Q: I’m pregnant with my first child. I plan to breastfeed, and have already taken a class at Englewood Hospital, where I plan to deliver. I know that I have to focus on the needs of my baby when it comes to breastfeeding (i.e. the baby has to suck for a long time to get the fatty part of the milk), and frankly, I’m fearful of the pain. Can you give me some suggestions on how to successfully breastfeed?

A: The timing for your question is excellent; the first week of August has actually been designated World Breastfeeding Week by the World Alliance for Breastfeeding Action, a global network concerned with the protection, promotion and support of breastfeeding worldwide. I laud your preparation; I, too, planned to breastfeed, and in fact gave my child my colostrum (which is loaded with antibodies, and gave her immune system a huge boost), but for a variety of reasons, including soreness from over nursing the first two days was unable to continue to breastfeed. After speaking with parenting educator, Shari Criso, who is a registered nurse, certified nurse midwife, international lactation consultant and creator of The Birth Boutique and My Baby Experts, I wish I’d known her when I first gave birth to my daughter.

Can you share your philosophy of breastfeeding?

I've made it my mission to educate women on how to successfully breastfeed. Most lactation education is baby-focused. My method of teaching is mom-focused. For example, common advice moms receive is to start by breastfeeding for twenty minutes on each side. Initially, I limit the feedings to five minutes on each side, because on the first day of life the baby doesn’t need a lot of volume right away (a newborn’s stomach is the size of a thimble), and the mother is less likely to get nipple soreness from overfeeding, which makes it painful to continue to breastfeed and often leads to the decision that breastfeeding isn’t right for her. After the first day, I gradually increase the amount of feeding and then when the mother's milk comes in we don't watch the clock.

I am happy to say that there is a recent mandate by the surgeon general to make nursing easier for mothers through support at home and at work. Scientific studies have demonstrated that breast milk helps boost a child’s immune system, reduces the risk of diarrhea, pneumonia, SIDS, ear infections, and asthma. It also is connected with a lower risk of ovarian and breast cancer in mothers.

How can I best prepare for breastfeeding?

Oddly enough, a generation ago, it was better and easier for women to breastfeed. Now, even though fewer women are breastfeeding successfully, while 75% of mothers start out breastfeeding, the average national rate is 13% after the six month point. To prepare, definitely take a breastfeeding class prior to delivery; don’t just rely on the lactation consultant in the hospital (most of them never see breast milk, since the majority of women leave before their milk comes in four or five days after giving birth) ; and also have an outside consultant. I find that women who use my DVD, Simply Breastfeeding: The Criso Breastfeeding Method, find a success rate of over 85%.I teach the correct way to get a newborn baby to latch (not through the popular clutch, cradle or lying down positions), but through the cross cradle position, and cover why it makes no sense to use a pump in the hospital after you’ve given birth; discuss how to deal with engorgement and lots more.

Are there key supplies you need to be successful?

Purchase basic breastfeeding essentials, before you give birth. For example, buy a good breast pump; it’s an incentive not to give up if you’ve already spent the money. Also, buy two nursing bras, disposable nursing pads, My Brest Friend nursing pillow, a high backed chair, and a nursing stool so that when you bend your knees they are higher than your hips (Medela makes a great one).

How do I know my baby is getting enough breast milk?

The way you know your baby is getting enough breast milk is by watching wet diapers. Six to eight wet diapers in a 24-hour period means the baby is hydrated and getting enough volume. You’ll also hear audible swallows from your baby while he is nursing, and a satisfied baby doesn’t cry after a feeding. If that is the case, there is usually no need to start supplementing. Most pediatricians will put breast fed babies on the Center for Disease Control and Prevention growth chart; a chart which was based on formula-fed babies (which are heavier, because they consume more). I recommend that women bring their doctors the growth chart from World Health Organization, which takes into account the weight of breast fed babies from around the world.

I have to go back to work in 6 weeks, is it still worth breastfeeding?

Yes, any amount of time spent breastfeeding is worth it. The American Academy of Pediatrics recommends breastfeeding exclusively for six months, and then after introducing solid foods to continue breastfeeding for up to 12 months or longer. If you want to supplement with formula; for the first couple of weeks try to exclusively breastfeed until your full supply comes in. Then try to pump, so that you can breast feed while at home; and at night substitute the supplement. If you stick to the same times for the supplement feeding your body learns when not to make milk. Its best to select a formula to supplement with that is organic, and free of hormones. Also avoid soy formula; corn syrup is the first ingredient in it, then genetically-modified soy and then sugar. A baby who receives soy formula takes the equivalent of five birth control pills a day.

Editor’s note: If you have questions related to parenting, raising kids or just generally being a mom, feel free to submit them to the author at estellewriter@aol.com, like the author at http://www.facebook.com/estelle.sobel.erasmus or email the editor at erik.wander@patch.com. Your question might just be featured in a future column.