The decision to breastfeed is a personal one and, increasingly, a common one. Canadian health organizations unanimously support breastfeeding, and they're spreading the message that breastmilk offers perfect nutrition and significant immunological and psychological benefits for the health of the babies. Certainly breastfeeding can't be beat for its practicality. Whenever the baby is hungry, mother offers a ready-to-serve, not to mention free, milk supply.

10 reasons to breastfeed
1. Breastfed infants have increased protection against major illnesses like meningitis and diabetes.

2. Breastmilk also helps protect against minor illnesses including ear and gastrointestinal infections, diarrhea, and colds, and may help protect against Sudden Infant Death Syndrome (SIDS).

3. When breastfed babies do get sick, they require hospitalization less frequently than bottle-fed babies.

4. Breastmilk offers superior nutrition.

5. The components of breastmilk change to meet the infant's changing nutritional needs as he grows.

6. Breastfeeding may protect against food allergies, if mother's diet contains only low allergenic foods.

7. Breastfeeding is convenient. There are no bottles to sterilize, no formula to mix.

8. Breastfeeding may save a family about $100 a month in formula and bottle supplies.

9. Breastfeeding is enjoyed by both mother and baby, and promotes attachment.

10. Women who breastfeed experience less ovarian and breast cancer.

Choosing to breastfeed
It's a decision each mother makes after considering all the available information and a constellation of family and community factors: how does she feel about breastfeeding? What does her partner think? Did her own mother breastfeed? Her sister? Her friends and neighbours? Will she feel comfortable breastfeeding in public? In the end, the decision lies with the soon-to-be mother, who may not always choose breastfeeding but who will choose what she feels is best for herself and her family.

About 80 per cent of Canadian mothers start breastfeeding in hospital; by the baby's sixth month, 75 per cent are using formula alone or in combination with breastfeeding.

Beginning to breastfeed
With the birth of your baby and the expulsion of the placenta the level of prolactin in your body rises, which stimulates the secretion of milk. Within the hour after birth, a baby's sucking instinct is at its strongest, and the baby will instinctively seek his mother's breast. When he wants to nurse depends on his quickly emerging personality.

Some babies are slow to develop an effective feeding pattern; they seem to prefer to open their eyes wide and look around or to nod off to sleep. Other babies suckle vigorously and often. Let your baby breastfeed whenever he indicates an interest, and aim for a minimum of 8 feedings in 24 hours. Some babies may breastfeed as often as 10 to 12 times in 24 hours. Look for hunger cues such as changing facial expressions, sucking, rooting, and bringing his hands up to his face.

From colostrum to mature milk
During the first days of nursing your first milk (called colostrum) is thick, sweet, and yellowish. New mothers have between 2 and 20 mL each day for two or three days. Not only does it give complete nourishment, it also supplies antibodies that protect the baby from disease. It has a laxative effect that helps clear out the meconium, the dark greenish material (a baby's first feces) that is passed by the third or fourth day. If the baby is nursed soon after birth and frequently thereafter, transition milk (a mixture of colostrum and mature milk) will be flowing within three or four days (with a first child) and will last until about the tenth day when a mother's mature milk begins to flow.

Breast engorgement
On day three after the birth, when your milk production increases, you may look like a fertility symbol but your painful breasts will make you feel like anything but a goddess. Day three engorgement is almost inevitable. The best way to treat this and other engorgement (which may occur later if you miss a feeding or two) is to nurse the baby frequently. You may be able to avoid further engorgement altogether by giving your baby frequent unrestricted opportunities to breastfeed. Engorgement makes your breasts hard and nursing difficult. You might express some milk with a breast pump until your areola softens, which will allow your baby to latch on to your breast more effectively. To relieve soreness before nursing, have a hot shower, or apply heat to your breasts with warm compresses or hot wash cloths. Gently massage the breast to help the milk flow.

If your breasts are very painful, take a pain reliever 20 minutes before nursing. Acetaminophen will not affect your baby. After feeding, apply ice packs for 15 to 20 minutes to help decrease swelling. With regular nursing, engorgement does eventually go away. For more information on breastfeeding problems, see Problems with breastfeeding.

Normal jaundice and breastmilk jaundice syndrome
If your baby's skin is developing a distinctive yellow tint, he may have normal jaundice, which affects approximately 50 per cent of all babies in the second to fourth day after birth. Most babies do not require treatment for jaundice but, if a blood test shows that the level of serum bilirubin (bile in the blood) is excessively high, your doctor may suggest phototherapy (light therapy) to help speed up the elimination of the bile which causes the yellowish tint. All infants with jaundice need to be monitored by a physician because of the association of high bilirubin with brain damage.

However, breastmilk jaundice syndrome is a rare condition affecting 2 to 4 per cent of breastfed newborns. It usually appears toward the end of the first week, peaks at ten to fifteen days, and may last three weeks or longer. Breastfeeding should not be interrupted because of either the normal jaundice or breastmilk jaundice syndrome. In fact, frequent unrestricted breastfeeding can be helpful to both the mother and the baby.

Who to turn to for help
The first three to five days after birth are crucial for successful breastfeeding. With the recent policy of discharging a new mother and child from the hospital 24 hours after birth, the onus lies firmly on the shoulders of the new parents to find help with breastfeeding.

You may think that breastfeeding will come naturally but, like most aspects of parenting, breastfeeding is a learned art. If you haven't set up breastfeeding support before your baby's birth, don't leave the hospital without a phone number to call with questions. You may also need someone who will meet with you, if needed, to coach and encourage you through any problems you may encounter.

Finding answers to a breastfeeding problem may be as simple as a phone call to your sister. Or maybe you have a friend who has nursed before, and you feel comfortable whipping off your top in front of her. She, too, has fallen in love with your baby and is more than willing to work with both of you on the mechanics of nursing. Or perhaps it's midnight, your breasts are rock-hard with engorgement, your baby's screeching and you feel you have no one to turn to. You're wrong.

With the decrease in the length of the hospital stay has come an increase in support to breastfeeding mothers. A good place to start is the hospital where you gave birth. A nurse will be able to give you some over-the-phone help and, if your hospital has a breastfeeding clinic, you'll be invited to join. Some hospitals also have a "warm line" which new mothers can phone for advice and support. You could check with your family physician who is trained to help you or who may refer you to a nurse, a midwife, or a lactation consultant -- a person who is fully informed about all aspects of breastfeeding. Another good source is your public health unit. Check the local or municipal Blue Pages in your telephone book. Public health nurses can offer everything from home visits to 24-hour phone-in lines to well-baby clinics to drop-ins.

La Leche League Canada may be a helpful source for you. La leche is Spanish for the milk and La Leche League is the largest women's health organization in the world, with more than three thousand breastfeeding support groups in 48 countries. Chances are that there's a group near you that can offer mother-to-mother support, monthly meetings, and telephone help. To locate your closest group, check for La Leche League in the business section of your phone book or call their Breastfeeding Referral Service at 1-800-665-4324.

You may also want to read The Womanly Art of Breastfeeding (6th edition, 40th anniversary, 1997), La Leche League International's runaway bestseller, considered by many as an essential resource for the breastfeeding family. Or watch one of their videos. The 60-minute video The Art of Breastfeeding
was made, in part, by La Leche League Canada.