Pregnancy and the birth of your baby are such happy times for parents. But they can also be times of worry.

I receive many questions before and after delivery about breastfeeding. There are so many decisions to make, and parents always want the best for their baby. But stress about breastfeeding can sometimes worry the parents unnecessarily.

Nancy Murray, RN, a lactation specialist for Duke University Health System, describes below some of the issues.

-- Dennis A. Clements, MD, PhD, MPH

Most parents choose to breastfeed their baby because of the overwhelming medical benefits of breast milk.

Medical evidence has detailed some of these benefits, such as:

• Resistance to common infections including diarrhea, respiratory infections and ear infections
• Improved response to many immunizations
• Reduced risk for many chronic diseases including diabetes, childhood cancer, and allergic diseases
• Improved digestion of necessary nutrients
• Lower incidence of Sudden Infant Death Syndrome
• Improved maternal health

Because of the benefits to mothers and babies, many obstetricians, pediatricians, and family doctors provide services to help mothers understand issues related to breastfeeding, from pregnancy until the baby is weaned.

Classes

Breastfeeding classes are usually offered to give parents an overview of what to expect before the baby is born.

These classes cover many topics, including:

• Positioning and latching on the breast
• Frequency of feedings
• How to know the baby is getting enough
• Other common breastfeeding problems
• Breastfeeding equipment

After the Birth

Once the baby is born, the nursing and medical staff work to ensure that the baby is latching to the breast well and can drink mother’s milk.

For the first few days after birth the baby drinks colostrum, “the first milk,” which is small in amount but rich in important nutrients. Then milk comes in fully, usually between three and five days after delivery.

At many institutions, like Duke University Hospital and Durham Regional Hospital, lactation consultants help improve the feeding of the baby and develop a detailed feeding plan before the baby and mother are discharged.

Lactation consultants can also assist in obtaining and using an electric breast pump to express milk if the baby is unable to feed right away. The staff works hard to ensure that premature babies receive breast milk as early as possible.

Specific feeding instructions are given to breastfeeding families at discharge, so that they know how to get through the first days at home.

Breastfeeding Equipment

If you need an electric pump or other breastfeeding equipment, most institutions have equipment for rent or purchase.

Often hospital-grade breast pumps are available for rent by the month for mothers who are having feeding problems, or for mothers with infants with health problems who are unable to feed directly at the breast for a while.

Alternatively, commercial shops near most hospitals specialize in breastfeeding for parents to purchase before or after their hospital discharge.

First Check-up

Most breastfed babies return to the pediatrician for their first visit within 48 to 72 hours after hospital discharge.

At this visit, the health of the baby and the feeding history is reviewed. The pediatrician or family medicine doctor and their staff can assist with common breastfeeding questions.

Most mothers begin to produce more breast milk by the time they return to the pediatrician’s office, and the staff can reassure the parents about feeding as well as help them understand how to know the baby is getting enough milk.

Most breastfed babies normally lose some weight in the first few days after birth and then begin to gain weight after the breast milk comes in. The medical provider will make sure that the baby’s weight gain is normal at each feeding, and watch the weight closely until the baby returns to birth weight -- usually within seven to 14 days.

At Duke the lactation consultant at Duke Children’s Primary Care gives advice and help with breastfeeding issues after discharge. She can work with the mother if there are problems with breast engorgement, nipple soreness, difficulty with latch, babies with slow weight gain, prematurity, or other feeding issues that may occur.

If difficulties arise, they usually occur in the first few weeks after bringing the baby home. Being sleep deprived and learning about how to care for a new baby can be overwhelming.

After the first few weeks, things calm down, and caring for the baby, including feeding, becomes much easier.

The American Academy of Pediatrics recommends providing some breast milk to babies throughout the first year of life.

Medical providers and institutions know that by promoting and supporting breastfeeding, they can improve the immediate and long-term health of infants and children.

-- Nancy Murray, RN, is a lactation specialist for Duke University Health System.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.