Breastfeeding at Home

Your baby still may not always be able to give you the “I’m hungry” signals or always breastfeed well by the time he or she leaves the hospital, but the Woman’s Center for Newborn and Infant Care staff and lactation consultants will be able to work with you to develop a discharge breastfeeding plan. Your discharge plan will be designed with you, and your baby’s unique situation in mind. However, the plan may include all, or some, of the features listed.

Common features of a breastfeeding plan

Click here for a printable breastfeeding chart! (Adobe Acrobat required) It may help to keep a simple checklist chart to mark daily feedings and diaper counts until your baby is gaining weight appropriately.

• Wake the baby to breastfeed every 3 hours or at least 8 to 10 times per day if he or she has not yet mastered signals that tell you “I’m hungry.” Some of the “I’m hungry” signals include rooting, sucking on hands, fussiness, and crying. Crying is a late sign of hunger.
• Nurse your baby whenever he does give you the “I’m hungry” signals, even if it has not been 3 hours since the last feeding.
• Monitor latch on, nutritive versus non-nutritive sucking patterns before, during, and after milk let-down, and the length of feedings.
• Chart the number, amount, and color of the baby’s urine and stools for wet and dirty diapers on a daily record. Your baby should produce six or more soaking wet diapers in 24 hours with a bowel movement following two or more feedings each day.
• Test weigh your baby before and after some feedings.
• Use breastfeeding devices such as a nipple shield to encourage nutritive sucking or supplemental bottles with formula or breastmilk to provide your baby with additional nutrition during the “learning to breastfeed” process.
• Offer additional expressed breast milk or a prescribed infant formula. This additional amount should be based on your baby’s progress at breast and changed as sucking ability improves. Supplementing should be expected if your milk supply at discharge was not fully meeting your baby’s needs or if your baby was not yet nursing well at every feeding. As your baby nurses more often and more effectively, your milk supply will most likely increase naturally, and your baby’s need for extra feedings will decrease. Pumping after feedings will also help to increase your milk supply.
• To make sure your baby receives enough calories, you may need to add powdered formula to your expressed breast milk. You can do this by mixing the formula into the breast milk before the feeding.
• You may need to fortify any additional expressed breast milk you offer your baby to maximize calorie intake. This is usually done by mixing powdered formula into the breast milk before feeding.
• Pump to remove milk until you and the baby’s doctor are satisfied that your baby no longer needs additional expressed breast milk. Your baby should completely empty your breasts during each nursing.
• Continue a schedule of follow-up care by the baby’s doctor and your lactation consultant to help you monitor breastfeeding progress and revise the plan as needed.
• If you still have problems with breastfeeding after you are home, the hints listed may help.

Hints for Breastfeeding at Home

• Skin-to-skin contact is not just something you do with your baby in the hospital. It continues to benefit you and your baby at home, too. Many mothers report that it seems to help them continue to produce milk. Also, it just feels good to cuddle this way.
• If your baby sometimes chokes during breastfeeding, he or she may be having difficulty controlling the milk flow during let-down. Most babies do learn to handle milk let-down as they mature. Until then, you might try pumping through the let-down immediately before a feeding. Another option is to take the baby off the breast until the milk flow slows. Some mothers find it helps to position the baby so that the back of his or her throat is higher than the nipple. The milk then travels uphill during a let-down, which slows the flow.
• When your baby has the basic idea of nutritive sucking but cannot seem to do it every time, try pumping one breast while nursing your baby on the other.
• You may want to stop a breastfeeding session if you or your baby gets too frustrated or when feedings are taking longer than 40 to 45 minutes. Often a high-risk baby will latch on and then let go of the breast repeatedly. You may also need to keep waking the baby if he quickly falls asleep after sucking for only 2 or 3 minutes. By stopping when frustrated or limiting the time of feedings, you will have more time to pump and remove milk well.
• You may want to let your baby’s father or other family members and friends help with the supplemental bottle feedings. This will free you to concentrate on the breastfeeding and pumping sessions.
• Stay in touch with the hospital lactation consultants who can describe and demonstrate alternative feeding methods and help you figure out which ones to try. Consultants can also help you revise your breastfeeding plan as often as needed as your baby’s nutritive sucking continues to improve.
  It may help to keep a daily feeding diary. The diary should include the number of breastfeedings, the amount and kind of supplement used, the number of diapers that are wet, and how many bowel movements for each day. Also include the time, length, and amount of milk obtained from additional pumping sessions.
• You may want to consider temporarily renting a scale at home to monitor your baby’s weight and intake. Talk with your breast pump rental station to find out if they have scales to rent as well. Medela® offers a rental scale for use with breastfeeding at home called the BabyWeigh™ Scale.
• Keep thinking positively. It is normal to get frustrated and think your high-risk baby will never learn to breastfeed well. It is normal if some days seem like a never-ending cycle of breastfeeding practice, bottle-feedings, and breast-pumping sessions. It is also normal for your confidence with breastfeeding to rise and fall.
• Get support by staying in touch with the hospital lactation consultants and contacting a local breastfeeding support group. Some of these groups are listed on the insert in the back of this booklet.