Breastfeeding Information and Support

Many mothers make the decision on how they will feed their baby long before the baby arrives. It is important to discuss this decision with your health care provider and share your thoughts and feelings with your partner and other support providers.

Remember, making breastmilk is a natural process that follows the delivery of a baby. There are very few mothers that cannot breastfeed or make enough breastmilk for their baby. Most women who have medical conditions or diseases or are taking medications can breastfeed. Only a very small number of women should not or cannot breastfeed. Talk to your health care provider and call York Region Health Connection for more information.

During pregnancy your body and your baby are getting ready to breastfeed:

• Your breasts will get larger and may feel heavier or tingly as they get ready to produce milk
• Your nipples and areolas will get darker and may get larger
• Your baby will practice sucking and swallowing
• Your breasts will be making colostrum during the last few weeks of your pregnancy. Colostrum is the first milk, is yellow-ish and thick and is very important to your baby. It provides your baby with all the nutrition and fluid needed in the first few days of life and strengthens your baby’s immune system.

It is rare that women cannot produce enough breastmilk. Women who have experienced the following are encouraged to speak to their health care provider to discuss how this may impact breastfeeding:

• Infertility or difficulty getting pregnant (related to the mother, including polycystic ovaries)
• Obesity
• Diabetes (if not well controlled)
• Thyroid issues (hypothyroidism)
• Breast reduction and other breast surgeries
• Absolutely no change in breast size or appearance during pregnancy

Even with these conditions, most women are able to produce all or most of the milk their baby needs. While exclusive breastfeeding is recommended, any amount of breastmilk is great for your baby.

It is also very possible to breastfeed twins, triplets or more! Here are some helpful tips for Breastfeeding Multiples.

Learning about breastfeeding during pregnancy is a great way to be prepared for feeding your baby after delivery. York Region offers prenatal classes which provide valuable information about getting breastfeeding off to a great start.

Mothers are encouraged to:

• Lean back and put baby skin-to-skin on their chest
• Allow and assist their baby to crawl toward their breast
• Breastfeed their baby within the first hour after birth
• Get help right away if baby is not showing interest in latching to the breast
• Offer their breast every few hours or sooner when baby is showing signs of hunger

Skin-to-Skin Contact is Important

Mothers should cuddle skin-to-skin with their baby as soon as possible after birth and between feedings. Spending time skin-to-skin will help the baby:

• Stay warm
• Recover from birth
• Follow the instinct to latch and feed at the breast

Getting a Good Latch at Every Feeding is Important

To encourage a good latch mothers can:

• Wait until the baby moves toward the breast
• Touch their nipple to the baby's upper lip and wait for the baby to latch
• Support the breast while the baby latches and feeds
• Make sure that the baby feels supported and comfortable

Some babies latch better when the breast is moulded into a “sandwich” shape. To do this, mothers can place their hand in a “U” shape under the breast and mould the breast to make it easier for baby to grasp.

When a baby is latched well:

• The baby's chin and cheeks should be touching the breast and head tilted back slightly
• Their nose will be tilted slightly away from the breast
• Their mouth will be open wide and their lips are flared
• Their chin and lower lip will touch the breast first
• They will have more of the breast below the nipple in his mouth
• They will have a strong and regular suck
• There will be no pain and nipples will not look pinched or white
• Mothers will often feel a “tugging” sensation but not pain
• Mothers will hear their baby make the "kaa" sound of swallowing. These swallows become more frequent each day. By day three or four mothers will hear a swallow for every one or two sucks

Try Different Positions

It is important that both mother and baby feel supported and comfortable while breastfeeding. A public health nurse or breastfeeding clinic can help mothers find positions that work for them.

When in a good position for breastfeeding:

• The mother should not experience pain or discomfort
• The mother’s back should be well supported
• The baby’s nose should be lined up with mother’s nipple to latch (nose to nipple)
• The baby’s tummy should be facing the mother
• The mother should be able to hold the baby close to her body
• The baby’s neck, shoulders and bottom should be supported

Babies should be fed at least eight times every 24 hours. Mothers will know it is time to feed when their baby shows these signs of hunger:

• Wiggling, tossing and turning or restlessness while sleeping
• Moving their hand towards the mouth and sucking on their fists
• Licking their lips
• Making sucking motions or sounds
• Rooting (opening their mouth, searching to suck and sucking on contact)
• Turning their head back and forth
• Sticking out their tongue
• Making soft cooing or sighing sounds
• Moving their arms and legs

Parents should try to feed their baby when they see the above signs. Crying is a late sign of hunger. If the baby is too upset to breastfeed well or latch, mothers can try:

• Sitting the baby upright on her chest, skin-to-skin
• Talking, rocking or gently stroking her baby in a calming way

Babies Should Breastfeed Frequently

Breastfed babies need to eat at least eight times every 24 hours. It is normal for babies to breastfeed 12 or even more times in a 24 hour period. Babies will often cluster some feedings together and then leave longer periods between other feedings.

During the first several weeks of life, babies will want to feed many times during the night. It may seem that the baby has “night and day mixed up”. This is normal for newborn babies and will help them grow and gain weight and will also help build the mother’s milk supply.

If the baby is not waking up to feed at least eight times in 24 hours, mothers should see their healthcare provider.

Diapers are the best way to tell if a baby is getting enough milk.

Mothers should talk to their health care provider, public health nurse or lactation consultant if their baby is not having enough wet and dirty diapers.

Day One

• One wet diaper
• One black stool

Day Two

• Two wet diapers
• One or two black or brown stools

Day Three

• Three wet diapers
• Two to three lighter brown stools

Day Four

• Four heavy wet diapers
• At least two yellow stools

Day Five

• Five heavy wet diapers
• At least two yellow stools

Day Six and On

• Six heavy wet diapers
• At least two yellow stools which may be runny and seedy

Breastmilk production works by supply and demand. The more often a baby breastfeeds and successfully removes milk from the breast, the more breastmilk is made. Mothers should feed their baby at least eight times every 24 hours to make sure they have enough breastmilk to feed their baby.

A mother’s breastmilk will start to change after 72 hours:

• Breastmilk supply should start to increase – breasts may feel full and warm
• Breastmilk gradually changes from sticky yellow colostrum to white, mature breastmilk over the first two weeks

Mothers should remove breastmilk frequently if their baby is not able to breastfeed. This can be done by hand or using a double electric breast pump. A Public Health Nurse can answer questions about removing milk by hand or by pump.

Babies Should Soften the First Breast Before Switching Sides

Mothers should make sure that the first breast is well drained before switching to the second. To do this, they can:

• Keep the baby on the first breast as long as the baby is swallowing milk
• When the breast feels softer and there are less swallows, the baby can be offered the second breast
• If the baby is still showing signs of hunger after both breasts, both breasts can be offered again
• By the end of the feed, at least one breast should feel soft and the baby should no longer be showing signs of hunger

Breasts Should not be Sore and Hard

A mother’s breasts should not become sore or hard if their baby is breastfeeding well. This happens when the breasts are full of milk that is not being removed. Hard, sore breasts can be treated with a cold compress or ice pack to reduce swelling between feedings.

If the baby cannot latch because breasts are too full and hard, mothers can remove some milk by hand or with a pump. This will soften the nipple/areola area to allow the baby to latch.

Tips for Mothers Whose Baby is not Latching Well

Mothers whose baby is not latching well can:

• Be patient and don’t give up; it may take days or weeks for the effects of birth to wear off
• Hold the baby wearing only a diaper to their naked chest (this helps the baby recover from birth and encourages feeding)
• Feed their baby another way while baby continues to work on breastfeeding
• Continue to remove milk from their breasts by hand or with a breast pump
• Breastfeed or remove breastmilk about eight times every 24 hours to keep breastmilk production up
• Get help; a health care professional or breastfeeding clinic can support mothers through this time and provide expert breastfeeding help

Formula should not be used unless necessary. Mothers should talk to a health care provider, public health nurse or breastfeeding expert about how and when to give extra milk also known as supplementing. Most breastfed babies do not need supplements. Babies may need supplements if:

• They are not having enough wet and dirty diapers for their age
• A health professional is worried that the baby is not growing well
• They cannot latch at the breast or do not drink well at the breast
• A health professional has assessed that breast milk supply is truly low
• They have been separated from their mother for medical or other reasons

In all of these cases, mothers should see a health care professional as soon as possible and get help from a breastfeeding expert. Breastfeeding support will help mother and baby establish breastfeeding, and often avoid the need for a supplement, or limit the amount that is necessary.

If Supplements are Needed

Mothers should still try to give as much breastmilk as possible if supplements are needed. Breastmilk can be removed by hand or using a double electric breast pump.  This milk can then be fed to the baby. Pasteurized human milk from an accredited milk bank would be the best second choice to a mother’s own milk, however, in Ontario this is only available for hospitalized babies. 

For a step-by-step guide to hand expression of breastmilk, please see Hand Expression

To watch a video which demonstrates hand expression, please visit:
Hand Expression Video - Stanford University

For information on how to safely store and use expressed breastmilk, please see Storing expressed breastmilk factsheet.

Infant formula (commercial cow milk-based) can be used if a mother does not produce enough breastmilk to feed her baby. Read our infant formula factsheet for information and safe preparation and storage instructions.

Canada is currently experiencing a shortage of infant formulas for infants with food allergies and certain medical conditions. Please note that there is no current shortage of regular infant formula in Canada.

For more information, please visit Health Canada

Bottle Nipples and Pacifiers Should be Avoided

Offering a bottle or a pacifier/soother may make learning how to breastfeed difficult for some babies. If babies need extra milk, mothers can try the following alternative feeding devices before using a bottle:

• Tube at the breast
• Finger-feeding tube
• Cup
• Spoon

For information about the use of any of the above feeding methods, please see the When your breastfed baby needs extra milk booklet.

Pacifier/soother use can interfere with a baby’s breastfeeding success.  Instead of using a pacifier, parents can try to calm their baby with cuddling, rocking and placing skin-to-skin.

Just Breastmilk for six Months

Babies do not need any foods or drinks other than breastmilk until six months of age. They can then be given solid foods, along with breastmilk. It is recommended babies continue to breastfeed with solid foods for two years and beyond. Breastmilk continues to provide older babies and toddlers with protection against illness and disease and continues to be an excellent source of nutrients for young children.

There is no need to give babies water in the first six months of life — breastmilk has all the water babies need.

All babies need extra vitamin D. Vitamin D has already been added to infant formula, however, breastfed babies and babies receiving breastmilk will need a vitamin D supplement.  Talk to your health care professional about giving vitamin D to your baby.

Mothers can get support:

• By calling Health Connection at 1-800-361-5653
• At one of York Region’s Breastfeeding Clinics
• 24 hours a day by calling Telehealth Ontario at 1-866-797-0000 (TTY 1-866-797-0007)
• By calling La Leche League Canada at 416-483-3368
• By reading the Breastfeeding Matters guide

Mothers should seek help if:

• Their baby is not having enough wet or dirty diapers
• Their baby is not able to latch or cannot latch well
• Their baby still seems hungry after breastfeeding and they have to feed their baby supplements. When Your Breastfed Baby Needs More Milk factsheet
• Their baby does not regain their birth weight after 14 days
• A health professional is worried about their baby’s growth
• They have sore nipples or breasts
• They have questions or want information or advice about feeding their baby

Hand expression in the first hour after birth and continuing after each feeding helps to establish a good milk supply, even when breastfeeding is going well.

Hand expression can:

• Provide baby with a taste of milk to get them interested in feeding
• Soften the area of the breast surrounding the nipple (areola) to help baby to latch
• Lessen the discomfort of overfull breasts
• Help maintain milk supply if separated from baby or unable to feed baby directly from the breast
• Save the cost of a breast pump

It is normal to get very little or no milk at first. You may only get a few drops or a teaspoon initially. This is the perfect amount for your new baby’s small tummy in those first few days. The more you hand express over time, the easier it will become and the more milk you will get.

Resources

• Video - Hand expressing breastmilk
• Video - Successful breastfeeding begins right at birth
• Hand expression resource

Continued breastfeeding after returning to work or school is possible and can often be easily incorporated into a family’s daily routine. Continued breastfeeding is important to the health of both mother and baby, and is a protected right covered under The Ontario Human Rights Commission.

Why keep breastfeeding?

Health Canada, the World Health Organization and the Canadian Paediatric Society recommend that babies be fed only breastmilk for the first six months of life (called exclusive breastfeeding), then be fed solid foods with continued breastfeeding for two years and beyond. 

Breastfeeding protects both maternal and child health. Many of the protective effects of breastfeeding increase over time. The longer a child is breastfed or receives human milk, the greater the protective effect against disease, for both mother and child.

Breastmilk:

• Helps to protect a child from common childhood illnesses, such as ear and lower respiratory tract infections, as well as diarrhea
• Decreases a child’s risk of diabetes, childhood cancers and obesity later in life. Children who are not breastfeed are at greater risk for these chronic diseases
• Supports a child’s immune system. Some of the illness-fighting cells present in breastmilk increase during the second year of lactation. This makes breastfeeding two years and beyond very important to a toddler’s health
• Continues to be a valuable source of nutrition for children, well beyond one year of age. Necessary vitamins, minerals and energy continue to be supportive of healthy growth and development
• Is very important to maternal health. Women who are breastfeeding or expressing milk have a decreased risk of breast and ovarian cancers, as well as depression, cardiovascular disease and type 2 diabetes

Did you know?

Mothers who breastfeed after returning to work take less time off work to care for ill children. This is because breastfed children get sick less often!

What are the options for continued breastfeeding?

There are several ways to continue breastfeeding or providing expressed breastmilk after returning to work or school. 

Options include:

• Having someone bring your child to work or school to be breastfed. Employers and schools will accommodate this as breastfeeding is a protected human right
• Expressing breastmilk at work or school and storing it in a fridge, or insulated cooler with ice pack. Expressed breastmilk can then be fed to your child in your absence
• Breastfeeding while you are with your child at home, but not expressing breastmilk or breastfeeding while at work or school. Milk supply will adjust to meet the needs of your child. However, once breastmilk supply has decreased, it may be difficult to increase again at a later time

What are my rights?

The Ontario Human Rights Commission states that you have the right to breastfeed your child, or to express your breastmilk, while at work or school. To learn more about this human right, please visit www.ohrc.on.ca

What must an employer do?

• Protect and support your right to breastfeed and/or express breastmilk
• Give you enough time to breastfeed or express your breastmilk
• Give you an appropriate place that is clean and private, to breastfeed or express your breastmilk

Tips for returning to work:

Before you return:

• Talk to your employer about your plans to breastfeed or express your breastmilk
• Talk to other breastfeeding mothers who spend time away from their children
• Practice expressing breastmilk by hand or pump
• Buy an insulated cooler bag to store breastmilk, or ensure there is a fridge at work or school that you can use to store your expressed milk
• Review Storing Expressed Breastmilk

  While you are at work or school:

• Wear a supportive and comfortable bra
• Express your milk when you feel full or uncomfortable, about every three to five hours depending upon the age of your child
• Expect that it may take days or weeks for your breastmilk supply to adjust to the amount of milk being removed

What will be helpful for my child?

• Breastfeed right before you leave the house and when you are reunited with your child again. Your child may wish to breastfeed frequently during the evening as well
• Understand that it is not unusual for children to want to breastfeed more often at night once separated from their mothers in the day. This may be short term, as your child adjusts to a new routine.
• Breastfeed on demand when you are with your child
• If you will not be directly breastfeeding your child at school or in the workplace, have your child practice drinking in another way. A sippy cup is an option if your child is under 18 months of age, or a cup without a lid once they are able to do so without excessive spillage
• If you decide to feed expressed breastmilk from a bottle, remember that artificial nipples may lead to earlier weaning from direct breastfeeding.
• By 18 months, children should be breastfeeding and/or drinking from a cup without a lid. Using a bottle or sippy cup should stop by eighteen months, as prolonged use may lead to dental problems

How can my childcare provider support breastfeeding?

Choose a childcare provider who:

• Understands that breastfeeding is important to health
• Will support your breastfeeding goals, and welcome you to breastfeed during dropoff and pickup
• Accepts expressed breast milk to feed your child in your absence
• Has a policy about how to store and offer expressed breastmilk

Remember, breastfeeding and expressing breastmilk at work, school or in public is a human right in Ontario. You have the right to breastfeeding anywhere, anytime!

Breast Friends is a program where you can connect with an experienced breastfeeding parent to help you reach your breastfeeding goals.

Importance of Breastfeeding Support

York Region Public Health provides breastfeeding support services to families by telephone and in person at our breastfeeding clinics. Breastfeeding peer support from other experienced parents is another way families can be supported to reach their breastfeeding goals.

Program Description

The Breast Friends program provides new parents with telephone support from parent volunteers with breastfeeding experience. Volunteers speak a variety of languages and provide support, encouragement, information, suggestions and understanding.

Our peer support volunteers are parents who have:

• Experience with breastfeeding.
• A positive attitude towards breastfeeding.
• Attended and completed in-person training.
• Completed vulnerable sector screening.

Your peer support volunteer will:

• Support you while you are breastfeeding your baby.
• Know what it’s like to breastfeed and share their own experience.
• Support you to make decisions that are right for you and your baby, based on accurate information.
• Provide you with information about where to get help if you experience challenges.

What to expect:

• Your volunteer will connect with you a few weeks before your due date and answer any questions you may have. You may then contact your volunteer at any time to ask questions and get support.
• If you are joining after your baby is born, your volunteer will connect with you right away.
• You will continue to receive support from your volunteer for 6 months after your baby arrives.
• This program is completely voluntary and you can stop receiving support at anytime.

Eligibility

All families living in York Region are eligible and can sign up while pregnant OR within the first month of having a baby.

Cost

FREE – there is no cost for you to enroll in this program.

How to Register

If you are interested in receiving breastfeeding support, please fill out the Intake Form and email it to @email

If you are interested in becoming a peer support volunteer, please fill out the Volunteer Application and email it to @email