Breastfeeding

During pregnancy, a mother's body goes through changes to prepare for breastfeeding as soon as her baby is born.

Breast milk has everything a baby needs and is the natural food for babies.

booklet cover pageAs your baby grows, breast milk supply changes to meet your baby's needs.

The World Health Organization, Health Canada, and the Canadian Paediatric Society agree:

  • Babies only need breast milk for the first six months
  • At six months, when baby is showing signs of readiness, age appropriate solid foods can be introduced
  • Continued breastfeeding for up to two years and longer is recommended

Breastfeeding Your Baby - Booklet

Breastfeeding Topics
arrowGetting the best start arrowLatch and positioning
arrowMilk supply arrowCaring for your breasts

arrowImportant things to know

arrowExpressing and storing breast milk

arrowVitamin D

arrowTwins, triplets and more

arrowNutrition and breastfeeding

arrowMedications and illness

arrowSmoking and breastfeeding arrowAlcohol and breastfeeding
arrowBirth control arrowWeaning
arrowReturning to work or school arrowBreastfeeding the older child
arrowBreastfeeding supports arrowPartners and family support
arrowYour right to breastfeed arrowCommunity Breastfeeding Alliance of Waterloo

Getting the best startmom holding sleeping baby on chest

Skin to Skin

Right after birth, ask your health care provider to help you place your baby in skin-to-skin contact with you. Skin-to-skin contact has many benefits and helps your baby get used to their new world. Skin-to-skin also has many benefits for breastfeeding.

Benefits of breastfeeding:

  • Improves milk supply
  • Can help your baby find the breast and self-latch
  • Your baby may breastfeed sooner and longer
  • Can help your baby breastfeed when they are sleepy

Learn more about skin-to-skin contact.

Mother and baby should remain together as much as possible to get the best start at breastfeeding.

Video with permission from Peel Health Unit - Skin-to-Skin

Breastfeed early

Begin breastfeeding as early as possible (within 30 minutes) after birth. Your baby is awake and ready to learn how to breastfeed during this time. Breastfeeding early helps to:
  • Increase oxytocin (an important hormone for mother's milk let-down, reducing stress, and controlling after birth bleeding, also called the "love" hormone)
  • Provide the newborn with drops of nutrient rich breast milk called colostrum
  • Tell your breasts to make more milk
Breastfeeding can take time for both you and your baby to learn. In the early hours, some babies may only lick and smell the breast. You can learn how to hand express your milk and give your baby colostrum with a spoon. Give your baby lots of skin-to-skin contact.

Video with permission from Peel Health Unit - Breastfeeding in the first hours
 
Ask your health care provider to help you get started with breastfeeding while you are in the hospital.
 
Any amount of breast milk you provide is better than none at all. The longer you breastfeed, the better it is for you and your baby!

Breastfeed often

mom holding newborn in hospital bedNewborns have small stomachs and need to feed often to satisfy both their hunger and thirst.

In the first 2-3 days, your breasts will make small amounts of special milk called colostrum. Colostrum is important as it helps to boost your baby's immune system and provides them with all the nutrients they need in the first few days after birth, before your breasts begin to make lots of milk.

A young baby will need to feed a minimum of eight times in 24 hours and often will feed much more frequently than this, especially in the evening and at night.

The second or third night after birth, your baby may seem fussy, be awake most of the night and want to suck at the breast frequently. This can be called cluster feeding. This behaviour is normal and has many benefits for mother and baby. Because your breasts respond to your baby feeding, frequent feeding can help to tell your breasts to make lots of milk.

While you and your baby are learning to breastfeed, you can give your baby extra colostrum by hand expressing drops onto your baby's mouth.

Tips to help with the first couple of days after birth:

  • Allow your baby to breastfeed often - this is a great time to learn your baby's hunger and satiation cues and the signs your baby is getting enough breast milk  
  • Ensure you have a good latch and positioning
  • Allow your baby to have their hands free (take off mittens and loosen blankets) so they can soothe themselves by sucking on their hands
  • When your baby falls asleep at the breast, gently break the latch and slide your nipple out of their mouth. Hold your baby until they fall into a deep sleep, then put them in a safe sleep environment
  • Cuddle your baby skin-to-skin (support persons can do this as well so you can rest!)
  • Use other strategies to help calm your fussy baby when you are not breastfeeding
  • A quiet, calm environment is helpful. If you find visitors distracting, ask them to visit in a few weeks or create visiting hours

Over the course of the next few days, your breasts will become fuller and the amount of breast milk you make will increase.

As your baby grows, you may notice a pattern of frequent feedings occur again. These are times your baby is growing more quickly, called growth spurts.

You may notice some cramping of your uterus while breastfeeding. This is your uterus beginning to return back to its normal size and helping to prevent after birth bleeding or hemorrhaging. These cramps can continue for up to 20 minutes after breastfeeding. This happens during breastfeeding because the same hormone that allows milk to flow from your breasts also makes your uterus return back to its normal size.

Keep your baby close to you and feed them whenever they are hungry. This helps to remind your body to make lots of milk

Watch your baby's feeding cues

You should not expect your baby to eat on a schedule. Every baby is different and needs to be fed when they show signs of hunger. Remember in the first few weeks these feeding cues may not be obvious and your baby may need to be woken up to breastfeed. See waking a sleepy baby.

Signs your baby may be hungry

Early cues:

  • Putting their hands in their mouth
  • Making sucking motions or soundsfussy baby
  • Sticking out their tongue and licking
  • Turning their head and searching with an open mouth
  • Restlessness

Late Cues:

  • Fussiness
  • Crying
  • Falling asleep

Signs your baby may be satisfied

  • Slows down or stops sucking
  • Closes the lips
  • Turns head away
  • Pushes nipple away
  • Takes more interest in surrounding things

 

Check here for pictures of baby feeding cues

Watch for these signs of hunger and try to feed your baby as soon as you see these signs. If you do not notice the hunger signs right away, your baby may begin to cry. It is easier to feed a calm baby.

Watch your baby. They will tell you when they're hungry and when they're full.

All babies breastfeed at different speeds. When your baby begins to show signs of being satisfied, offer your baby more to see if they are interested. Your baby will let you know if he was just taking a break, or if they have had enough. 

Give your baby only breast milk

Breast milk is the only food a healthy baby needs for the first six months of life. Giving other foods or drinks before this time may slow down your milk supply as your baby is not drinking from your breast reminding your body to continue to make milk. Some foods or drinks may also affect your baby's health.

DO NOT feed any of the following to babies under six months of age:

  • Water since breast milk will satisfy a baby's thirst
  • Evaporated or condensed milk since these are not suitable for babies and may cause harm
  • Cow's milk, soy or rice beverages since these do not have all the nutrients your baby needs
  • Cereal or other solid foods; when babies are fed these they may not get enough breast milk with the nutrients they need
Note: Giving cereal will not help your baby sleep through the night!

Wait until your baby is six months old and showing signs of being ready before offering solids. Iron rich foods should be the first foods offered to your baby. See Introducing Solids page. Then breast milk should continue to be given (along with solid food) for up to two years and beyond.  

Avoid using pacifiers and artificial nipples

Avoid using artificial nipples and pacifiers (soothers) as they can negatively affect breastfeeding and decrease the amount of time your baby spends at the breast. If you make an informed decision to use artificial nipples or pacifiers, avoid their use during the first 4-6 weeks while breastfeeding is being established. This gives your baby a chance to learn to breastfeed well and helps increase your milk supply.

Be well supported

Before you have your baby is the best time to get information about breastfeeding. The more information and support you have, the more likely it is for you to have a good breastfeeding experience with your baby.

There are many breastfeeding supports available in our community to help you whenever you may need help, both over the telephone and in person.

See Breastfeeding Supports or call Region of Waterloo Public Health at 519-575-4400 to speak with a Public Health Nurse.


Latch and Positioning

Positioning 

Good positioning is important for a good latch! There are many different positions you can try while breastfeeding. Pick the position that works best for you and your baby and allows your baby to have a deep latch and easy swallowing. In the beginning, while you and your baby are learning, you may feel most comfortable in a position that provides more support, such as in a chair or lying down.

Tips to remember:

  • Your baby's chest and body is turned towards you - "Tummy to Mummy"
  • Your baby's head is slightly tilted back to get a deep latch, and be able to swallow and breathe easily
  • You are comfortable and relaxed; your back and arms are well supported
  • Your baby's whole body is supported and tucked in close to your body (avoid holding the back of their head)

Baby-led Latching

Breastfeeding Positions

Video with permission from Peel Health Unit - Breastfeeding Positions 

Babies are born to breastfeed!

Latch

Video with permission from Peel Health Unit - Latch 

A good latch is key for a successful breastfeeding experience. At the start of the breastfeeding, your baby will have shallow quick sucks. This starts your milk flowing. Then your baby's suck becomes deep and slow. There is a pause during sucking where your baby's mouth opens wide for swallowing. This pause is also for your baby to take some breaths.

Signs of a good latch:

  • You hear a quiet "ka ka" sound
  • You see your baby sucking and swallowing
  • Your baby has a wide open mouth with lips curled out and their chin pressed into your breast
  • You feel your nipple being pulled with no pain
  • Your nipples look the same shape after a feeding and not pinched
  • Your baby is able to stay on the breast without slipping off

Latching Your Baby Visuals  

 

How to break the latch:

If you feel pain or you want to take your baby off the breast, break the latch to avoid hurting your nipples.

  • Press down on your breast
  • Pull down your baby's chin
  • Insert your clean finger into the corner of your baby's mouth to break the latch

Get Breastfeeding Support if you do not see the signs of good latch or you are having trouble positioning and latching your baby.


Milk Supply

Know the signs of a well-fed baby

In the first few weeks, your baby should be fed at least eight times in a 24 hour period.

Some babies are very sleepy for the first couple of weeks and may not let you know that they are hungry.

You should wake your baby until they:

  • Have regained their birth weight
  • Have 6-8 heavy wet diapers and 3-4 yellow stools each day
  • Wake for feedings on their own

Check here to learn how to wake a sleepy baby.

Once breastfeeding has been well established, feed whenever your baby shows signs of hunger.

One good way to know if your baby is well fed is by the number of wet and dirty diapers your baby has. See the Best Start Guidelines chart.

Other signs your baby is getting enough milk:

  • Your baby has a loud cry and moves actively
  • Your baby's mouth is moist and pink
  • Your baby's eyes are alert
  • You can hear or see your baby swallowing (e.g. a quiet 'ka ka' sound)
  • Your breasts feel softer and less full after breastfeeding
  • Your baby comes off the breast looking satisfied
  • Your baby has a good latch with no nipple pain
It is normal for babies to lose an average of seven per cent of their birth weight in the first three days after birth. Your baby should regain their birth weight by 10 -14 days of age.

Be sure to see your primary health care provider within 48 hours of going home from the hospital to have your baby's health assessed.

Most breastfed babies then gain at least 4 - 8oz a week in the first three months. Then they gain 2.5 - 4.5oz a week from 4 - 6 months of age.

Breastfed babies tend to grow more quickly than non-breastfed babies in the first six months and grow more slowly from 6 -12 months of age.

Get help right away if your baby is not showing signs of breastfeeding well or if:

  • Your baby is very hard to wake to feed
  • Your baby is crying and will not settle after feedings
  • Your nipples are sore and not getting better
  • You have a fever, chills, flu-like symptoms, or a red and painful area on your breast

If you are concerned about the amount of breast milk your baby is getting, contact your primary health care provider, Breastfeeding Supports or go to the Emergency Department at the hospital.

There are many different herbs, foods and medications available that are being used to increase a mother's milk supply with varying degrees of success. There is little research done on the effectiveness of these options. If you are considering any of these options, speak with your health care provider or contact Motherrisk at 1-877-439-2744 or go to www.motherrisk.org

Video with permission from Peel Health Unit - Milk Supply

Over supply of breast milk

It is common for women to make more milk than their baby needs. Breastfeeding frequently, having a good latch and positioning, and allowing your baby to finish breastfeeding on your first breast before switching to the next breast, can help your baby better control your milk supply or milk that is flowing fast.

Sometimes over supply of milk can result in difficulties with breast fullness, engorgement and plugged ducts, or a baby that appears gassy, fussy, or has trouble latching at the breast.

If you experience difficulties with over supply, it is a good idea to get breastfeeding support from a breastfeeding expert.

Tip:
If you are expressing and storing your extra breast milk in the freezer, you can use it once your baby is eating solids by adding it to their cereal or other baby foods.

You can also donate expressed breast milk you are not using to a Human Milk Bank for sick or premature babies. To learn more, go to www.milkbankontario.ca

Trust your body to make all the food your baby needs.

Caring for your breasts

Caring for your breasts is important since your baby will be breastfeeding often.

Nipple care

Many women think having sore nipples is a normal part of breastfeeding. This is not true!

If you have sore nipples, ask for help and find out why!

It is best to prevent breastfeeding issues before they happen.

Here are some tips:

  • Do not wash your nipples before or after each feed. Your regular bathing routine is all that is necessary
  • Rinse your breasts with water once a day and let them air dry
  • Wear a bra that fits well and is not too tight
  • Avoid underwire bras
  • If you are using breast shells, be sure they have good ventilation
  • If you are using breast pads, avoid pads with a plastic back
  • Wash your hands before touching your nipples, especially if they are cracked

For sore nipples:

  • Express some breast milk onto your nipples after each feeding and let it dry (avoid this if your nipples are cracked or you or your baby have signs of thrush)
  • Some women have found soaking their breast in a mild salt water solution or an Epsom salt bath to be helpful. While there is no evidence to support the success of this practice for sore nipples, there is likely no harm as long as your baby is not drinking the solution
The main cure for sore nipples is good latch and positioning

Get Breastfeeding Support if:

  • Your nipples are cracked or bleeding
  • It is painful to breastfeed
  • Your sore nipples are not getting better
Remember you and your baby are learning. Keep practicing!

Breast care

When your breasts begin to make more milk, your breasts may feel fuller, heavy and warm - this is called breast fullness. This feeling usually begins 2-4 days after birth. Breast fullness is normal and is different than engorgement.

After a few weeks of breastfeeding this breast fullness will lessen. You may find your breasts begin to feel softer. This change is common and means your breasts are adjusting to making milk for your baby. It does not mean your milk supply has gone away! Continue to breastfeed or remove milk regularly to remind your breasts to keep making milk. Continue to watch for the signs that your baby is getting enough breast milk.

Caring For Your Breasts Visual

Your body goes through many changes while breastfeeding. Softer breasts do not mean less milk.

Engorgement, Mastitis, Thrush, Plugged Ducts

Engorgement

Engorgement (painful, swollen breasts) is different than breast fullness. Three to four days after birth, a lot of women find their breasts feel bigger, heavier, and slightly tender. This is considered breast fullness and may last a couple of days.

If you have engorgement:

  • Your breasts feel painful
  • Your breasts feel hard
  • Your breasts feel tender and swollen
  • You have a low-grade fever
  • Your baby is having a hard time latching to your breasts

Engorgement is often caused by a build up of milk in your breasts that is not being removed often or well enough. It can also be happening because there is swelling of your breast tissue.

Tips for preventing engorgement:

Tips for helping engorgement:

  • Make sure you have a good latch and positioning
  • Breastfeed often, even through the night
  • Gently massage or squeeze breasts while your baby is feeding at the breast
  • Express some breast milk before breastfeeding to soften breasts for your baby to latch
  • Express just enough breast milk in between feedings for comfort
  • Use cold packs on your breasts between feedings
  • Avoid tight bras
  • Talk to a Breastfeeding Support person

Mastitis

Mastitis is a breast infection and medications are needed to treat it.

See your health care provider immediately if you have symptoms of mastitis.

Note: You should contact your health care provider immediately if:

  • Your breast is painful and hot to touch
  • Your breast is red
  • You have a fever, chills or body aches

Tips for helping with mastitis:

  • Take your prescription medications until finished
  • Continue breastfeeding often, even through the night
  • Express breast milk frequently - It is important to keep the breast milk flowing
  • Gently massage and squeeze your breasts while breastfeeding
  • Use cold packs on your breasts in between feedings
  • Rest and drink fluids
  • Talk to a Breastfeeding Support person

Thrush

Thrush is also known as a yeast infection. Sore nipples are not always caused by issues with latch and positioning - it is possible the cause is thrush. You can continue to breastfeed if you and your baby have thrush.

Signs of thrush:

  • Painful or itchy nipples during or between feedings
  • Nipples may be shiny, red, cracked, flaky or have white spots
  • You may have a vaginal yeast infection at the same time
  • Your baby has white patches inside their mouth, cheeks or tongue
  • Your baby has a diaper rash
  • Your baby is fussy, refuses the breast or is gassy

Things you can do to help with thrush:

  • Consider all possible sources of infection (e.g. sexual partners, other children, pets)
  • See your primary health care provider for treatment for yourself and your baby
  • Wash hands frequently
  • After each breastfeed, wash nipples with water and allow to air dry. Do not express breast milk onto nipples
  • Avoid breast pads if you can or use disposable pads and throw them out after each feeding
  • Apply a cold cloth to your breasts for comfort
  • Wash bras frequently and if possible and allow them to dry in the sun
  • Sterilize all breast pump equipment and any objects your baby puts in their mouth
  • Eat a well-balanced diet that follows Eating Well with Canada's Food Guide

Plugged ducts

Plugged ducts can happen when one or more of the ducts within the breast become plugged with breast milk or other components. Most plugged ducts will resolve within 1-2 days.

If you have plugged ducts:

  • You might have mild soreness or swelling in one area of the breast
  • You may have a pink or reddened lump
  • You may have engorgement or over supply of milk 
  • You may see a small white dot or "bleb" at the end of the nipple
  • Your baby is fussy at the breast, refuses the breast, or has few short or hurried feeds

Tips for preventing plugged ducts:

  • Breastfeed frequently, at least eight times in 24 hours including overnight
  • Follow your baby's early feeding cues
  • Ensure your baby has a good latch and positioning 
  • Avoid missing or shortening a breastfeed. Express your breast milk  if you miss a feeding
  • Avoid wearing underwire bras or clothes that put a lot of pressure on your breasts

Tips for resolving plugged ducts:

  • Continue breastfeeding frequently and do not limit breastfeeds
  • Follow your baby's early feeding cues 
  • Gently massage area towards the nipple while breastfeeding
  • Apply moist heat
  • Offer the breast with the plugged duct first to ensure strong sucking and drainage
  • Rotate breastfeeding position to help drain all ducts in the breast
  • Rest, eat a healthy diet and reduce stress as much as possible
  • Talk to a Breastfeeding Support person
Monitor your symptoms and see your health care provider immediately if mastitis is suspected.

Important things to know

Video with permission from Peel Health Unit - What to do when?

Waking a sleepy baby

Newborn babies sleep a lot. You should wake your baby up for feedings for the first couple of weeks or until they are waking themselves and have regained their birth weight.

Remember to feed your baby at least eight times in 24 hours.

Here are tips for waking a sleepy baby:

  • Undress your baby and remove blankets - your baby will stay warm being skin-to-skin with you while breastfeedingdad talking to sleepy baby
  • Change your baby's diaper
  • Give your baby a massage or rub their back
  • Roll your baby gently from side to side
  • Talk or sing to your baby
  • Express drops of milk from your breast with your hand into your baby's mouth to give your baby a taste
  • Gently squeeze your breast while breastfeeding to help your milk flow and give your baby extra milk

Calming a fussy baby

Babies cry for many reasons, but never to make you angry. It is normal for a baby to cry for up to two hours total in a 24 hour period. The crying usually subsides by the fourth or fifth month.

To read more about crying and calming a fussy baby, see the Infant Crying page.

Jaundice

Babies are born with many red blood cells that their body must break down. Sometimes there is a build up of these red blood cells in your baby's body, this causes jaundice and usually begins in the first few days after birth.

Your baby might:

  • Have yellowing skin or eyes
  • Be extra sleepy

A simple blood test can be done by your health care provider to check if the jaundice or bilirubin level is too high. Many things can be done to help prevent and treat jaundice.

Here are some ways you can help if your baby has jaundice:

Do not put your baby in direct sunlight as they can get sunburnt very quickly.

Growth Spurts

Growth spurts are times your baby is growing more quickly. They usually occur around two weeks, three weeks, six weeks, three months and six months of age. A growth spurt may last a few days each time.

Your baby may need to breastfeed more often during a growth spurt. This in turn helps your body make more milk.

Check here for more information about your baby's growth and development.


Expressing and storing breast milk

Most women are able to express breast milk by hand. It can take time to learn, but becomes easier with practice. It is good for all mothers to learn how to express colostrum and breast milk by hand. There are no fees, it is always available and it can be done anytime, anywhere. See how to express milk by hand.

Sometimes, there are reasons to express breast milk such as:

  • Separation from your baby after birth
  • Softening engorged breasts that are too hard for your baby to latch on to
  • Stimulating your breasts to increase your milk supply
  • Going back to work or school
  • Medical reasons suggested by your doctor

You can express breast milk by hand or by using a pump and give the milk to your baby by spoon or cup. To learn more about cup and spoon feeding, call  Region of Waterloo Public Health at 519-575-4400 and ask to speak with a Public Health Nurse.

For suggestions of the best way to express your breast milk, see the Expressing Breast Milk handout.

Check here for information about Storing Breast Milk

Check here for information about Thawing Frozen Breast Milk 


Twins, triplets and more

Breast milk is especially beneficial for twins and other multiple birth babies.

These babies are often small at birth and need all the health advantages human milk provides.

Breastfeeding will also help you create that special attachment with all yourmom and dad with twins babies.

Many mothers of multiples worry about being able to supply enough milk for all their babies, however this is rarely a problem. Feeding your babies often and on demand will tell your body how much milk to produce for your babies needs.

If you or your babies experience health problems that result in separation it does not mean you cannot have a successful breastfeeding experience. Expressing breast milk early and often can help to establish and maintain a good milk supply for your babies.

Continuing to express breast milk from each breast at least eight times in 24 hours, including overnight will help maintain your milk supply until you or your babies are well enough to breastfeed.

Other Tips:

  • Make preparations in advance to have extra help around the house with meals, cleaning etc.
  • You may want to feed your babies one at a time in the early days while you learn this new skill
  • Use lots of pillows to support your babies so your hands are free to assist with latching
  • Breastfeeding two babies at the same time can be helpful for time management once you are more comfortable with breastfeeding
  • Experiment with different positions to find what works for you and your babies
  • It is good for each baby to be offered milk from both breasts. Throughout the day, offer both breasts to each baby
  • Learn where to get support. Along with Region of Waterloo Public Health, organizations such as La Leche League Canada or Breastfeeding Buddies can offer local support as needed

Vitamin D

Health Canada recommends giving all breastfed babies a vitamin D supplement of 400 IU every day until they are two years old.

 Do not put your baby in direct sunlight as they can get sunburnt very quickly.

For more information about giving vitamin D to your baby, talk to your Health Care Provider or call Region of Waterloo Public Health at 519-575-4400 to speak with a Public Health Nurse.


Nutrition and breastfeeding

You do not need to avoid any food unless you have a food allergy. Even if your diet isn't perfect every day, your breast milk will still have the nutrients your baby needs.

Tips:

  • Enjoy a variety of foods and follow Eating Well with Canada's Food Guide
  • Drink water whenever you are thirsty
  • Eat 2-3 extra Canada's Food Guide servings every day for added calories
Caffeine does pass into breast milk so avoiding large amounts of caffeine is best.

Health Canada recommends no more than 300mg of caffeine per day for breastfeeding women. This is approximately two cups (237ml each) of coffee. If possible, try having caffeinated drinks and food immediately after breastfeeding.

If you have a restricted diet, such as vegan, you should speak with a Registered Dietitian by calling Eat Right Ontario at 1-877-510-5102.

Go to www.eatrightontario.ca for more information about nutrition.

For a copy of Eating Well with Canada's Food Guide, call Region of Waterloo Public Health Resource Centre at 519-575-4400 ext. 2196 or go online to Health Canada - Canada's Food Guide to print a copy.


Medications and illness

It is usually safe to continue breastfeeding when taking medications or when you or your child is sick.

Before taking any substance, including prescription medications, over-the-counter drugs, alternative therapies or herbal supplements, contact Motherrisk at 1-877-439-2744 or go to www.motherrisk.org or contact Region of Waterloo Public Health at 519-575-4400 to speak with a Public Health Nurse.

If there is a concern about a medication you are taking while breastfeeding, ask your primary health care provider if there is another medication you can take that is safe while breastfeeding.

If you are sick and need to be separated from your child or unable to breastfeed, here are some tips:

  • Protect your milk supply by expressing breast milk
  • Feed your child your breast milk with a cup or spoon (contact Region of Waterloo at 519-575-4400 to learn more)
  • If you can, avoid using bottles so your child can get back to breastfeeding easily

See expressing and storing breast milk handouts.

Speak with your health care provider if you are using street drugs since many street drugs can be harmful to your baby. For help to quit, visit the Centre for Addiction and Mental Health.

Check here for some information on Pregnancy, Breastfeeding and Substance Use


Smoking and breastfeeding

Breast milk is still the best choice for your baby if you smoke.

Nicotine does pass into the breast milk so the safest choice is to not smoke at all.

If you smoke, try to minimize the effects of smoking on your baby by:

  • Breastfeeding before you smoke
  • Using a Nicotine Replacement Therapy (NRT)
  • Not smoking, or allowing others to smoke in the house, car or near the baby
  • Removing your smoking clothes and washing your hands before coming inside or holding your baby

If you need support to quit smoking, talk to your health care provider about Nicotine Replacement Therapy such as gum, lozenges or inhalers.

For information and help with quitting or cutting back, call the free Smoker's Helpline 1-877-513-5333 or visit www.smokershelpline.ca.

For online support visit You Can Make it Happen for a complete listing of resources available to help.


Alcohol and breastfeeding

Breast milk is still the best choice for your baby if you choose to have the occasional alcoholic drink.

Alcohol passes into breast milk so the safest choice is to avoid drinking alcohol while breastfeeding.

If you are going to have an occasional alcoholic drink:

  • Express and store breast milk before drinking alcohol
  • Breastfeed before you drink
  • Limit the amount to one standard drink
  • Wait three hours after having one standard drink before the next feeding at the breast

shows how much a standard drink is

For more information, contact Motherisk at 1-877-327-4636 or visit www.motherisk.org


Birth control and breastfeeding

You can still continue breastfeeding once you start using birth control. Certain types of birth control can affect breast milk supply so it is important to speak with your health care provider before choosing a method.

See this chart for more information, Birth Control for New Parents

For questions, contact Region of Waterloo Public Health Sexual Health Program at 519-883-2267 to speak with a Public Health Nurse.


Weaning

Weaning is a natural process when your child begins to eat solid foods other than breast milk. There is no best time or way to stop breastfeeding; it is different for every mother and child. Weaning is most successful when your child decides they are ready.

At six months of age, when your child shows signs of being ready, you may start to offer other foods to meet their nutritional needs. As you introduce new foods, it is recommended that you continue to breastfeed.

See the Introduction to Solids page.

There may be other reasons for weaning as well. If possible, try to avoid weaning quickly or weaning during a time of stress for your child (e.g. teething, illness, arrival of a new sibling).

For more information about weaning your child, see the Weaning Your Breastfed Child fact sheet.

Here are some strategies to help while weaning:

  • Make small changes in your daily routine
  • Not offering your breast, but allowing your child to breastfeed if they want to
  • Offering distractions
  • Delaying breastfeeding if you feel your child can wait

You may consider expressing your breast milk while weaning your child.

Nursing strike is not considered weaning, especially under one year of age. Nursing strike is when a child suddenly refuses to breastfeed. This is usually temporary and may occur for many different reasons. If this occurs, call 519-575-4400 to speak with a Public Health Nurse. See Nursing Strike for more information.


Breastfeeding and returning to work or school

Returning to work or school after having a baby may be a stressful and hard time for you. When the time comes to return to work or school, it helps to be prepared. Research shows that women who breastfeed their children miss fewer days of work from caring for a sick child. Continuing to breastfeed and giving your child your breast milk has many benefits for you, your child and your employer.

In Ontario, pregnant and breastfeeding mothers are protected from discrimination under the Ontario Human Rights Commission. This includes your right to be accommodated when you return to work or school so that you can continue to breastfeed.

Here are some questions to consider in your planning:

  • Is your workplace or school close to home or your childcare provider?
  • Is your employer or teachers supportive of breastfeeding?
  • Can you have your child with you at work/school?
  • Can you go to your child to breastfeed at lunch and on breaks?
  • Can someone bring your child to you at work/school so you can breastfeed them?
  • Are there facilities at work/school where you can pump and refrigerate your milk?
  • Can you take an insulated cooler with blue ice packs to school or work?
  • Does your job have flexibility? Working from home? Working part-time? Flexible work hours?mother with briefcase holding baby

Tips to help you return to work or school:

  • Consider meeting with your employer before returning to work so that you can discuss your breastfeeding plan.
  • Talk to other mothers who have continued breastfeeding after returning to work or school to learn about their strategies.
  • Practice expressing your breast milk before returning to work or school. For more information, see Expressing Breast Milk.
  • Breastfeed before you leave and when you get home from work or school.
  • Store your expressed milk in a refrigerator or a cooler bag with ice packs.
  • Leave your expressed milk with your child's caregiver while you are at work or school. You may want to ask your child's caregiver if they are aware of the recommendations for proper storage and thawing of expressed breast milk.

For more information visit Best Start - Returning to Work After Baby.

If you or your employer would like information on breastfeeding friendly workplaces, please see the Creating a Breastfeeding Friendly Workplace Strategy toolkit which has several helpful ideas to get started.


Breastfeeding the older child

Health Canada promotes breastfeeding exclusively for the first six months, and continued breastfeeding for up to two years or longer with additional feeding of solid foods when baby shows signs of being ready.

Continuing to breastfeed your child past six months of age allows you and your baby to spend special time together. It also continues to provide nutrition and protection from illnesses for your child, as well as comfort and security as they explore and learn new things.

mom breastfeeding child As your baby grows, breastfeeding behaviours can change. Your child may take less time to breastfeed, be more interested in things going on around them while they breastfeed, may choose different breastfeeding positions, or may hold your breast while they feed.

These changes in your child's growth also bring new learnings such as introducing solid foods, or possible breastfeeding challenges such as teething, nursing strikes, pregnancy, or breastfeeding two children at once.

Introducing solid foods

At six months of age, when your baby shows signs of being ready, you may offer solid foods to meet their nutritional needs.

As you introduce new foods, continue to breastfeed.

Your breast milk supply will change to meet your baby's needs as long as your baby continues to breastfeed. See the Introduction to Solids page.

Teething

It is good to continue breastfeeding while your child is teething to help them with their discomfort. Many mothers worry about their child biting once they have teeth or are teething.

Your child may chew on your nipples to help with their discomfort or because they are learning how to use their new teeth. Your child does not understand that this may cause you pain.

Teething does not mean your child will bite you. Changes in breastfeeding patterns may occur during teething as your child's gums are sore.

If your child is teething:

  • Offer them something cold to chew on, for example a clean cold wet cloth before breastfeeding
  • Avoid gum numbing medications before breastfeeding - it can numb your child's mouth affecting the latch or even numb your breast
  • Make sure your child has a deep latch - this makes it harder for them to bite down
  • If your child does bite, try to stay calm and break the latch. This tells your child that their meal stops when they bite
  • Watch and recognize when your child is finished drinking - they are unable to bite when they are actively drinking
  • A good milk supply is important because it helps to reduce frustration and may help to prevent biting
  • Keep your breastfeeding time together relaxed and positive

Remember, teething is temporary!

To learn more about teething, see the Oral Health page or call 519-575-4400 to speak with a Public Health Nurse.

Breastfeeding does more than just provide your baby with nutrition; it also provides your baby with comfort and security.

Pregnancy

If you find out you are pregnant, you can continue to breastfeed. In a healthy pregnancy, breastfeeding has not been shown to be a risk to an unborn baby.

The World Health Organization recommends infants be breastfed until at least two years of age and beyond. A healthy pregnancy that occurs before your child turns two years of age does not need to interrupt the child's continued need for breast milk.

Pregnancy and breastfeeding require extra nutrients and calories to ensure that you, your breastfed child and your developing baby are getting the extra calories and nutrients needed.

Tips to help with getting enough calories and nutrients:

Being more tired is common in pregnancy and is more noticeable when you have an older active child. Breastfeeding your older child will provide the opportunity for you and your child to relax quietly together.

You may notice your nipples become tender. This is normal in pregnancy and is related to pregnancy hormones.

Tips to help with nipple tenderness:

  • Make sure your child has a good latch
  • Breastfeed for shorter times to reduce comfort sucking

The presence of Braxton-Hicks contractions (periodic uterine tightening) is expected in pregnancy. These contractions are caused by frequent breastfeeding and they usually stop when your child is finished breastfeeding. If you are concerned about these contractions or if they do not stop when your child is finished breastfeeding, contact your health care provider to discuss the signs and symptoms of preterm labour.

It is possible for your milk supply to decrease or the flavour of your milk to change around the fourth or fifth month of pregnancy. Most children don't notice a difference or mind the change. Watch your child's weight gain and make sure they are getting enough age appropriate nutrition. If your child does stop breastfeeding, seek breastfeeding support.

See more information on Introduction to Solids or Weaning

Feeding two children at once/ Tandem Nursing

You can continue to breastfeed your older child when your new baby is born. Breastfeeding two children of different ages at the same time is called tandem nursing.

During the first week after birth, it is important to meet the needs of your newborn.

Tips on how to meet the needs of your newborn:

  • Make sure your newborn baby receives colostrum (nutrient-rich milk available in the first few days after birth)
  • Breastfeed your newborn baby first
  • Offer your newborn both breasts at each feed
  • Breastfeed your newborn a minimum of eight times in 24 hours

A couple of weeks after birth, your breast milk supply will adjust to meet the needs of both your children.

When your milk comes in, some women experience breast fullness or engorgement. Your older child will be able to assist in milk removal, making your breasts feel much more comfortable as well as make it easier for your newborn to latch on to your breast. See more tips for helping with engorgement.

Your older child's reaction towards sharing breastfeeding with their younger sibling will depend on the child's age, temperament and sucking needs.

Try offering a consistent time for your older child to breastfeed or try breastfeeding your child whenever they ask for it and see which plan works best for them. See the Introducing Siblings page for other tips on this new adjustment for your older child.

As a mother you will not only want what is best for your children but also what is best for yourself.

You can feed both your children at the same time or at different times. Breastfeeding two children together can save you time. However, some mothers feel irritable when feeding both children at the same time. Some mothers like to breastfeed whenever their children want. Do what works best for you and your family.

Refusing the breast/Nursing Strike

Nursing strike is when your child suddenly refuses to breastfeed. This is not considered weaning, especially if it occurs before your child is one year of age. A nursing strike can last approximately 2-4 days and your child is usually unhappy about it. Most of the time there is a reason such as illness, teething, or even changes in routine. If this happens, here are some tips:

  • Spend time doing skin-to-skin and cuddle with your child
  • Protect your milk supply by expressing and feeding your child your breast milk in other ways. See the Expressing and Storing Breast Milk handouts
  • Avoid using bottles and artificial nipples/pacifiers as this can prevent your child from returning to the breast; try feeding your child using a cup
  • Offer the breast while your child is in a light sleep or tired
  • Use the breastfeeding position your child likes the most
  • Continue to make breastfeeding a relaxing and positive experience

For more information about breastfeeding your older child, call 519-575-4400 to speak with a Public Health Nurse. 


Breastfeeding support

Although breastfeeding is natural, it can take time to learn. The more help and support you have, the better. It is helpful to get support from health care professionals who have experience and knowledge about breastfeeding.

Prenatal Breastfeeding Education

Me? Breastfeed? - a free workshop designed to help you learn the basics of breastfeeding before your baby is born

Peer Breastfeeding Support

Breastfeeding Buddies - a peer program inspired by breastfeeding moms

Breastfeeding Buddies Café - a drop-in café for breastfeeding mothers to get peer support and to meet other breastfeeding moms

Telephone Breastfeeding Support

Region of Waterloo Public Health, 519-575-4400 - breastfeeding advice and connections to supports in the region

Telehealth, 1-866-797-0000 - 24/7 breastfeeding support by Registered Nurses and Lactation Experts

Breastfeeding Support in Waterloo Region

Early Breastfeeding Contact Clinic - offers individualized breastfeeding assessments/advice/referrals for families with infants of all ages; Region of Waterloo Public Health, 519-575-4400 

Breastfeeding Supports in Waterloo Region - a list of community programs and websites available to you once you have your baby


Partner and family support

Partners and family are very important sources of support for breastfeeding mothers. Family and friends who have breastfed can be great to go to with questions and for support. Partners are great for encouragement and can provide help and comfort to you and your baby.

Check the Partners Supporting Breastfeeding fact sheet for more information.


Your right to breastfeed

The Ontario Human Rights Commission (OHRC) protects your right to breastfeed anytime, anywhere. It is against your human rights to be asked to stop feeding your child, move to a new location, or cover up.

Protecting the rights of mothers to feed their children anytime, anywhere is important because it sends a message to families that they are supported in nurturing their children. It also provides a message that breastfeeding is both normal and natural.

When breastfeeding rights are denied

What can you do if your breastfeeding rights have been denied?

It is important to remember that all families have the right to breastfeed their children anytime that their child is hungry, anywhere that they are.

If you have been asked to stop breastfeeding, cover up, or breastfeed in another location, the Self Advocacy Guide provided below might help you decide on a course of action. The Guide contains two sample letters that you could use or adapt to suit your purpose. The package also provides some ideas about where to send the letter.

This resource may be adapted and distributed for cover page of guidenon profit or educational purposes without obtaining permission. Please credit the Community Breastfeeding Alliance of Waterloo Region as the source of these materials. Copies of any materials produced will be appreciated. Please send an email to communitybreastfeedingalliance@gmail.com letting them know about your work, and include electronic copies of the documents if possible.

Breastfeeding and Your Rights: A Guide for Self Advocacy

For assistance in this area, please contact the Ontario Human Rights Commission


Community Breastfeeding Alliance of Waterloo Region

The Community Breastfeeding Alliance of Waterloo Region (CBAWR) works toward a vision where breastfeeding anywhere, anytime is supported and valued in Waterloo Region through the following activities:

  • Advocacy for Policy Development through campaigns and initiatives to promote Baby Friendly policies in public and private spaces
  • Education and Promotion of a breastfeeding friendly community through targeted forums, events and announcements, and other venues as appropriate
  • Networking and Sharing among health care providers and individuals related to breastfeeding-related projects

Our membership includes hospital staff, doulas, breastfeeding mothers, childbirth educators, La Leche League leaders, a peer breastfeeding program coordinator, breastfeeding peer workers, public Health staff, midwives, physicians, and researchers.

Click here to see our Terms of Reference

Click here to read about our Past and Current Projects

Creating a breastfeeding policy

Development of breastfeeding policies in businesses, institutions, organizations and public spaces helps to protect, promote and support breastfeeding in our community.

Why is a breastfeeding policy important?

  • To ensure that women and their families have the information they need to decide how they will feed their babies
  • To give reliable and up to date information to pregnant and breastfeeding women and their families
  • To encourage a supportive environment so that women can breastfeed their babies for as long as they want to
  • To make breastfeeding information and support available for health care providers who are helping families
  • To make breastfeeding normal in our community

How do I create a breastfeeding policy?

The following policy development packages were created by the members of the Community Breastfeeding Alliance of Waterloo Region.

These materials may be adapted and distributed for non profit or educational purposes without obtaining permission.

Breastfeeding-Friendly Child Care

Breastfeeding-Friendly Public Facilities

Please credit the Community Breastfeeding Alliance of Waterloo Region as the source of these materials. Copies of any materials produced will be appreciated. Please email communitybreastfeedingalliance@gmail.com letting them know about your work, and include electronic copies of the documents if possible.

Contact Information

Looking for more information about the Community Breastfeeding Alliance of Waterloo Region?

Email: communitybreastfeedingalliance@gmail.com
Phone: 519-575-4400 ext. 6151

CBAWATERLOOREGION on Instagram

CBAOFWR on Twitter

CBAWR on Facebook

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