Hesperian Health Guides


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A first-time mother may need help with breastfeeding. Help her stay calm and focused. Prop her up with blankets and pillows so she is sitting upright and comfortable. Ask family and visitors to give the mother and baby some privacy. Be encouraging. Breastfeeding becomes easier with time and practice.

Breast milk is better for a baby than any mix or formula.

Avoid painful, cracked nipples with a good breastfeeding position. Turn the baby’s whole body toward the mother so his neck is not twisted. Wait until he opens his mouth wide. Then bring him onto the breast. The nipple and much of the dark area surrounding it (areola) should be deep in his mouth.

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Nipple deep in the
baby's mouth
Lower lip folded down
Mouth open wide
Baby held close to the
mother's body
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Like this. Not like this. A bad position
can cause painful
cracked nipples.

The first milk is like liquid gold

The first milk, called colostrum, comes in small amounts, but it is the right amount for a new baby. (A baby's stomach holds only a few teaspoons at a time.) Colostrum is sticky and looks yellowish, but even though it looks different, it is the perfect food for a new baby. It contains antibodies – substances made by the mother’s body that protect the baby from infection. Do not throw the first milk away: it is worth more to a baby than any medicine. Breastfeeding in the first 2 days is also important because it brings the mature milk that the mother begins to produce in about 3 days after birth. The more the baby nurses, the more milk the mother will make.

Is the baby getting enough milk?

Do not let anyone tell you that you cannot produce enough milk for your baby, especially in the first few days when your body is just starting to produce milk.

Because of pressure from others and self-doubt, mothers (or grandmothers or aunties or nurses who are trying to help) give formula, or porridge, or some other food to a new or young baby. These extra foods are a waste of money and can cause diarrhea in the baby. Diarrhea causes the baby to lose weight and become weak. And using these extra foods makes the mother produce less milk. So she becomes even more convinced she cannot feed the baby enough with just her breasts. If you are a health worker, you can prevent this cycle of serious health problems by showing mothers that you believe in their ability to nurse. Help with positioning the baby, but also give the mother time to learn for herself how nursing works. Speak gently. Be patient.

To make enough milk

  • Nurse often. The more you breastfeed, the more milk you will make.
  • Drink enough fluids and eat more. Feed your baby by feeding yourself.
  • Rest often. When the father and family help with chores, the mother can better care for her new baby.

The more you breastfeed, the more milk you will make.

Most babies lose a little weight in the first week, which is normal. After that, weight loss means the baby is not getting enough to eat. Similarly, babies do not urinate much on the first day, but after that they should start passing urine every few hours. If a baby does not urinate much after two days, he is not getting enough milk. But what if the baby is nursing often and does not urinate or grow? In these rare cases, you may need to substitute with another milk. Do not give sugar or rice water. Do not give packaged formula unless you are sure you can afford to give the recommended amount (watering it down causes diarrhea and sickness). And do not use bottles: they are hard to clean so they spread germs that cause diarrhea.

Other milk must be given if the mother dies or is separated from her baby, or in the rare case that she truly is not making enough milk. You can ask another mother to breastfeed the baby. She should get an HIV test to know if this is safe, because HIV can pass to the baby through breastfeeding. Another option is to make an animal milk formula:


2 parts cow or goat milk
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1 part water
1 large spoonful of sugar

1 part sheep milk
1 part water
1 large spoonful of sugar

2 parts canned evaporated (not sweetened) milk
3 parts water
1 spoonful of sugar

Briefly boil your formula to kill germs. Then let it cool and feed it to the baby with a clean cup or spoon.

Milking the breast by hand (extracting milk)

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If you must go to work or leave the baby for another reason, you can try milking the breast and when you are gone someone else can give the baby your milk.

  1. Wash your hands and a jar. Boil the jar if you can.
  2. illustration of the below: milking the breast into a jar.
  3. Hold your fingers and thumb at the edge of the dark part of the breast (areola). Press toward the chest. Then press your fingers together as you roll forward toward the nipple. Relax and think about the baby while you extract the milk–it can help the milk come down.

    Breast milk will keep about 8 hours if it is not too hot outside. It will keep longer if you can keep it cold.


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Use a small, clean piece of cloth to spread the medication inside the baby’s mouth.

White patches on the tongue or inside the cheeks and irritability with nursing can be a sign of a yeast infection of the mouth, called thrush. This infection can spread to the mother’s nipple and can cause redness, itching, and pain.

Try rinsing the nipple with a little vinegar, and then water. Or if you have no vinegar, just gently rinse and dry the nipples after each time you nurse. If this does not cure the thrush, paint a little gentian violet on the nipple 2 times a day for 3 days. Also paint the inside of the baby’s mouth once a day. (This will turn everything purple, but it is safe.)

If gentian violet does not help, give the baby nystatin.

If thrush keeps coming back again and again, the baby may have another problem that is weakening her ability to fight the infection. For example, babies who have HIV may get thrush many times. See HIV and AIDS (in development).

Breast pain, swelling, blockage, or infection

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Sometimes milk clogs a duct (the small tubes inside the breast that carry milk). The breast becomes swollen, red, and painful. Soon an infection can start.

  • A hot, red, hard area on one breast.
  • Pain in the breast and while breastfeeding.

If there is fever, then the blocked duct has become infected.

  • Rest. Drink fluids.
  • Breastfeed at least every 2 hours. Breastfeeding with a breast infection is safe for the baby and is the best way to flush out the infection.
a woman massaging her breast in a downward motion while breastfeeding.
Use a firm pushing motion to massage the clogged area out
  • Be sure you have a good breastfeeding position. The baby's whole body should face the mother. The baby's mouth should open wide, and the nipple should go deep in the baby's mouth.
  • Breastfeed on the sore side first, and let the baby empty that breast.
  • Warm, wet cloths or a hot bath can help.
    Warm the breast for 15 or 20 minutes, at least 4 times a day.
    Or, put cool cloths or cabbage leaves on the breast to relieve the swelling.

If there is fever, give 250 mg erythromycin, 4 times a day.

HIV and breastfeeding

Pregnant women with HIV can take medicines to stay healthy and also prevent their babies from getting HIV. To protect women and children, every pregnant woman should be able to get an HIV test. And if she has HIV, she should be provided with HIV medicines during pregnancy and for the entire time she is breastfeeding which will protect her baby from HIV, and afterwards for her own health. See HIV and AIDS (in development).

Is it safe to breastfeed when you have HIV?

HIV medicines taken by the mother and the baby prevent babies from getting HIV during breastfeeding. The baby must take medicines every day for at least 6 weeks. If the mother did not get HIV medicines through her entire pregnancy, give the baby medicine for at least 12 weeks. If the mother is not taking HIV medicines, give the baby medicine until 1 week after the baby stops breastfeeding. The baby's health is also protected by giving only breast milk for the first 6 months (or until he gets his first teeth). Giving porridge and other drinks before 6 months is not healthy for the baby and can make HIV infection more likely.

HIV medicines for the mother and her baby
will keep both of them healthy.

When there are no HIV medicines, there is some risk of HIV passing through breast milk. But the risk of sickness from giving formula is much greater. Most mothers with HIV do not have the clean water, fuel, or money to safely get, prepare, and give formula. Their babies are likely to become malnourished and get diarrhea, and they may die. What this means is breast milk is safest–even when the mother or baby is not taking HIV medicines.

For babies and mothers everywhere, breast is best


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  • Is much less expensive. You do not need to buy formula, bottles, or anything else.
  • Helps stop the mother’s bleeding after birth.
  • Helps prevent pregnancy in the months after birth.
  • Protects the mother from cancers and weak bones
    later in life.
  • Is always fresh, warm, and ready-to-eat.
  • Has all the nutrients a new baby needs.
  • Helps protect babies against diarrhea, pneumonia, and other illnesses.
  • Gives long-term protection against diabetes, allergies, and cancers later in the baby’s life.
  • Keeps the baby safe and warm next to the mother.
  • Brings the mother and baby closer together.
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This page was updated:30 Jan 2018