Breastfeeding - Low Carb Diet

A low-carb diet is a great option for some women because they can take off weight very quickly. However, diets like Atkins, South Beach and other Low-carb alternatives can cause some problems for a breastfeeding mom.

Most of these problems are related to what a very low carb diet can do to your body. During the early phases of these diets, you leave out carbohydrates in order to enter a fat-burning stage called ketosis. This burns fat, lessens hunger and flushes water out of the body. However, the ketones released into your breast milk WILL reach your nursing child and they have not yet determined if that is safe.


According to Atkins Health and Medical Information Services:“The reason for [recommending that breastfeeding mothers not follow the Atkins diet] is because the only studies that observe ketosis in pregnancy or breast feeding are in uncontrolled diabetics who are in ketoacidosis, not the same thing as ketosis.
There are NO studies that show the safety of burning ketones and its effect on babies (either in utero or breast feeding). We do know that ketones are found in breast milk. Babies may have a different threshold of tolerating ketones than adults, maybe not, but I'm sure you do not want your child to be the guinea pig!”



Having said that, as long as you only use the maintenance stage of a low card diet, you will still probably lose weight, but slower and without releasing ketones.

Tips for moms who still wish to try a low-carb diet:
•Wait until baby is at least 6 months old before dieting and has started solids foods.

•Avoid dehydration by drinking water, water and MORE WATER!


•Start gradually and avoid “phase one” of any of the diets.


•Do not drop below 1800 calories per day on a low carb plan.


•Keep an eye on baby's diaper output and weight gain. If you notice a decrease in your milk supply, stop immediately.

Neonatal circumcision: Effects on Breastfeeding

Neonatal circumcision: Effects on breastfeeding and outcomes associated with breastfeeding.

Aim: There have been recurrent claims made that neonatal circumcision disrupts the development and maintenance of breastfeeding in infants. The aim of the current study was to use a longitudinal birth cohort study to examine the associations between neonatal circumcision status and both breastfeeding outcomes, and health and cognitive ability outcomes associated with breastfeeding.

Method: Data were obtained from the Christchurch Health and Development Study, a longitudinal study of over 1000 individuals born in Christchurch New Zealand in mid 1977. Data were obtained for male cohort members (n = 635) on circumcision status, breastfeeding outcomes, health outcomes in infancy and cognitive ability outcomes later in life.

Results: Circumcision status was not significantly associated (P > 0.05) with breastfeeding outcomes in infancy, even following adjustment for covariate factors, including maternal age, family socio-economic status, ethnicity and birthweight. Also, circumcision status was not significantly associated (P > 0.05) with health in infancy and cognitive ability outcomes in later childhood, even after adjustment for covariate factors.

Conclusions: There was no evidence of an association between neonatal circumcision status and breastfeeding outcomes, or between circumcision status and health and cognitive ability outcomes associated with breastfeeding, and the findings do not support the view that neonatal circumcision disrupts breastfeeding.

Breastfeeding Pics

Photo courtesy of 007 Breasts


Breastfeeding pictures can be viewed on the link provided above.

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Cetirizine / Zyrtec® in Pregnancy and Breastfeeding

Cetirizine (Zyrtec®)
CATEGORY: B
Antihistamine. Metabolite of hydroxyzine. Molecular weight: 461.82.
"In mice, rats, and rabbits, cetirizine was not teratogenic at oral doses up to 96, 225, and 135 mg/kg, respectively (approximately 40, 180 and 220 times the maximum recommended daily oral dose in adults on a mg/m 2 basis)".

In a prospective, controlled, observational study of women exposed to either hydroxyzine or cetirizine during pregnancy 39 women were exposed to cetirizine during organogenesis. Most of the women had been treated with cetirizine for rhinitis or urticaria. There were no significant differences found between the cetirizine group and a control group in the rates of major or minor anomalies, spontaneous abortions, stillbirths, mean birth weight, mode of delivery, gestational age, or presence of neonatal distress.

In an observational study of newly marketed drugs prescribed in England cetirizine was taken during the first trimester in 20 pregnancies. One patient chose to have an elective abortion. There were 4 spontaneous abortions. The remaining mothers delivered 16 normal infants (one set of twins).

The American College of Obstetricians and Gynecologists (ACOG) and The American College of Allergy, Asthma and Immunology (ACAAI) recommend chlorpheniramine and tripelennamine as the antihistamines of choice for pregnant women. Cetirizine and loratadine may be considered (preferably after the first trimester) in patients who cannot tolerate or do not respond to maximal doses of topical therapy.

BREAST FEEDING: Excreted into human milk. Not considered compatible with breast feeding by the manufacturer.

Will Breastfeeding Confine Me to Home?

No! During the first months when babies need to be breastfed often you can carry on with your usual activities, just bring your baby along. Breastfed babies are very portable. You’ve already got your supply of milk handy, just grab your diaper bag when you leave! As your baby gets older and the time between feedings spaces out, you may be able to accomplish your errands between feedings. At other times you may need to leave your baby and some of your pumped breast milk with a caregiver. Either way, you can resume breastfeeding when you return home.

Breastfeeding - How do I know when it's time for a feeding?

At first, you're going to do a lot of feeding on demand, feeding your baby whenever she's hungry. This could mean up to every two to three hours. Typically, you can expect to breastfeed 8 to 12 times over a 24-hour period.

Feed your baby from each breast for as long as she wants. Alternate the breast you begin with at each feeding. This allows each breast to produce the proper amount of milk at each feeding.

Sometimes babies may want to feed more frequently and for very short periods of time. This is called “cluster feeding” and often occurs in the evening. This may mean your baby is going through a growth spurt. These usually happen around 2 weeks, 4 to 6 weeks, 3 months, and 6 months. Let your baby set the pace.

Will Breastfeeding Cause Me to Lose My Figure?

No! Quite the contrary! Breastfeeding has the extra advantage of helping you get back to your pre-pregnancy figure faster. our body will “burn” approximately 500-700 extra calories each day in the production of breast milk for your baby.
While you may be concerned about losing the weight you gained during pregnancy, gradual weight loss over 6-12 months is recommended. Eating a well-balanced diet and avoiding the “empty calories” found in sweets and fatty foods should help you to lose weight. You can also participate in your favorite activities, sports and exercise programs of stretching and low impact aerobics when your physician gives the approval. Poor diet and lack of exercise can adversely affect your recovery.
Your breast size should increase during pregnancy and while breastfeeding. Breasts return to their pre-pregnancy state well after weaning. While your breasts may become less firm, this is a result of pregnancy - not breastfeeding.

Why is Breastfeeding Best for Me and My Baby?

Easy and convenient. Infant formulas require preparation, warming or sterilization of milk or bottles for feeding. When you breastfeed, you will always have just the right amount, at just the right temperature with no bottles to clean! Enhances bonding and helps encourage a close relationship with your baby.

Improves mom’s recovery time. The hormones released while breastfeeding cause the uterus to contract and return to its previous size. When you breastfeed immediately and frequently after delivery, bleeding is reduced since your uterus is already beginning to contract and reduce in size.

Helps prevent maternal illnesses. Mothers who do not breastfeed have a higher incidence of anemia (low iron levels), breast cancer, ovarian cancer, uterine cancer and osteoporosis in later life.

Improves baby’s future dental health. The type of suckling babies use with bottles leads to higher incidence of severe dental problems and more orthodontic corrections later in life.

Saves money. Using infant formula for the first year of your baby’s life can cost as much as $1,500-$1,800! That doesn’t even include the cost of bottles, artificial nipples.

Why is Breast Milk the Best Choice?

Your baby will most likely be healthier! Formula fed babies have more colds, diarrhea, ear infections, urinary infections
and hospital admissions. Research shows they also have a higher incidence of diabetes, obesity and certain kinds of
cancer in childhood. Formula fed babies also develop more allergies and asthma.
Your baby will most likely be smarter! Research shows that formula fed babies may have lower IQs.
Breast milk contains unique ingredients not found in infant formulas that are important for growth and development of your baby. Breast milk is all the nutrition your baby will need for the first six months of life. Cows milk, which is the basis of most infant formulas, is ideally suited for the needs of a newborn calf and is substantially altered in an attempt to mimic breast milk.

Breast milk provides your baby with immunities not found in infant formula. The milk you produce during pregnancy is called colostrum. Colostrum, baby’s first milk, is very high in immunity factors. This plays a major role in protection against
infection and disease in your newborn. These immunity factors continue to be found in mature breast milk as well.

Breastfeeding - Attaching Baby to the Breast

Latching the baby on correctly is the key to a pleasant, rewarding breastfeeding experience. Nursing behavior patterns are established early. Once set, bad habits are difficult to correct. Make sure you and your baby get off to a good start. A variety of reading materials and videos are helpful, but there is nothing like hands-on assistance from an experienced health care provider. Don't hesitate to ask for help the first few times. If you are still having difficulty by the time you leave the hospital, contact a breastfeeding specialist or a La Leche League leader.

Step 1

For most women, sitting up in bed or in a comfortable chair is easiest for breastfeeding. Make sure you are relaxed before you put the baby to breast. Use pillows on your lap, under your arms and behind your back. Putting your feet on a footstool to raise your knees slightly above your hips will eliminate back strain and put your body at the right angle.

Make sure your baby is comfortable and feels secure and supported. Nestle the baby in your arm at the level of your breast with his head and shoulders supported by your forearm just below your elbow, with your other hand holding his bottom. A nursing pillow can also help support your baby comfortably, while providing a resting place for your arms. The baby should be turned toward you, chest to chest, his head and trunk in a straight line, so that he doesn't have to strain or turn his head to attach to the breast. Tuck the baby's lower arm into the pocket between the two of you; if necessary, hold his upper arm down gently with the thumb of your supporting hand. Be careful not to tilt the baby's head down, as it will be difficult for him to swallow in that position. A very slight extension of the baby's head, with his chin touching your breast, will help keep his nose clear without your having to press on your breast tissue.

The proper way to hold the baby is chest-to-chest, at the level of the breast. Baby's head should
be in the crook of your arm and your hand should hold baby's buttocks.

The football hold is a good position for latch-on problems, or for premature or Cesarean birth babies.

The lying down position is especially useful after a Cesarean birth.


Two alternative positions are the clutch (football) hold, and lying down. The clutch is especially helpful if you are having difficulty getting the baby attached to the breast or if you have had a Cesarean birth.

Step 2

Hold your breast with your fingers underneath and thumb on top, making sure all of your fingers are placed well away from the areola. It is sometimes helpful if you roll your nipple between your fingers for a couple of seconds to help it become more erect. Then manually express a couple of drops of colostrum to entice the baby to take the breast. A woman with large breasts may find it comfortable to help support the weight with a rolled washcloth or diaper under the breast.

Step 3

Gently tickle the baby's lower lip with your nipple to encourage him to open his mouth wide. The moment he opens wide, almost like a yawn, quickly pull him in close to you. Do not lean forward, trying to put your breast into the baby's mouth. Instead, pull the baby toward you so that he has a large mouthful of breast tissue. His chin should be pressing into your breast; his nose should be just touching your breast. Keep supporting your breast with your hand until the baby is latched-on and is sucking well. Women with large breasts may have to support their breast throughout the entire feeding; smaller-breasted women may not need support.

The key to successful latch-on and preventing nipple soreness is to teach your baby to take a large portion of the areola into his mouth.

Breastfeeding - Getting Enough Milk

Most new mothers are concerned about their babies getting enough milk. In the first few days, when you're in the hospital your baby should stay with you in your room if there are no complications with the delivery or with your baby's health. The baby will be sleepy. Don't expect the baby to wake you up when he or she is hungry. You will have to wake the baby every one to two hours to feed him or her. At first you will be feeding your baby colostrum, your first milk that is precious thick yellowish milk. Even though it looks like only a small amount, this is the only food your baby needs. In the beginning, you can expect your baby to lose some weight. This is very normal and is not from breastfeeding. As long as the baby doesn't lose more than 7 to 10% of his or her birth weight during the first three to five days, he or she is getting enough to eat.

You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, when your milk is low in volume and high in nutrients, your baby will have only 1 or 2 wet diapers a day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day. Consult your pediatrician if you are concerned about your baby's weight gain. You should visit your pediatrician between three to five days after your baby's birth and then again at two weeks of age.

This chart shows the minimum number of diapers for most babies.
It is fine if your baby has more.

Day 1 (birth) 1 Thick, tarry and black
Day 2 2 Thick, tarry and black
Day 3 3 Greenish yellow
Day 4 5 - 6 Greenish yellow
Day 5 5 - 6 Seedy, watery mustard color
Day 6 5 - 6 Seedy, watery mustard color
Day 7 5 - 6 Seedy, watery mustard color

After you and your baby go home from the hospital, your baby still needs to eat about every one to two hours and should need several diaper changes. You still may need to wake your baby to feed him or her because babies are usually sleepy for the first month. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the feeding. If you are having a hard time waking your baby, you can try undressing or wiping his or her face with a cool washcloth. If your baby falls asleep while breastfeeding, you can try breast compression. As your milk comes in after the baby is born, there will be more and more diaper changes. The baby's stools will become runny, yellowish, and may have little white bumpy "seeds."

Overall, you can feel confident that your baby is getting enough to eat because your breasts will regulate the amount of milk your baby needs. If your baby needs to eat more or more often, your breasts will increase the amount of milk they produce. To keep up your milk supply when you give bottles of expressed breast milk for feedings, pump your milk when your baby gets a bottle of breast milk.

Other signs that your baby is getting enough milk are:


Steady weight gain, after the first week of age. From birth to three months, typical weight gain is four to eight ounces per week.

Pale yellow urine, not deep yellow or orange.

Sleeping well, yet baby is alert and looks healthy when awake.

Remember that the more often and effectively a baby nurses, the more milk there will be. Breasts produce and supply milk directly in response to the baby's need or demand.

Breastfeeding - Breast Compression

Breast compression is a technique made popular by pediatrician and breastfeeding expert Dr. Jack Newman and helps a baby get more milk at each feeding. Once your baby is latched-on well, breast compression will keep him or her feeding actively for a longer time and to “finish” the first breast offered. This is especially helpful for babies who tend to fall asleep at the breast in the middle of a feeding. Despite what many mothers in the hospital are told, this technique does not raise your risk of getting plugged ducts.

When the baby is drinking milk, you do not need to use any breast compression, but once the baby is no longer drinking and is just nibbling, you can start the technique.

Once your baby has finished the first breast and still wants more milk, you can offer the other breast. Signs that your baby has finished with the first breast are falling asleep at the breast and doing no more opening wide, pausing, then sucking. If the compression does not work at first, it does not mean that you have to switch breasts right away. If your baby comes off the breast by him or herself, you might want to try offering the first breast again to see if he or she will drink more. If not, or if your baby is getting fussy or sleepy because the milk flow is slow, you can change your baby over to the other breast. You can experiment with this technique and do a variation of it that works best for you.

Breastfeeding - Tips for Making It Work

Breastfeeding can be a wonderful experience for you and your baby. It's important not to get frustrated if you are having problems. What works for one mother and baby may not work for another, so just focus on finding a comfortable routine and positions for you and your baby. Here are some tips for making it work:

1. Get an early start. You should start nursing as early as you can after delivery (within an hour or two if it is possible), when your baby is awake and the sucking instinct is strong. At first your breasts contain a kind of milk called colostrum, which is thick and usually yellow or golden in color. Colostrum is gentle to your baby's stomach and helps protect your baby from disease. Your milk supply will increase and the color will change to a bluish-white color during the next few days after your baby's birth.

2. Nurse on demand. Newborns need to nurse often. Breastfeed at least every 2 hours and when they show signs of hunger, such as being more alert or active, mouthing (putting hands or fists to mouth and making sucking motion with mouth), or rooting (turning head in search of nipple). Crying is a late sign of hunger. Most newborn babies want to breastfeed about 8 to 12 times in 24 hours.

3. Feed your baby only breast milk. Nursing babies don't need water, sugar water or formula. Breastfeed exclusively for about the first six months. Giving other liquids reduces the baby's intake of vitamins from breast milk.

4. Delay artificial nipples (bottle nipples and pacifiers). A newborn needs time to learn how to breastfeed. It is best to wait until the newborn develops a good sucking pattern before giving her or him a pacifier. Artificial nipples require a different sucking action than real ones. Sucking at a bottle can also confuse some babies when they are first learning how to breastfeed. If, after birth, your baby needs to be taken away from you for a length of time and has to be given formula, ask the nurse to use a syringe or cup when feeding him/her to avoid nipple confusion.

5. Breastfeed your sick baby during and after illness. Oftentimes sick babies will refuse to eat but will continue to breastfeed. Breast milk will give your baby needed nutrients and prevent dehydration.

6. Air dry your nipples. Right after birth, you can air-dry your nipples after each nursing to keep them from cracking. Cracking can lead to infection. If your nipples do crack, coat them with breast milk or a natural moisturizer, such as lanolin, to help them heal. It isn't necessary to use soap on your nipples, and it may remove helpful natural oils that are secreted by the montgomery glands, which are in the areola. Soap can cause drying and cracking and make the nipple more prone to soreness.

7. Watch for infection. Signs of breast infection include fever, irritation, and painful lumps and redness in the breast. You need to see a doctor right away if you have any of these symptoms. Click here for more information.

8. Promptly treat engorgement. It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. This normal breast fullness may turn into engorgement. When this happens, you should feed the baby often. Your body will, over time, adjust and produce only the amount of milk your baby needs. To relieve engorgement, you can put warm, wet washcloths on your breasts and take warm baths before breastfeeding. If the engorgement is severe, placing ice packs on the breasts between nursings may help. Talk with a lactation consultant if you have problems with breast engorgement. Click here for more information.

9. woman sleeping with baby Eat right and get enough rest. You may be thirstier and have a bigger appetite while you are breastfeeding. Drink enough non-caffeinated beverages to keep from being thirsty. Making milk will use about 500 extra calories a day. Women often try to improve their diets while they are pregnant. Continuing with an improved diet after your baby is born will help you stay healthy. But, even if you don't always eat well, the quality of your milk won't change much. Your body adjusts to make sure your baby's milk supply is protected. Get as much rest as you can. This will help prevent breast infections, which are worsened by fatigue.


If you are on a strict vegetarian diet, you may need to increase your vitamin B12 intake and should talk with your health care provider. Infants breastfed by women on this type of diet can show signs of not getting enough vitamin B12.

Adult lactation- Breastfeeding of an Adult

Adult lactation means breastfeeding of an adult partner or re-lactation for primarily erotic reasons. Depending on the context, other terms are used such as adult suckling, adult nursing, adult breastfeeding, Adult Nursing Relationship (ANR), or nursing couple(s). The scientific-sounding terms Milk fetishism or Lactophilia as well as paraphilia (in this context) are incorrect according to the definitions of ICD-10 and DSM-IV. In scientific terminology, these would be disorders – the diagnoses of which should be based on precise criteria. One non-exclusive element of said criteria is that an individual is suffering from such a disorder. Therefore Milk fetishism or Lactophilia should also be avoided in colloquial speech.[1]

Breasts, and especially nipples, are highly erogenous zones (both for men and women). One hypothesis assumes that during evolution, those women prevailed who were motivated by physical pleasure to nurse their babies in the best possible way. The same holds true for the lips, also erogenous zones where pleasure may have lead to "kiss feeding", in which mothers chew food before passing it on to the child.[2]

Because female breasts and nipples are normally an important part of sexual activities and perception, it is not surprising that couples may proceed from intensive kissing of the nipples to actual breastfeeding. In lesbian partnerships, mutual breastfeeding has been regarded as a familiar expression of affection and tenderness.[3]

In its Sunday issue of March 13, 2005, the London daily The Times gave a report of a scientific survey (comprised of 1690 British men) revealing that in 25 to 33% of all couples, the male partner had suckled his wife's breasts. Regularly the men gave a genuine emotional need as their motive.[4]

Beyond these, there exist hardly any reports or investigations. Nevertheless, from European Middle Ages a multitude of subliminally erotic visionary experiences of saints have been passed on in which breastfeeding plays a major role. One prominent example is the Lactatio of Saint Bernard of Clairvaux[5]. Generally speaking this was a rather strong taboo, and it can be concluded that an adult man suckling for milk is in contradiction to well established images of masculinity.

Unintended milk flow (Galactorrhea) is often caused by nipple stimulation and it is possible to reach normal milk production exclusively by suckling on the breast.

Breastfeeding - How Breast Milk is Made

Knowing how the breast is made and how it works to produce milk can help you understand the breastfeeding process. The breast actually begins developing in the first few weeks of gestation, before birth. But the mammary gland, the gland that produces milk, does not become fully functional until lactation begins. When a woman's breasts become swollen during pregnancy, this is a sign that the mammary gland is getting ready to work. The breast itself is a gland that is composed of several parts, including glandular tissue, connective tissue, blood, lymph, nerves, and fatty tissue. Fatty tissue is what mostly affects the size of a woman's breast. Breast size does not have an effect on the amount of milk or the quality of milk a woman produces.

Milk is secreted from the alveoli cells. When the alveoli cells are stimulated by a hormone, they contract and push the milk into the ductules and down into larger milk ducts underneath the nipple and areola. When the baby's gums press on the areola and nipple, milk is squeezed into the baby's mouth. The nipple tissue protrudes and becomes firmer with stimulation, which makes it more flexible and easier for the baby to grasp in the mouth. In the diagram, you can see that each mammary gland forms a lobe in the breast. Each lobe consists of a single branch of alveoli and milk ducts that narrow into an opening in the nipple. Each breast has about seven to ten lobes.
The Role of Hormones

Hormones play a key role in breastfeeding. The increase of estrogen during pregnancy stimulates the ductules to grow. After delivery, estrogen levels drop and remain low in the first several months of breastfeeding. The increase of progesterone during pregnancy also causes the alveoli and lobes to grow. Prolactin, also called the "mothering hormone," is another hormone that is increased during pregnancy and adds to the growth of breast tissue. Prolactin levels also rise during feedings as the nipple is stimulated. As prolactin is released from the brain into the mother's bloodstream during breastfeeding, alveolar cells respond by making milk. Oxytocin is the other hormone that plays a vital role because it is necessary for the let-down, or milk-ejection reflex to occur. It stimulates the alveoli cells to contract so the milk can be pushed down into the ducts. Oxytocin also contracts the muscle of the uterus during and after birth, which helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth. The release of both prolactin and oxytocin may be responsible in part for a mother's intense feeling of needing to be with her baby.

Breastfeeding - Human Milk Banks

Ideally, breast milk comes from a baby's own mother. But when this is not possible, you can give your baby breast milk from donors (other women's breast milk), which provides the same precious nutrition and disease fighting properties as your own breast milk. If your baby has special needs, such as intolerance to formula, severe allergies, is failing to thrive on formula, is premature or has other health problems, he or she may need donated human milk not only for health, but also for survival.

There are several reasons why a mother may not be able to breastfeed her own baby:

* In a premature delivery, a mother's milk supply may not become established enough to provide milk for her baby. Sometimes the stress of caring for a very ill infant prevents the milk supply from developing.
* A mother who delivers twins or triplets might not have enough milk supply to nourish all of the babies.
* Some medicines taken by the mother for a health problem, such as chemotherapy for cancer, can harm a baby.
* A mother might have an infection that could be spread to her baby through breastfeeding, such as HIV or hepatitis.
* A mother might have a health problem that prevents her from breastfeeding or makes it impossible for her to produce milk.

Breast milk from donors is stored in human milk banks. At this time, there are only six human milk banks in the United States. While the number of infants and children who depend upon donor milk for health or survival is small, their numbers are greater than is the supply available from these milk banks.

Human milk banks screen the donors, and collect, screen, process, and dispense donor human milk. Because babies who use donor milk are not related to the donors, every possible step is taken to ensure the milk is safe. And the milk is only dispensed by a prescription from your health care provider. The prescription must show how many ounces of processed milk are needed per day, and for how many weeks or months. The milk bank also needs your name, the baby's name, and your address and phone number. Then, you or your health care provider can contact a milk bank to order the milk. If the milk bank is close to you, you can pick up the milk there. If you live out of the area, the milk bank can ship the frozen milk in coolers every few days.

The cost of donor milk is about $3 per ounce. Sometimes there is another fee for shipping. Most health insurance companies cover the cost of donor milk if it is medically necessary. To find out if your insurance will cover the cost of the milk, call your insurance company or ask your health care provider. If your insurance company does not cover the cost of the milk, talk with the milk bank to find out how payment can be made later on, or how to get help with the payments. A milk bank will never deny donor milk to a baby in need.

Breast Feeding - Shared Breastfeeding

It is sometimes common for more than one woman to feed a child, such as in developing nations within Africa. This shared breastfeeding has been highlighted as a source of HIV infection in infants. A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry.

Breastfeeding - Tandem Breastfeeding

Feeding two infants simultaneously is called tandem breastfeeding (Sidenote: Feeding a child while being pregnant with another can also be considered a tandem breastfeeding condition for the nursing mother, as she also provides the nutrition for two[58]). The most common need for tandem breastfeeding is after the birth of twins where both babies are fed at the same time. The appetite and feeding habits of each baby may not be the same, which could mean feeding each according to their own individual needs, while also trying to get them to breastfeed together to minimize time spent breastfeeding.

In cases of multiple births with three or more children, it can be extremely difficult for the mother to organise feeding around the appetites of all the babies. While breasts can produce large quantities of milk, according to the demand placed upon them,[59] it is common for women to use alternatives, although many mothers have been able to breastfeed their infants successfully without them.

Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply.

Breastfeeding - Mixed Feeding

Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. When feeding from the breast, the tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; when feeding from a bottle, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can induce the infant to prefer the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference

Breast feeding - Expressing breast milk

When direct breastfeeding is not possible a baby can still be fed breast milk. By expressing (artificially removing and storing) her milk, a mother can enable her child to be fed with her milk while she is away. With manual massage or the use of a breast pump a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. This container may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that antioxidant activity in expressed breast milk decreases over time but it still remains in higher levels than in infant formula.

Expressing breast milk can keep up a mother's milk supply when she and her child are apart for long. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. When an older baby grows teeth and bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again. Babies or toddler that are truly feeding cannot physically bite the nipple, if they are, they arent' feeding but playing.

It is generally advised to delay using a bottle in feeding expressed breast milk until the baby is about 4-6 weeks old and is good at sucking directly from the breast. This is to avoid nipple confusion and nursing strike, when the baby prefers to suck from bottle, which takes less effort, and so loses its desire to suck from the breast. If feeding expressed breast milk (EBM) must be done before 4-6 weeks of age, it is recommended that it be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle with other people.[citation needed]

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though some dislike the idea of feeding their own child with another woman's milk, others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.