Breastfeeding Q&A

New parents are faced with the decision of how to feed their newborn. The options include exclusive breastfeeding, breastfeeding and supplementing with pumped milk or formula, pumping and feeding breastmilk in a bottle, giving donor milk or giving formula. Oftentimes circumstances require making changes to the feeding plan, despite an already agreed upon method. For mom’s who choose to breastfeed, it’s very important for them to receive adequate support.

The feeding method families choose is a personal choice. My recommendation is that families discuss the options with their pediatrician prior to the birth of their baby. (For those families who do not yet have a pediatrician, this is a great time to make that choice!) However, you may still have questions. Here are some points to consider.

• Breastfeeding offers health benefits for mom and baby.
• Babies get important antibodies that prevent infection in the early months of life.
• Babies who are breastfed may have decreased risk of developing allergies and a decreased risk of sudden infant death syndrome.
• Moms who are breastfeeding have decreased postpartum bleeding and decreased risk of ovarian and breast cancer.

When should mothers avoid breastfeeding?

• Babies with galactosemia should not breastfeed. They require special formula that they can properly digest.
• Mothers with HIV are discouraged from breastfeeding.
• Breastfeeding mothers should avoid illegal drugs and marijuana.
• Alcohol can be consumed, ideally about 2 hours before the next feeding. Mothers do not need to pump and dump.

How do you know if baby is getting enough milk?

• You should see about 1 wet diaper per day of life until the milk comes in around day 4. Poops will be black and tarry at first but should transition to yellow by day 4. If you do not see adequate output, have your baby weighed.
• Your pediatrician will weigh your baby until they see good weight gain.
• If your baby looks yellow (jaundiced), take them to see the pediatrician.
• Overall, feed your baby until they are completely finished. If they still seem hungry, feed on the other side. Once baby no longer seems hungry, expect the next feeding to be anywhere between 1-3 hours later.

What if you are asked to supplement or think you need to?

• If your pediatrician asks you to supplement, be sure to know how much is recommended. I typically recommend breastfeeding first so that baby extracts all of the milk they can. This helps with the supply and demand part of milk production.
• Ask your pediatrician what they recommend to supplement with. You may be able to pump your milk and give that to your baby. Otherwise, safe and pasteurized donor milk or formula is perfectly fine.

What if you are prescribed medication while you are breastfeeding?
Most over the counter and prescription medications are generally considered safe during breastfeeding. However, some medications can cause side effects for baby and some can actually affect your ability to make milk. Your obstetrician or pediatrician has access to books and databases that provide important information regarding medications while breastfeeding.

Local resources
A terrific local resource for breastfeeding moms is the San Diego Breastfeeding Coalition. For moms using formula, visit https://www.drjaimefriedman.com/baby-formula/ for more information.