings until their babies’ expected birth dates. By that time, mothers said that their babies had enough suction pressure to draw their nipple into the mouth during breastfeeding, and that they stayed awake long enough to take enough milk at the breast without the shield. You will notice this change in suction over time by looking at the position of your nipple in the shield chamber after your baby feeds. The baby’s growing suction pressure pulls the mother’s nipple further into the shield chamber. Watching for this change in the position of your nipple inside the shield is another way to determine when you can stop using the shield.

    In studies, most mothers gradually stopped using the shield over the first few weeks at home. Some found that they did not need the shield for certain feedings during the day when their babies were more awake and eager to feed. Gradually, as their babies matured, the mothers stopped using the shields completely. Other mothers found that their babies were eager to eat at the beginning of breastfeedings, but that they fell asleep before they had taken enough milk. These mothers started the feedings without the shield, and put it on once the babies started to fall asleep, so that the babies would feed for a longer time. Either way, your baby will outgrow the need for the shield around the time of the expected birth date. Overall, the nipple shield will be just a short part of the breastfeeding experience for you and your premature baby.

    ©Rush-Presbyterian St. Luke's Medical Center
    Rush Mothers' Milk Club
    Special Care Nursery
    Used under permission.

    Written by Paula P. Meier, R.N., DNSc, FAAN, Rush-Presbyterian St. Luke's Medical Center.

    Permission granted to distribute for non-commercial purposes
  • Get The Breastfeeding Information Guide!

    One of our most popular resources, the Breastfeeding Information Guide contains a wealth of information that can help set you up for breastfeeding success.

    • Benefits of breastmilk
    • Breastfeeding basics
    • Breastpumping
    • Collection & storage of breastmilk
    • Cleaning
    • Online breastfeeding resources
    • And more!

    Download the Breastfeeding Information Guide now

Going Back to Work

  • Why continue to breastfeed?

    The American Academy of Pediatrics recommends breastfeeding for at least 12 months. The longer babies are breastfed, the greater the health effects for both mom and baby. Breastfeeding is good for your employer too - it reduces parent absence for baby’s illnesses. Breastfeeding reduces cases of:

    • Ear infections
    • Diarrhea
    • Infections
    • Pneumonia
    • SIDS
    • Diabetes
    • Cancer
    • Urinary Tract Infections
    • Meningitis

    • Postpartum bleeding
    • Ovarian cancer
    • Premenopausal breast cancer
    • Obesity (breastfeeding women return to pre-pregnancy weight quicker)
    • Broken bones from osteoporosis

  • How can I find out what I need to know?

    Online resources provide great tips. Browse through our website, visit www.lalecheleague.org, and other breastfeeding websites. Consult with your own lactation consultant. To find a local lactation professional, call 1-800-TELL YOU, or visit the Breastfeeding National Network (BNN).

  • How can I establish a good supply of breastmilk?

    Early breastfeeding is the time when the milk supply is set. Breastfeed frequently to help make lots of milk. Enjoy the time after your baby is born, and rest to regain your energy. Avoid frequent bottles when you and baby are together. Begin offering small bottle feeds when the baby is 3-4 weeks old to help the baby get used to bottles.

  • How can I keep my milk when back at work?

    Flexible scheduling, telecommuting, and job sharing can help. Plan three 15-minute pumping breaks during each 8-hour workday. If your shift is longer than 8 hours, try to add another short pumping session. Double pumping cuts down pumping time, but it is important to pump for 12-15 minutes during each break. You can continue to add small amounts of cooled breastmilk to the same refrigerated container throughout the day.  Avoid adding warm milk to already cooled milk.

    Breastfeed often in the evenings and learn how to breastfeed lying down while you rest. Nighttime breastfeeding boosts supply! If your supply is low, breastfeeding or pumping more often is the simplest way to increase supply.

  • Keeping it all together

    Returning to work after an extended time with baby can be both challenging and rewarding.  During this period you have grown quite fond of your little one and the thought of being away can cause stress and fears.  It also is an opportunity for your baby to experience new things and begin a life of interactivity and discovery.  Learn how to prepare yourself and to make life easier with the helpful information in the related files.  

Breastpumping Information

  • Double Pumping With Medela Breastpumps

    Double-pumping kits offer timesaving benefits by allowing you to express both breasts simultaneously. By cutting pumping time virtually in half, you can successfully complete a pumping session during a regular break period (15 minutes if you're at work). In addition, research indicates that double pumping may increase levels of prolactin, your milk-producing hormone. This unexpected side benefit is important to working mothers and mothers of preterm infants who may have difficulty maintaining and increasing milk supply when the baby isn't available for breast stimulation.

  • Choosing a Breast Pump

    Every breastfeeding mom has a unique experience. Some moms find breastfeeding easy and uncomplicated, while others may find it more challenging. No matter what the experience, all moms breastfeed better with the support of family, friends, and often with the help of a good breastpump.

    Different moms have different needs, so Medela makes a variety of breast pumps. While manual breast pumps are great for moms who spend most of their days and nights with their babies, electric breast pumps are the better choice for moms who are frequently separated from the babies because of work or health problems.

    Hospital-Grade pumps: Recommended if mom is unable to nurse at all due to medical reasons. These pumps are designed to help build and maintain milk supply and are available on a rental basis from hospitals, lactation consultants, or medical equipment rental stores.

    Daily use double pumps: Recommended if mom is employed full-time or needs to pump every few hours.

    Occasional use single or double pumps: Recommended if mom needs to pump just once or twice per day, or a few times per week.

    Shop for Medela breast pumps here, or find them in your local area

  • Choosing Your PersonalFitâ„¢ Breastshield Size

    Medela PersonalFit breastshields are available in five sizes:

    Many women benefit from a size other than the standard 24 mm breastshield. It is almost impossible to tell which size breastshield is the best fit without watching the nipple movement during pumping.

    Should you try a new size?
    • Does your nipple rub sides of tunnel, to the point of causing discomfort?
    • Do you see excessive areola being pulled into tunnel?
    • Do you see any redness?
    • Is your nipple or areola turning white?
    • Do you feel unexpressed milk after pumping?
    Did you know?
    • Pressing breastshields too hard could block milk ducts.
    • Your breastshield size will depend on your breast tissue and skin elasticity.
    • When you apply vacuum pressure, your nipple size could change.
    • Your breastshield size could change over the duration of your pumping experience.
    • You may even need a different size per breast.

    Shop PersonalFit breastshields

    Learn more with our Choosing Your PersonalFit Breastshield Size handout

  • Can I Buy Or Borrow A Pre-owned Breastpump?

    Many mothers have asked if they can safely sell, purchase, or use a previously owned breastpump. Medela is concerned about the health and welfare of breastfeeding mothers and their babies. Medela personal-use breastpumps, such as the Pump In Style® and Freestyle® pumps are designed as single-user products and are registered as such with the FDA.  However, Medela does make hospital-grade breastpumps that are designed for multiple users and available to rent so moms can use the same pump at home that she utilized in the hospital, such as Medela’s Symphony or Lactina pumps.

    The difference between personal use pumps and rental pumps is as follows: 

    Personal Use Breastpumps Personal use pumps that you buy at the store are personal care items, much like a toothbrush. Personal use pumps should never be resold or shared among mothers. The Medela Pump In Style Advanced has an internal diaphragm that cannot be removed, replaced, or fully sterilized. Therefore, the risk of cross-contamination associated with re-using a previously owned pump such as the Pump In Style cannot be dismissed, even when using a new kit or tubing. Another consideration when deciding to borrow or even lend a previously owned electric pump is the pump’s motor life. A high quality electric double pump might last through the breastfeeding of your second child, or even several children. However, like computers or other electronic products, an electric breastpump has a limited lifetime. Medela guarantees its pump motors with a one year warranty. If you use an electronic pump that has been used for more than one year, there is no guarantee that it will generate as much speed and vacuum as it did earlier in it’s life. By using your own pump, you can compare the pump’s performance with each child. However if you borrow a pump, you cannot gauge its performance to ensure it is operating at full capacity.

    Rental Pumps
    Rental pumps such as Medela’s Symphony, and Lactina are designed for multiple users. These pumps have special barriers and filters to prohibit milk from entering the pump motor, which prevent cross-contamination. In addition, each renter uses her own personal set of breastshields, containers and tubing, to ensure the safe use of these pumps.

    Different mothers have different pumping needs and economic means. For this reason, Medela pumps come in a variety of styles and prices. There are also grant programs available for mothers in need. For information on this and Medela products, ask your local rental station. For product information, availability and pricing, visit Breastfeeding National Network (BNN) or call 1- 800 TELL YOU to find a local rental/retail location. Customer Service is available at 1 800 435-8316 for product questions. 


    Contributions made by: Kathleen B. Bruce, BSN, IBCLC, Barbara Wilson-Clay BS, IBCLC; Catherine Watson Genna, BS, IBCLC, and Mary Bibb, BA, IBCLC.

    1 American Academy of Pediatrics: Report of the Committee on Infectious Disease, ed 24, Elk Grove Village, Ill, 1997.

    Blenkharn J: Infection risks from electrically operated breast pumps, J. Hospt Infection 1989; 13:27-31

    Lawrence R and Lawrence R: Breastfeeding: A Guide for the Medical
    Profession 5th ed, Mosby, St Louis, 1999. Pg. 224-225.


  • Exclusive Pumping

    Some mothers exclusively pump and bottle-feed expressed breastmilk. Some mothers pump exclusively from birth by choice, while others reluctantly resort to pumping full or part-time due to problems with breastfeeding that have not been solved. Some reasons that mothers may resort to exclusive pumping might be:

    • Premature or ill baby
    • Anatomic problems in baby
    • Baby who will not latch on to the breast.
    • Severe engorgement, pain, mastitis, inverted or flat nipples
    • Painful breastfeeding
    • Poor or no help with early breastfeeding causing mom to stop breastfeeding
    • Unnecessary advice recommending weaning
    • Temporary medical crisis involving medications
    • Mother who has psychological issue around breastfeeding, i.e. sexual abuse victims
    • Desire to pump exclusively without medical or other indication
    • Perceived low supply

    For mothers who are pumping but who wish to breastfeed directly, we recommend personal consultation for breastfeeding problems with an IBCLC. There are other excellent support services such as physicians, La Leche League, and the Nursing Mothers’ Council. Go to Medela’s Ask the LC pages for on-line support. Problems such as low milk supply, or low weight gain in the infant can often be easily fixed with help and support.

    If a mother cannot or does not wish to breastfeed directly, exclusive pumping, begun soon after birth, can provide baby with breastmilk, which is highly superior to artificial baby formula. Use a hospital grade pump with a double kit, such as the Lactina Select, or the Symphony. Milk production depends on frequent and effective milk removal from the breasts. Pump at least 8 times in 24 hours, or a minimum of 100 minutes per day. Many exclusively pumping mothers find it helps their milk supply if their baby is allowed to spend time skin-to-skin at the breast, even if the baby only nuzzles the nipple.

    Several short pumping sessions are preferable and more effective than longer less frequent sessions. Some herbs and medications can be used to improve supply in mothers who find supply to be an issue. Avoid medications that may cause a decrease in supply, such as birth control medications and over-the-counter oral cold medicines.

    Make sure that the breastpump flange fits well, and that the nipple moves freely within the flange. If a larger breastshield flange is needed, Medela makes PersonalFit™ kits with wider flanges, large ( 27 mm diameter) and extra large (30 mm diameter). If a mother wishes to exclusively pump, the correct equipment, comfortably fitted and used properly and frequently will make her experience more successful.

    Sometimes, mothers who exclusively pump worry that they won’t have enough milk to meet the needs of the older, heavier, 3-6 month old infant. It is normal for milk production to be fairly constant over time. Interestingly, while the volume of milk produced doesn’t change much, the energy requirements of babies actually decrease as they grow towards the 6- month mark. This is because the rate of growth of babies is very rapid at first, but slows down later, providing protection against obesity.

    For information on ways to remedy low supply, see FAQ Low supply or ask our LC.


    Barbara Wilson-Clay BSEd, IBCLC
    Mary V. Bibb BA, IBCLC
    Catherine Watson Genna, BS, IBCLC


    Cunningham AS, Jelliffe DB, Jelliffe EFP. Breastfeeding and health in the 1980's: a global epidemiologic review. J Pediatr 1991;118:659-66

    De Carvalho M, Anderson DM, Giangreco A et al: Frequency of milk expression and milk production by mothers of non-nursing premature neonates, Am J Dis Child 139:483, 1985.

    Hale, Thomas PhD. Medications in Mothers’ Milk. 9th edition. 2000.

    Hill PD, Brown LP, Harker TL: Initiation and frequency of breast expression in breastfeeding mothers of LBW and VLBW infants. Nurs Res 44:352- 5, 1995.

    Hill PD, Aldag JC, Chatterton RT: The effect of sequential and simultaneous breast pumping on milk volume and prolactin levels: A pilot study. J Hum Lact 12:193-9, 1996.

    Hopkinson J, Schanler R, Garza C: Milk production by mothers of premature infants. Pediatrics 81:315-20, 1988.

    P Hill, J Aldag, R Chatterton, Effects of Pumping Style on Milk Production in Mothers of Non-Nursing Preterm Infants, JHL 1999, 15(3):209-216

    P Hill, J Aldag, R Chatterton, Initiation and Frequency of Pumping and Milk Production in Mothers of Non-Nursing Preterm Infants, JHL 2001, 17(1):9-13

    Walker M. A fresh look at the risks of artificial feeding. J Hum Lact 1993;9:97-107 2. Cunningham AS, Jelliffe DB, Jelliffe EFP. Breastfeeding and health in the 1980's: a global epidemiologic review. J Pediatr 1991;118:659-66

  • Expressing Milk for your Premature Baby

    By Paula P. Meier, RN, DNSc, FAAN, Rush-Presbyterian St. Luke's Medical Center

    Breastfeeding a preemie

    Mothers' milk provides important health benefits for premature infants, so whether you've decided to express milk for a short time or to breastfeed for several months, your milk is an important part of your baby's treatment plan. Many people think that giving birth prematurely limits a mother's ability to make enough milk, but this is not true. The extra stress, discomfort, and fatigue that go along with the birth of a premature baby can cause a slow start with milk production. In the first few days after giving birth, mothers may make just drops of milk each time they use the breast pump, so it is easy to get discouraged. Remember, these drops are like a medicine for your baby, because they provide protection from infection. And-- this slow start usually gives way to an adequate milk supply by the fifth or sixth day after birth. Answers to the following common questions will help you get started with milk expression for your premature baby.
    What Type of Breast Pump Should I Use?

    Studies have evaluated the different kinds of breast pumps available to new mothers. The findings show that mothers who are expressing milk for premature babies should use a hospital-grade electric breast pump-ideally with a double collection kit, so that both breasts can be emptied at the same time. This type of pump is the most effective in stimulating release of the milk-making hormone, prolactin, which results in the greatest amount of milk. Mothers sometimes report that they have received a battery-operated or a less-powerful electric pump as a "baby shower" gift, and want to use it to express milk for their premature baby. While this type of pump is suitable for a mother who uses it only once or twice a day and breastfeeds a full-term baby the rest of the time, it does not provide enough stimulation to establish and maintain a good milk supply for a mother who is pumping for a premature baby. If you have received one of these pumps as a gift, you will be able to use it later-after your baby comes home and is feeding.well from the breast. But, in the first few weeks after premature delivery, you should plan to rent a hospital-grade electric pump.

    How Often Should I Use the Pump?

    During your first week or two of milk expression you should use the pump as frequently as 8-10 times daily-about as often as a healthy, full-term baby would feed at the breast in the early days after birth. The purpose of this frequent pumping is to stimulate prolactin during the time that your body is beginning to make milk in plentiful amounts. While you may get only drops of milk at first, frequent pumping is important in building an abundant, long-lasting milk supply. You may not see the results of your pumping immediately, but your efforts should pay off toward the end of the first week of milk expression. Do not set a clock to wake up at night to pump. However, if you wake up on your own-as many mothers do-an extra night-time pumping may help boost your milk supply. You may want to call the nursery, check in on your baby, and use the pump before going back to sleep.

    How Long Should a Pumping Last?

    In the first few days after birth, most mothers express very small amounts of milk-from a few drops to a few teaspoons-at each pumping. During this time, a pumping session should last from 10-15 minutes, which is enough time to stimulate the release of prolactin. However, after the milk has "come in" several days later, and you produce more than half an ounce at each expression, you should use the pump until your milk has stopped flowing for at least 1-2 minutes. The last droplets of milk released during pumping contain very high levels of fat, which provides most of the calories in your milk. If you stop pumping after 10 or 15 minutes while your milk is still flowing, your baby may not receive these valuable fat calories. Also, your breasts need to be emptied as much as possible--meaning that milk flow has stopped-otherwise your body thinks that the milk left in the breasts isn't needed, and less will be produced. A few mothers say that the milk never "stops" flowing while they pump. As a general rule, you should not pump for more than 30 minutes, even if milk continues to flow. Also, if you pump for this long at each milk expression, you do not need to pump as frequently as a mother who can express her breasts in less time.

    What is a "Normal" Amount of Milk?

    Nearly all mothers of premature babies worry about whether they are producing a "normal" amount of milk. Many things affect the amount of milk a mother produces-especially in the first few days after giving birth. A mother of a full-term breastfeeding baby produces only about an ounce of milk during the first 24 hours after birth, but by the 3rd or 4th day is making several times that amount. Mothers of prematures frequently take a longer time to go from a few drops to an ounce or more at a pumping. This condition is referred to as a delayed onset of lactation, and is related more to pregnancy complications-such as bedrest, medications for high blood pressure and premature labor, and Cesarean deliveries-rather than to premature birth itself. No one knows exactly why this is the case, but researchers think that the milk-making hormones or tissues in the breast may be affected temporarily by these complications and medications. A slower onset of milk production does not necessarily mean that a mother will not make enough milk for her baby-only that it may take her a few extra days in the beginning to catch up with mothers who have had uncomplicated deliveries. Ideally, by the end of the second week of pumping, you'll be producing at least 500 ml (about two cups) of milk each day. This is the amount of milk that your baby will need at the time of hospital discharge. Thereafter, you will want to maintain or even increase this amount so that you have enough milk to feed your baby after discharge hospital discharge.

    Can I Do Anything to Increase My Milk Supply?

    Fatigue, pain, and stress-all of which are common among mothers of prematures-cause the body to release a substance that interferes with prolactin. While it may be difficult for you to overcome all of these barriers, most of these do diminish or become more manageable over time. Some things have been shown to increase the milk supply. First, try to spend as much time in the nursery with your baby as possible during these early days, if that is where you are the most relaxed. Family members often feel that mothers should stay at home and rest after giving birth prematurely, but mothers report that being separated from their babies causes even greater stress. When you are in the nursery, request a comfortable chair, and use the breast pump at your baby's bedside where you can see and touch your baby. When you are not in the nursery, pump where you can see your baby's picture. If your baby's condition permits, ask to hold your baby in Kangaroo--or skin-to-skin-Care. Don't be afraid to take pain medications that your doctor has prescribed. These medications can be used safely with breastfeeding, and pain relief is important to milk production. In some instances, prescription medications may be used to stimulate prolactin and increase the milk supply. Typically these medications are used after the second week of lactation, and require a prescription from your obstetrical care provider.

    ©Rush-Presbyterian St. Luke's Medical Center
    Rush Mothers' Milk Club
    Special Care Nursery
    Used under permission.

    Written by Paula P. Meier, R.N., DNSc, FAAN, Rush-Presbyterian St. Luke's Medical Center.

    Permission granted to distribute for non-commercial purposes

    For additional questions and for help in transitioning your baby to the breast when the baby is ready, talk to your doctor, the NICU nurse at your hospital, and your IBCLC lactation consultant. For help in in finding a breastpump rental location or breastfeeding professional where you live, visit the Breastfeeding National Network (BNN) or call 1 800 TELL YOU. You can also get a referral to an IBCLC lactation consultant from your local La Leche League Leader (www.lalecheleague.org). You can e-mail the Medela online nurse lactation consultant with any breastfeeding questions.

  • How to Manually Express Breastmilk - The Marmet Technique

    Draining the Milk Reservoirs

    1. Position the thumb (above the nipple) and first two fingers (below the nipple) about 1” to 1–1/2” from the nipple, though not necessarily at the outer edges of the areola. Use this measurement as a guide, since breasts and areolas vary in size from one woman to another. Be sure the hand forms the letter “C” and the finger pads are at 6 and 12 o’clock in line with the nipple. Note the fingers are positioned so that the milk reservoirs lie beneath them.

    • Avoid cupping the breast

    2. Push straight into the chest wall

    • Avoid spreading the fingers apart.
    • For large breasts, first lift and then push into the chest wall

    3. Roll thumb and fingers forward at the same time. This rolling motion compresses and empties milk reservoirs without injuring sensitive breast tissue. 

    Note the position of thumb and fingernails during the finish roll as shown in the illustration.

    4. Repeat rhythmically to completely drain reservoirs.
    • Position, push, roll...
    • Position, push, roll...

    5. Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast.

     Avoid These Motions

    1. Do not squeeze the breast, as this can cause bruising.

    2. Sliding hands over the breast may cause painful skin burns.

    3. Avoid pulling the nipple which may result in tissue damage.


    Marmet Technique copyright 1978, revised 1979, 1981 and 1988. Used with permission of Chele Marmet and the Lactation Institute, 1616 Ventura Blvd., Suite 223, Encino, California 91436

  • Keeping a Feeding/Pumping Log

    Congratulations on your decision to provide the healthy benefits of breastmilk to your baby!

    Thinking about keeping a feeding/pumping log? It's a good idea - a log can help:

    • Provide a record to track your baby's feedings
    • Record important information to share with your pediatric healthcare provider
    • Track baby's wet and dirty diapers
    • Provide you with useful information and tips on breastfeeding, pumping and breastmilk handling
    • Identify possible breastfeeding and pumping concerns before your milk supply may become an issue

    Here are a couple of ways to keep your feeding/pumping log:



    The MyMedela App
    In addition to tracking feeding and pumping, the MyMedela app helps you stay confident and reach your goals with personalized tips and dashboards as well as encouraging motivations. Learn more + download






    Printable Feeding/Pumping Log
    Provides a great way to keep track on paper if you don't have the MyMedela app, or to keep for entry into the app later. Download now

Ask The LC

At Medela we are committed to supporting mothers who wish to breastfeed their babies by providing the best breastfeeding related products and services.  We invite you to consult one-on-one via email with our Board-Certified Lactation Consultant who will assist you with your breastfeeding questions and concerns.

Read our Legal Disclaimer Regarding Online Lactation Assistance

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Breastfeeding University

                                                                                                                                                                                             En Español 

Medela's Breastfeeding University is a collection of online courses and videos designed to help prepare expectant and existing mothers, fathers and even grandparents for the experience of breastfeeding.

Set yourself up for success!
Breastfeeding is a natural process, but it's also a learned skill that improves with knowledge and practice. These classes and videos can help you achieve your breastfeeding goals. The courses are self-paced, so it's easy to fit into your schedule.


Introducing a Bottle to Your Breastfed Baby

Using The Calma Feeding Nipple with Your Breastfed Baby

Online Courses
All About Breastfeeding Online Course Topics
(10-15 minutes each)


  • Making the Decision on How to Feed Your Baby
  • The Breastfeeding Lifestyle
  • Preparation for Breastfeeding
  • How Breastfeeding Works
  • Beginning Breastfeeding
  • Life With a Breastfed Baby
  • Overcoming Possible Breastfeeding Difficulties
  • Special Situations

Want to know more about the classes? Watch an overview now 


All About Breastfeeding

Enroll Now

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