Breast Feeding Coalition Rhode Island 2011

RHODE ISLAND
BREASTFEEDING
RESOURCE DIRECTORY
2011–2012
1
TABLE OF CONTENTS
TA B L E O F C O N T E N T S
INTRODUCTION
Introductory Statements............................................................................................................2
P R E N ATA L & P O S T PA R T U M S U P P O R T
The WHO/UNICEF Baby Friendly Hospital Initiative ....................................................................5
Women, Infants, and Children (WIC) Program ..........................................................................6
Prenatal Breastfeeding Classes ..................................................................................................8
Breastfeeding Warm-Lines ......................................................................................................10
Outpatient Lactation Support..................................................................................................11
Postpartum Breastfeeding Support Groups/Classes .................................................................13
Postpartum Depression ...........................................................................................................16
L O C A L & N AT I O N A L R E S O U R C E S
Breastfeeding Laws .................................................................................................................18
Breastfeeding in the Workplace ..............................................................................................19
Breast Pump Medical Insurance Coverage...............................................................................20
Breast Pump Rental/Sales ........................................................................................................22
Mothers’ Milk Banks ...............................................................................................................24
Websites.................................................................................................................................26
Videos ....................................................................................................................................30
Books for the Nursing Mother ................................................................................................33
C L I N I C A L I N F O R M AT I O N & R E S O U R C E S
Criteria for Breastfeeding Referral ...........................................................................................36
Information Lines/Websites for Professionals ...........................................................................37
Resource Texts for Professionals ..............................................................................................39
Continuing Education in Lactation Management/Breastfeeding ..............................................42
BREASTFEEDING TOOLS & GUIDELINES

Guidelines for Managing Common Breastfeeding Concerns ...................................................44
Ages and Stages: Breastfeeding During Your Baby’s First Year.................................................57
Frequently Asked Questions about Breastfeeding....................................................................64
Breastfeeding Record for Baby’s First Week .............................................................................72
Breastfeeding Your Baby .........................................................................................................74
Breastfeeding and Going Back to Work or School...................................................................76
Tips for Childcare Providers.....................................................................................................78
Birth Weight Conversion Tables...............................................................................................80
2
ABOUT THIS RESOURCE DIRECTORY
A B O U T T H I S R E S O U R C E D I R E C T O RY
Dear Health Care Professional,
During this important time in a woman’s life, a pregnant or breastfeeding mother may have
questions or concerns about breastfeeding her child. There are numerous resources available to
mothers and health care professionals to help answer those questions and provide useful
information, services, and support.
In this directory you will find breastfeeding resources including classes, professional services,
insurance information, state laws, books, videos, and websites. In addition, this directory has
tools and guidelines that health professionals can turn to for easy access to information on
managing common breastfeeding problems. It is our hope that you will become familiar with
the information available in this resource directory so that you may better guide the next
mother who needs information or support to make her breastfeeding experience a positive one.
Warmly,
Erin E. Dugan, MPH, CLC

Chair, Rhode Island Breastfeeding Coalition
Emily Eisenstein, MPH, CLC

Secretary, Rhode Island Breastfeeding Coalition
State Breastfeeding Coordinator, Rhode Island Department of Health
ACKNOWLEDGMENTS
The Rhode Island Breastfeeding Coalition would like to acknowledge the work and efforts of
the members of the coalition, without whose help this project would not have been possible.
This resource directory and updated information are available at

www.health.ri.gov/breastfeeding
3
THE RHODE ISLAND BREASTFEEDING COALITION
P O S I T I O N PA P E R O N B R E A S T F E E D I N G
P O S I T I O N PA P E R O N B R E A S T F E E D I N G
The Rhode Island Breastfeeding Coalition is a coalition of community organizations working to
protect, promote, and support breastfeeding in Rhode Island. Members represent local birthing
hospitals, health insurance companies, WIC, visiting nurse organizations, Early Head Start
Programs, public health clinics, private clinical practices, La Leche League, research
organizations, and the Department of Health.
The Rhode Island Breastfeeding Coalition recognizes breastfeeding as the optimal method of
infant feeding. To date, a large body of scientific literature regarding infant feeding indicates
that human milk provides infants with ideally balanced nutrients and immunologic protection
against infection and allergies unparalleled by breast milk substitutes. Breastfeeding has been
shown to decrease infant mortality and morbidity, thereby reducing health care expenses.
Breastfeeding also creates a unique opportunity for strong mother-infant attachment. As the
physiologic completion of the reproductive cycle, breastfeeding provides numerous maternal
health benefits. All of these advantages cost little or nothing to the family.
The vision of the coalition is that all babies in Rhode Island will be breastfed and breastfeeding
will be accepted as the norm for infant feeding in Rhode Island. We strive to achieve that
vision by increasing statewide breastfeeding rates and durations to levels outlined in the
national Healthy People 2020 health promotion and disease prevention initiative:
» 81.9% of mothers will breastfeed

» 60.5% of mothers will breastfeed at 6 months
» 34.1% of mothers will breastfeed at 12 months
» 44.3% of mothers will breastfeed exclusively through 3 months
» 23.7% of mothers will breastfeed exclusively through 6 months
Our primary strategies to meet these objectives are to increase breastfeeding knowledge and
awareness among breastfeeding families and health care professionals, develop community
resources, and build community partnerships throughout Rhode Island.
The Physicians' Committee for Breastfeeding in Rhode Island, a subgroup of the Coalition,
tackles issues sensitive to legitimacy such as legislation, insurance advocacy, and provider-to-
provider relations. The Physicians’ Committee includes physicians, midwives, nurses, lactation
consultants, medical and nursing students, and public health professionals. This group serves
as the official Breastfeeding Committee of the Rhode Island Chapters of the American
Academy of Pediatrics and the American Academy of Family Physicians.
2 | PRENATAL & POSTPARTUM SUPPORT
1
5
THE WHO/UNICEF BABY FRIENDLY HOSPITAL INITIATIVE
T H E W H O / U N I C E F B A B Y F R I E N D LY H O S P I TA L I N I T I AT I V E
The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health
Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and
recognize hospitals and birthing centers that offer an optimal level of care for infant feeding.
The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to
successfully initiate and continue breastfeeding their babies or feeding formula safely.
To achieve the Baby-Friendly Designation, facilities must correctly integrate all “10 Steps To
Successful Breastfeeding” outlined by UNICEF/WHO into their practice for healthy newborns.
In Rhode Island, Newport Hospital, South County Hospital, and Westerly Hospital have each
received the Baby-Friendly Designation through Baby-Friendly USA (www.babyfriendlyusa.org.),
the national authority for the BFHI in the United States.
The CDC 2010 Breastfeeding Report Card (www.cdc.gov/breastfeeding/data/reportcard.htm)

indicates that 13.13% of live birth in Rhode Island occured at facilities designated as Baby-
Friendly in accordance with BFHI. Rhode Island already exceeds the Healthy People 2020
(www.healthypeople.gov/2020) indicator to increase to 8.1% the proportion of live births
occuring in facilities that provide recommended care for lactating mothers and their babies.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one half-hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are
separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice ‘rooming in’ by allowing mothers and babies to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.
6
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: W O M E N , I N FA N T S , A N D C H I L D R E N ( W I C ) P R O G R A M
WOMEN, INFANTS, AND CHILDREN (WIC)
The WIC Program provides breastfeeding education to women prenatally and provides support
for breastfeeding mothers. In addition to the WIC nutritionists, many local WIC agencies also
have trained Breastfeeding Peer Counselors who work with WIC clients prenatally and for the
duration of their breastfeeding experience.
Chad Brown Health Center

International Institute ..................................................................................................831-0020
Providence...................................................................................................................831-0020
Children’s Friend and Service

Central Falls ............................................................................................728-5920 or 728-5936
Pawtucket ...................................................................................................................721-6416
Breastfeeding Peer Counselor: Ana Mosquera
Comprehensive Community Action Program, Inc.

Cranston .....................................................................................................................946-4650
Coventry......................................................................................................................589-2610
Breastfeeding Peer Counselor: Amy Burns
East Bay Community Action Program

Bristol ..........................................................................................................................253-7577
East Providence............................................................................................................437-1007
Newport ......................................................................................................................848-6697
Tiverton .......................................................................................................................625-1364
Breastfeeding Peer Counselors: Sarah Durand, Courtney Lautieri, Melanie Robinson
Westbay Community Action, Inc.

Warwick ......................................................................................................................732-4660
West Warwick.........................................................................................826-3230 or 826-3020
Breastfeeding Peer Counselor: Chantelle Dos Remedios
7
Providence Community Health Centers, Inc.
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: W O M E N , I N FA N T S , A N D C H I L D R E N ( W I C ) P R O G R A M
Allenberry Health Center .............................................................................................444-0570
Capitol Hill Health Center ............................................................................................444-0550
Chafee Health Center..................................................................................................444-0530
Olneyville Health Center ..............................................................................................444-0540
Breastfeeding Peer Counselors: Janice Lopez, Sherry Rivera, Yohana Sosa
Lactation Consultant: Janice Lopez
St. Joseph Health Services

Providence...................................................................................................................456-4045
Breastfeeding Peer Counselor: Ana Santiago
Thundermist Health Center

Woonsocket ................................................................................................................767-4109
Breastfeeding Peer Counselor: Pam Cote
Thundermist Health Center of South County

Wakefield ....................................................................................................................783-0523
North Kingstown .........................................................................................................667-2915
Breastfeeding Peer Counselor: Jodie Rathbun
Tri-Town Economic Opportunity Committee

Johnston......................................................................................................................519-1932
Providence...................................................................................................................632-4770
Burrillville.....................................................................................................................567-0510
Breastfeeding Peer Counselor: Elaine DeSisto...............................................................519-1908
Women & Infants Hospital

Providence ........................................................................................................274-1122 x2768
Breastfeeding Peer Counselor: Jessica Vargas
Lactation Consultants: Michael Fink, Lori Hurley, Janice Lopez, Ana Semedo
Wood River Health Center

Hope Valley .................................................................................................................539-2461
Westerly ......................................................................................................................539-2461
Breastfeeding Peer Counselor: Wendy Costa .......................................................539-2461 x138
State WIC Office .......................................................................................................222-5960

State WIC Breastfeeding Coordinator: Emily Eisenstein ................................................222-4605
8
PRENATAL BREASTFEEDING CLASSES
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P R E N ATA L B R E A S T F E E D I N G C L A S S E S

Health insurance may cover the cost of these classes.
Bellani Maternity ......................................................................................................234-1279

www.bellanimaternity.com
Two hour breastfeeding classes taught by a lactation
counselor on weeknights and weekends in Warwick.
$58 or $52 fee per couple. Call to register.
Healthy Babies, Happy Moms Inc............................................................................884-8273

www.healthybabieshappymoms.com 866-744-2229
Two hour breastfeeding classes taught by an nurse
and lactation consultant once a month on a weeknight
in East Greenwich. $50 per couple. Call to register.
Kent County Hospital ...............................................................................................684-2788

www.kenthospital.org (select My Baby @ Kent)
Classes held at various times throughout the month.
Call or visit the website for details.
La Leche League of Rhode Island

La Leche League encourages women to attend meetings
prenatally for information and support. See page 14 to find
the La Leche League leader and group closest to you. No fee.
Landmark Medical Center, Woonsocket Unit ..............................................769-4100 x2218

Breastfeeding classes held once a month.
Call for details. $10 fee.
Memorial Hospital ..................................................................................... English: 729-2510

Two-hour breastfeeding classes offered every other Spanish: 729-2800
month in English. Spanish breastfeeding classes
integrated into Spanish childbirth preparation classes.
Women welcome to return for help. $23 fee,
subject to change, covered by RIte Care.
9
Newport Hospital .....................................................................................................845-1133
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P R E N ATA L B R E A S T F E E D I N G C L A S S E S

www.lifespan.org/newport/services/birthingctr
Prenatal breastfeeding classes offered once a month
on the second Tuesday of the month,
7:00 p.m. – 9:00 p.m. $25 fee.
South County Hospital .............................................................................................792-2229

Breastfeeding classes offered every seventh Wednesday,
7:00 p.m. – 9:00 p.m. $50 fee per couple.
Westerly Hospital .....................................................................................................348-3365

www.westerlyhospital.org
Prenatal breastfeeding classes offered every six weeks
on a Tuesday, 6:00 p.m. – 9:00 p.m. $35 fee.
Call or visit the website for details.
Women & Infants Hospital..............................................................................276-7800 x100

http://womenandinfants.org/childbirth
Two and a half hour breastfeeding classes offered
four to five times a month on variable evenings in
Providence. Classes also available in East Greenwich.
$30 fee. Call or visit the website to register.
10
BREASTFEEDING WARM-LINES
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: B R E A S T F E E D I N G WA R M - L I N E S
The following are hospital "warm-line" numbers that breastfeeding mothers may call upon
discharge from the hospital should they have questions or concerns about breastfeeding.
Kent County Hospital................................................................737-7010 x3332 or 736-2229

Leave a message and a lactation consultant will return your call.
Landmark Medical Center .............................................................................769-4100 x2218

24-hour call-in assistance available.
Memorial Hospital ....................................................................................................729-2291

24 hour call-in assistance available.

24-hour call-in assistance available.

Leave a message and a lactation consultant will return your call.

24 hour call-in assistance available.
Women & Infants Hospital ...............................................................................800-711-7011

Monday – Friday, 9:00 a.m. – 9:00 p.m. Saturday and Sunday,
9:00 a.m. – 5:00 p.m. Leave a message and a nurse will return your call.
Appointments are available for mothers after hospital discharge.
Services are provided in English and Spanish.
11
OUTPATIENT LACTATION SUPPORT
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: O U T PAT I E N T L A C TAT I O N S U P P O R T

Health insurance may cover the cost of these visits.
H O S P I TA L - B A S E D O U T PAT I E N T S E R V I C E S
Kent County Hospital................................................................737-7010 x3332 or 736-2229
Appointments available Monday – Friday, (Warm Line)
7:30 a.m. – 12:30 p.m. Available for calls weekdays.
Landmark Medical Center .............................................................................769-4100 x2218

Postpartum mothers may call and make an appointment (Warm Line)
to be seen by a lactation consultant.

Postpartum mothers may call and make an appointment (Warm Line)
to be seen by a lactation consultant.

Appointments available most days. Best to call to schedule
an appointment between 8:00 a.m. and 4:00 p.m.
After hours, call the warm-line at 845-1110.

Appointments available Monday – Friday, 9:00 a.m. – 3:00 p.m. (Warm Line)
and Saturdays, 9:00 a.m. – 3:00 p.m. if necessary.
Available for calls daily.

Call for an appointment Monday – Friday, 7:00 a.m. – 3:00 p.m. (Warm Line)

Appointments available Monday – Saturday, (Warm Line)
variable hours. Call to schedule an appointment
Monday – Friday, 9:00 a.m. – 9:00 p.m. and
Saturday and Sunday, 9:00 a.m. – 5:00 p.m.
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L A C TAT I O N C O N S U LTA N T S I N P R I VAT E P R A C T I C E
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: O U T PAT I E N T L A C TAT I O N S U P P O R T

An International Board Certified Lactation Consultant (IBCLC) is a health care professional who
specializes in the clinical management of breastfeeding. IBCLCs are certified by the International
Board of Lactation Consultant Examiners, Inc. (www.iblce.org) under the direction of the United
States National Commission for Certifying Agencies. IBCLCs work in a wide variety of health
care settings, including hospitals, pediatric offices, public health clinics, and private practice.

Kathleen Moren, RN, IBCLC 866-744-2229
4512 Post Road, East Greenwich, RI 02818
Email: [email protected]
www.healthybabieshappymoms.com
Nurslings....................................................................................................................261-0245
Wendi Bosland, IBCLC
Wendy Nilsson, IBCLC
www.thenurslings.com
MIDWIFE BREASTFEEDING SPECIALISTS

Cynthia Siegel, CNM, MSN, IBCLC ...........................................................................727-4800
Women’s Care
18 Imperial Place, Suite 2D, Providence, RI 02903
1407 South County Trail, Suite 420, East Greenwich, RI 02818
PHYSICIAN BREASTFEEDING SPECIALISTS

Julie Taylor, MD, MSc, IBCLC ....................................................................................729-2206
Family Care Center Team B, Memorial Hospital
111 Brewster Street, Pawtucket, RI 02860
Laura Viehmann, MD, FAAP.....................................................................................728-9201

Mill River Pediatrics, 126 Prospect Street, Pawtucket, RI 02860
13
POSTPARTUM BREASTFEEDING
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P O S T PA R T U M B R E A S T F E E D I N G S U P P O R T G R O U P S / C L A S S E S
SUPPORT GROUPS/CLASSES
There is generally no fee associated with breastfeeding support groups unless otherwise indicated.
H O S P I TA L - B A S E D S U P P O R T G R O U P S / C L A S S E S
Kent County Hospital ....................................................................................737-7010 x3332
New Mothers support group meets every Wednesday, (Warm Line)
10:30 a.m. – 12:00 p.m. in the Women’s Care Unit on the 3rd floor.
Breastfeeding support is available.

Breastfeeding support group held on the 1st and 3rd
Wednesday of the month, 10:00 a.m. – 11:30 a.m.
in the Family Care Center. Call to register.

Breastfeeding support group held on Thursdays, (Warm Line)
12:30 p.m. – 2:30 p.m. in the Birthing Center on the 7th floor.

Breastfeeding support group/New Mom’s Club meets Tuesdays, (Warm Line)
9:00 a.m. – 11:00 a.m. in the South County Hospital Conference Center,
14 Woodruff Avenue, Narragansett. Additional group meets Wednesdays,
1:30 p.m. – 3:30 p.m. at the East Greenwich South County Hospital
Wellness Center, 3461 South County Trail, East Greenwich.
Free. All mothers welcome.

Breastfeeding support group held on Saturdays,
10:00 a.m. – 11:30 a.m. in the Nardone Conference Room.

New Mothers Group, an informal mother-baby gathering, (Warm Line)
meets every Wednesday, 10:00 a.m. – 12:00 p.m.
Call Health Education Department at 276-7800 x100 for details.
Postpartum Day Support Group and outpatient lactation visits available.
Call the Breastfeeding Warm Line for more information.
14
L A L E C H E L E A G U E I N T E R N AT I O N A L
La Leche League International (LLLI) is a non-profit organization that provides breastfeeding
information and support to nursing mothers via telephone help and monthly meetings.
Accredited by LLLI, volunteer leaders are experienced breastfeeding mothers who are familiar
with the practical, physical, and psychological aspects of breastfeeding. For more information
and to confirm listed meeting times and locations, please contact the leader nearest you.
Updated listings may be found on the web at www.llli.org or by calling La Leche League
International at 847-519-7730.
Cumberland and Lincoln, RI

Leaders: Lori .............................................................................................................334-0191
Patty ...........................................................................................................333-2275
Meetings: Second Tuesday of the month
10:30 a.m. – 12:00 p.m.
Cumberland Public Library, Hayden Center
1464 Diamond Hill Road, Cumberland, RI
North Kingstown, RI
Leaders: Crystal ........................................................................................................667-7369
Mimi ...........................................................................................................826-2669
Meetings: First Tuesday of the month
10:00 a.m. – 11:30 a.m.
North Kingstown Library
100 Boone Street, North Kingstown, RI
Providence, RI
Leaders: Mimi ...........................................................................................................826-2669
Wendy
Wendi
Meetings: Last Friday of the month
12:30 p.m. – 2:00 p.m.
Providence Public Library, Rochambeau Branch
708 Hope Street, Providence, RI
15
Somerset, MA
Leaders: Jamelle ................................................................................................508-672-9272
Karin....................................................................................................508-822-2279
Polly.....................................................................................................508-673-5975
Meetings: Second Tuesday of the month
10:00 a.m. – 11:30 a.m.
Somerset Public Library
1464 County Street, Somerset, MA
Warwick, RI
Leaders: Crystal ........................................................................................................667-7369
Mimi ...........................................................................................................826-2669
Meetings: Second Saturday of the month
1:00 p.m. – 2:30 p.m.
Bellani Maternity
12786 Bald Hill Road, Warwick, RI
16
POSTPARTUM DEPRESSION
P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P O S T PA R T U M D E P R E S S I O N
Providers who work with postpartum women are likely to encounter women suffering from
postpartum depression. The lifetime risk of postpartum depression for any woman is between
10% and 25% (DSM-IV, 1994). Women with symptoms of postpartum depression are strongly
encouraged to seek treatment. A small number of these women may have symptoms that
become severe, potentially leading to psychosis. Some antidepressants used to treat
postpartum depression are considered safe to use while breastfeeding. A detailed list of
breastfeeding pharmacology resources is included on page 38 of this directory.
Behavioral health professionals with experience working with postpartum depression are
usually sensitive to the needs of breastfeeding mothers and have clinical knowledge of which
medications are compatible with breastfeeding. They should be informed when a mother is
breastfeeding.
B E H AV I O R A L H E A LT H P R O V I D E R S
Women & Infants Day Hospital ....................................................................274-1122 x2870
www.womenandinfants.org (keyword search “Day Hospital”)
2 Dudley Street, 1st Floor, Providence, RI 02905
Monday – Friday, 9:00 a.m. – 4:30 p.m.
The Rhode Island Birth Network posts a comprehensive list of local mental health providers
on their website at www.ribirth.net (click Provider Directory then select Maternal Mental Health
from the Specialty pick list).
WEBSITES
The following websites offer resources and support for women and their families coping with
postpartum mental health issues. A comprehensive list of related resources is posted at
www.postpartumstress.com/pages/resources.html.
The Online PPD Support Group

www.ppdsupportpage.com
The Postpartum Stress Center

www.postpartumstress.com
Postpartum Support International

www.postpartum.net
2 | LOCAL & NATIONAL RESOURCES
2
18
BREASTFEEDING LAWS
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T F E E D I N G L AW S I N R H O D E I S L A N D
Links to Rhode Island breastfeeding laws are posted at www.health.ri.gov/breastfeeding.
Summaries of all federal and state breastfeeding laws are posted on the National Conference
of State Legislatures’ website at www.ncsl.org/programs/health/breast50.htm.
On March 23, 2010, the Patient Protection and Affordable Care Act amended section 7 of the
United States Fair Labor Standards Act to provide reasonable break time for nursing mothers.
Details are available through the United States Department of Labor at
www.dol.gov/whd/nursingmothers.
R H O D E I S L A N D L AW S
R.I. Gen. Laws § 23-13.5 (2008) allows a woman to breastfeed or bottle-feed her child in
any place open to the public and allows her a private cause of action for denial of that right.
(HB 7467B, SB 2283A)
R.I. Gen. Laws § 23-13.2-1 (2003) requires employers to reasonably accommodate a

breastfeeding mother by providing flexible breaks and a safe, clean, private place to pump or
breastfeed her child. (HB 5507A, SB 0151A)
R.I. Gen. Laws § 23-72-3 (2001) requires the Department of Health to prepare a consumer
mercury alert notice. The notice shall explain the danger of eating mercury-contaminated fish
to women who are pregnant or breastfeeding their children. (HB 6112)
R.I. Gen. Laws § 11-45-2 (1998) protects mothers breastfeeding in public from disorderly
conduct laws. (HB 8103, SB 2319)
N AT I O N A L L AW S
Fair Labor Standards Act § 7 (2010) requires employers to provide reasonable break time for
an employee to express breast milk for her nursing child for one year after the child’s birth
each time such employee has need to express the milk. Employers are also required to provide
a place, other than a bathroom, that is shielded from view and free from intrusion from
coworkers and the public, which may be used by an employee to express breast milk.
19
BREASTFEEDING IN THE WORKPLACE
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T F E E D I N G I N T H E W O R K P L A C E
Mothers can continue to breastfeed when they return to work by pumping and storing their
breastmilk during the workday. Details about breast pump medical insurance coverage and
breast pump rental and sales are included in the following pages. Mothers can learn more
about breastfeeding and going back to work or school in the brochure printed on page 76 of
this directory and posted online at www.health.ri.gov/breastfeeding.
B R E A S T F E E D I N G - F R I E N D LY W O R K P L A C E S
Employers that accommodate breastfeeding families improve their bottom line through
increased employee loyalty and productivity, lower turnover rates, fewer missed work days, and
reduced health care costs. Lactation support requires few resources and can be implemented
through simple, cost-effective strategies. Tips for supporting breastfeeding in the workplace
are posted at www.health.ri.gov/breastfeeding/for/employers.
Recognition as a Breastfeeding-Friendly Workplace in Rhode Island is based on the successful

establishment of supportive policies, facilities, and resources for breastfeeding employees and
clients. Award criteria and a list of employers previously recognized at the Bronze, Silver, and
Gold levels are posted at www.health.ri.gov/awards/breastfeedingfriendly.
The Rhode Island Breastfeeding Coalition offers competitive mini-grants to businesses and
organizations seeking to establish or enhance a lactation program in the workplace by
implementing the Business Case for Breastfeeding (www.womenshealth.gov/breastfeeding).
Mini-grant details are posted at www.health.ri.gov/breastfeeding.
T H E N U R S I N G W O R K I N G M O T H E R S L AW
R.I. Gen. Laws § 23-13.2-1 (2003) requires employers to reasonably accommodate a
breastfeeding mother by providing flexible breaks and a safe, clean, private place to pump or
breastfeed her child. (HB 5507A, SB 0151A)
C O R P O R AT E L A C TAT I O N P R O G R A M S
Kathleen Moren, RN, IBCLC 866-744-2229
20
BREAST PUMP MEDICAL INSURANCE COVERAGE
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T P U M P M E D I C A L I N S U R A N C E C O V E R A G E
Please note that the information listed below is accurate as of the date of publication. Specific
details related to breast pump coverage by health plans change frequently. Please contact the
medical insurance provider for any updates.
RITE CARE MEMBERS

Members of RIte Care may be entitled to a manual or electric pump at no cost when their
baby is in the NICU, when it is medically necessary*, or when a mother returns to work or
school depending on the insurance provider. The insurance providers for RIte Care members
include UnitedHealthcare and Neighborhood Health Plan of Rhode Island (NHPRI). Detailed
criteria for obtaining breast pumps from these insurance providers are posted at
www.health.ri.gov/breastfeeding/about/insurancecoverage.
RIte Care members can ask about obtaining a breast pump by contacting their physician or
primary care provider. If breast pumps are a covered benefit, the primary care provider will
either write a prescription for a pump or call the health plan’s durable medical equipment
(DME) provider directly and request a breast pump for the patient. The RIte Care benefits
posted at www.health.ri.gov/breastfeeding/about/insurancecoverage describe which DME
providers carry which pumps for each insurer. DME providers and additional breast pump rental
stations are listed on the following pages.
Health care providers can download a standard breast pump prescription and recommended
breast pump selection criteria at www.health.ri.gov/breastfeeding/about/insurancecoverage.
*Medical Necessity includes the following conditions:

» Baby unable to initiate breastfeeding due to medical conditions such as prematurity, oral
defect, etc.
» Temporary weaning due to:
» Mother/baby separation
» Mother’s use of a medication or need for a diagnostic test that is contraindicated for
breastfeeding
» Inadequate milk supply
» Engorgement
» Breast infection
» Ineffective latch
21
DME PROVIDERS PHONE FAX
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T P U M P M E D I C A L I N S U R A N C E C O V E R A G E
A Fitting Experience ...................................................................398-2639
5600 Post Road, East Greenwich, RI
Kent County Home Medical Equipment ............................800-232-0644 681-1090

11 Knight Street, Building D15, Warwick, RI 732-0022
Majors Medical Supply........................................................877-625-6771 231-0763

197 Putnam Pike, Johnston, RI 231-7100
South County Surgical Supply ...................................................783-1850 783-2082

14 Woodruff Avenue, Narragansett, RI
Simpson's Pharmacy ...................................................................722-7600 722-9738

10 Newport Avenue, Pawtucket, RI
Vanguard Home Medical Equipment ........................................468-1300 468-1333

155 Jefferson Boulevard, Warwick, RI
COMMERCIAL INSURANCE MEMBERS

Specific details related to breast pump coverage by health plans change frequently. Please
contact the medical insurance provider for details. Commercial insurers include Blue Cross &
Blue Shield of Rhode Island, Tufts Health Plan, UnitedHealthcare, and several other insurers
based both inside and outside of Rhode Island.
22
BREAST PUMP RENTAL/SALES
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T P U M P R E N TA L / S A L E S
Electric breast pumps are available for the mother with special breastfeeding situations,
including working mothers and mothers with babies in special care nurseries. These pumps
may be covered by your health insurance company as outlined in the previous pages.
Sources for electric breast pump rentals and sales in Rhode Island are listed below.
For updated listings, contact the Women & Infants Hospital Warm-Line at 800-711-7011.
A Fitting Experience .................................................................................................398-2639

www.rifittingexperience.com
5600 Post Road, East Greenwich, RI
Sales of Ameda personal electric pumps
Tuesday – Friday, 10:30 a.m. – 5:30 p.m.
Saturday, 10:00 a.m. – 4:00 p.m.
Ameda ..............................................................................................................866-99-AMEDA
www.ameda.com (26332)
Rental and sales of Ameda pumps
Bellani Maternity ......................................................................................................234-1279

www.bellanimaternity.com Fax 822-9900
1276 Bald Hill Road, Warwick, RI
Rental and sales of Ameda pumps
Open variable hours Monday – Sunday
Dartmouth Medical Supply...............................................................................508-997-1241

www.dmecos.com Fax 508-997-7550
19 Old Westport Road, North Dartmouth, MA
Sales of Ameda and Medela pumps
Saturday, 9:00 a.m. – 1:00 p.m.
Deborah Winthrop....................................................................................................682-2272
www.deborahwinthrop.com Fax 682-2273
103 Clock Tower Square, Portsmouth, RI
Sales of Medela personal electric pumps
Saturday, 10:00 a.m. – 5:00 p.m.
23
L O C A L A N D N AT I O N A L R E S O U R C E S : B R E A S T P U M P R E N TA L / S A L E S
www.healthybabieshappymoms.com 866-744-2229
Rental and sales of Medela pumps and scales
Kent County Home Medical Equipment ..........................................................800-232-0644

11 Knight Street, Building D15, Warwick, RI 732-0022
Rental and sales of Ameda and Medela pumps Fax 681-1090
Medela................................................................................................................800-835-5968
www.medela.com
Rental and sales of Medela pumps and products
Simpson's Pharmacy .................................................................................................722-7600

www.simpsonspharmacy.com Fax 722-9738
10 Newport Avenue, Pawtucket, RI
Sales of Ameda and Medela pumps
Saturday, 9:00 a.m. – 4:00 p.m.
Sunday, 9:00 a.m. – 1:00 p.m.
South County Surgical Supply .................................................................................783-1850

14 Woodruff Avenue, Narragansett, RI
Rental and sales of Medela pumps

25 Wells Street, Westerly, RI Fax 348-3734
Sales of Medela pumps
Women & Infants Hospital Nursing Moms, Etc......................................................453-7940

www.nursingmomsetc.com
101 Dudley Street, Providence, RI
Rental and sales of Ameda and Medela pumps
Monday – Saturday, 10:00 a.m. – 4:00 p.m.
Sunday, 10:00 a.m. – 2:00 p.m.
24
MOTHERS’ MILK BANKS
L O C A L A N D N AT I O N A L R E S O U R C E S : M O T H E R S ’ M I L K B A N K S
Current Mothers’ Milk Bank listings can be found on the Human Milk Banking Association of
North America’s website at www.hmbana.org under Milk Bank Locations.
U N I T E D S TAT E S PHONE FAX
CALIFORNIA
Mothers’ Milk Bank .............................................................408-998-4550 408-297-9208
751 South Bascom Avenue, San Jose, CA 95128
www.sanjosemilkbank.com
COLORADO
Mothers’ Milk Bank Presbyterian/......................................303-869-1888
St. Luke’s Medical Center and
Rocky Mountain Hospital for Children
1719 East 19th Avenue, Denver, CO 80218
www.milkbankcolorado.org
FLORIDA
Mothers’ Milk Bank of Florida (developing)
2520 North Orange Avenue, Suite 103, Orlando, FL 32804
INDIANA
Indiana Mother’s Milk Bank, Inc.........................................317-536-1670 317-536-1676
4755 Kingsway Drive, Suite 120, Indianapolis, IN 46205 ........877-829-7470
www.immilkbank.org
IOWA
Mother’s Milk Bank of Iowa ...............................................319-356-2652 319-384-9933
Department of Food and Nutrition Services
University of Iowa Hospitals and Clinics
University of Iowa at Liberty Square
119 Second Street, Suite 400, Coralville, IA 52241
www.uihealthcare.com/depts/uichildrenshospital/milkbank
MICHIGAN
Bronson Mothers’ Milk Bank ..............................................269-341-8849 269-341-8918
601 John Street, Suite N1300, Kalamazoo, MI 49007
www.bronsonhealth.com/MedicalServices/Obstetrics/page928.html
25
NEW ENGLAND PHONE FAX
Mothers’ Milk Bank of New England (developing) ..........781-535-7594
L O C A L A N D N AT I O N A L R E S O U R C E S : M O T H E R S ’ M I L K B A N K S
PO Box 600091, Newtonville, MA 02460
www.milkbankne.org
NORTH CAROLINA
WakeMed Mothers’ Milk Bank and Lactation Center ......919-350-8599 919-350-8923
3000 New Bern Avenue, Raleigh, NC 27610
www.wakemed.com/body.cfm?id=135
OHIO
Mothers’ Milk Bank of Ohio .............................................. 614-544-0810 614-544-0812
Grant Medical Center at Victorian Village Health Center
1087 Dennison Avenue, Columbus, OH 43201
www.ohiohealth.com/bodymaternity.cfm?id=1049
OREGON
Northwest Mothers Milk Bank (developing)
Grant Medical Center at Victorian Village Health Center
3439 NE Sandy Boulevard #130, Portland, OR 97232
www.nwmmb.org
TEXAS
Mothers’ Milk Bank at Austin.............................................512-494-0800 512-494-0880
2911 Medical Arts Street, Suite 12, Austin, TX 78705 ............877-813-6455
www.milkbank.org
Mothers’ Milk Bank of North Texas ...................................817-810-0071 817-810-0087

1300 West Lancaster, Suite 108, Fort Worth, TX 76102 .........866-810-0071
www.texasmilkbank.org
CANADA PHONE FAX
BC Women’s Milk Bank .......................................................604-875-2282 604-875-2871

C & W Lactation Services
4500 Oak Street, IU 30, Vancouver, BC V6H 3N1
www.bcwomens.ca/Services/PregnancyBirthNewborns/HospitalCare/Breastfeeding.htm
Ontario Human Milk Bank (developing)

Toronto, ON
26
WEBSITES
L O C A L A N D N AT I O N A L R E S O U R C E S : W E B S I T E S
Most of the following websites are designed for families and professionals.
Additional professional websites are listed on pages 37 and 38 of this directory.
LOCAL WEBSITES
Bellani Maternity
www.bellanimaternity.com
Offers breast pump rentals and sales, maternity and breastfeeding products, and breastfeeding
classes. Based in Warwick.
Deborah Winthrop
www.deborahwinthrop.com
Sells breastfeeding pumps, nursing bras, and nursing clothing. Based in Portsmouth.
Healthy Babies, Happy Moms Inc.

Provides breast pumps to rent and purchase, lactation consultations, feeding devices, nursing
bras, and a wide variety of breastfeeding accessories. Based in East Greenwich.
Massachusetts Breastfeeding Coalition

www.massbfc.org
Breastfeeding resources for parents and reference materials for health care professionals.
Rhode Island Birth Network

www.ribirth.net
Resources for pregnancy, gentle birth, and complete healthcare for new families.
Rhode Island Department of Health

www.health.ri.gov/breastfeeding
Breastfeeding information and resources for families, employers, and health care professionals.
Women & Infants Hospital of Rhode Island

www.womenandinfants.org/body.cfm?id=194
Provides information about support groups for new mothers, frequently asked questions, and
breastfeeding tips. Based in Providence.
Women & Infant’s Nursing Moms, Etc.

www.nursingmomsetc.com
Sells nursing clothing, nursing bras, nursing accessories, newborn products, preemie clothing,
books, and videos. Based in Providence.
27
N AT I O N A L W E B S I T E S
Ameda
www.ameda.com
Provides breast pumps, breastfeeding products, and resources for breastfeeding mothers.
American Academy of Pediatrics

www.aap.org/healthtopics/breastfeeding.cfm
Provides breastfeeding information and resources for families and communities.
Baby Friendly USA (Baby-Friendly Hospital Initiative)

www.babyfriendlyusa.org
Information on implementing the Baby Friendly Hospital Initiative in the United States.
Banthebags.org
www.banthebags.org
Provides information and resources on a national campaign to stop formula company
marketing in maternity hospitals.
Best for Babes

www.best4babes.org
Information and advocacy to inspire, prepare, and empower new mothers and to identify and
decrease cultural and societal breastfeeding barriers.
Breastfeeding.com
www.breastfeeding.com
Provides information on positioning techniques, advocacy, shopping, and access to chat rooms.
Breastfeeding Online
www.breastfeedingonline.com
Offers breastfeeding advice and products plus articles and videos by Jack Newman, MD.
Dr. Jack Newman and Edith Kernerman

www.drjacknewman.com
Provides detailed instructional videos, books, and handouts on breastfeeding topics.
Infant Feeding Action Coalition (Canada)

www.infactcanada.ca
Coalition working to implement the International Code of Marketing of Breast-milk Substitutes.
28
International Baby Food Action Network
www.ibfan.org
Aims to improve the health and well being of babies and young children, their mothers and
their families through the protection, promotion and support of breastfeeding and optimal
infant feeding practices.
La Leche League International

www.llli.org
Provides mother-to-mother support, encouragement, information, and education. Includes
resources and events for health care professionals and foreign language resources.
Medela, Inc.
www.medela.com
Provides an extensive catalogue of breast pumps and breastfeeding paraphernalia.
National Alliance for Breastfeeding Advocacy

www.naba-breastfeeding.org
Coordinates breastfeeding advocacy efforts in the United States. Represents International Baby
Food Action Network and World Alliance for Breastfeeding Action in the United States.
National Women’s Health Information Center

www.womenshealth.gov/Breastfeeding
Provides breastfeeding information and resources for families.
United States Breastfeeding Committee

www.usbreastfeeding.org
Provides publications on various breastfeeding topics and links to international breastfeeding
policy statements.
United States Centers for Disease Control and Prevention

www.cdc.gov/breastfeeding
Develops and utilizes evidence-based policies, recommendations, data, statistics, research, and
evaluation to protect, promote, and support breastfeeding.
United States Department of Agriculture

www.fns.usda.gov/wic/breastfeeding/breastfeedingmainpage.htm
Covers breastfeeding promotion and support through the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC).
29
World Alliance for Breastfeeding Action
www.waba.org.my
Network working to protect, promote and support breastfeeding worldwide.
World Health Organization

www.who.int/topics/breastfeeding/en
Provides international information, resources, standards, and statistics on breastfeeding.
ZipMilk
www.zipmilk.org
Provides lactation resources in Massachusetts, North Carolina, and Louisiana organized by zip
code and vetted by state breastfeeding coalitions.
30
VIDEOS
L O C A L A N D N AT I O N A L R E S O U R C E S : V I D E O S
Breastfeeding videos on other topics may be available through the producers listed in the
descriptions below and through the following online sources:
Childbirth Graphics: 800-299-3366 x287, www.childbirthgraphics.com
Hale Publishing: 800-378-1317, www.iBreastfeeding.com
La Leche League International: 800-525-3243, www.llli.org
Noodle Soup: 800-795-9295, www.noodlesoup.com
Baby-Led Breastfeeding... The Mother-Baby Dance (1995) .......................................$39.95

Christina M. Smillie, MD
Geddes Productions: 323-344-8045, www.geddesproduction.com
See mothers learning to breastfeed naturally by letting their babies show them how. Like
kittens and puppies, human babies are already hardwired to seek out and find the breast. In
this video, we see just how babies can do it when we get out of their way. We also see Kittie
Frantz, RN, CPNP-PC, who now uses this same approach in her own practice. (16 minutes plus
over an hour of bonus footage)
The Benefits of Breastfeeding (2003) ..........................................................................$59.00

Eagle Video Productions: 800-838-5848, www.eaglevideo.com
Features Dr. Ruth Lawrence. Combines scientific facts with personal thoughts and feelings of
parents. Discusses the benefits of breastfeeding for the baby, nutritionally and health wise; the
benefits of breastfeeding for the mother; common questions mothers have; as well as the keys
to breastfeeding success. Available in English or Spanish with subtitles. Also available for rental
at www.amazon.com. (21 minutes)
Better Breastfeeding: Your Guide to a Healthy Start (2008) ...................................$159.95

Injoy Videos: 800-326-2082, www.injoyvideos.com
This video, developed with the help of the International Lactation Consultant Association
(ILCA), teaches new parents how to succeed in breastfeeding by demonstrating the most
recent recommendations in six educator-friendly segments. Includes clear feeding guidelines,
3D animation of an asymmetrical latch, updated breast anatomy and a diverse group of
families. Available in English or Spanish. (25 minutes)
31
Biological Nurturing: Laid Back Breastfeeding (2008) .........................75.00 English pounds
Suzanne Colson, MD
The Nurturing Project, www.biologicalnurturing.com
This video uses unique and compelling video clips of mother baby pairs to show the versatility
of mother/baby breastfeeding positions that release innate behaviours to stimulate latch and
sustain milk transfer. The laid back positions are contrasted with taught upright positions,
especially in those mothers where the baby reflex cues hindered latch. The first program
explains the mechanisms of biological nurturing and the second menu introduces baby reflex
cues and some mother-led strategies to use when difficulties arise. (60 minutes)
Breastfeeding and Returning to Work (2003).............................................................$59.00

Eagle Video Productions: 919-779-7891, www.eaglevideo.com
This detailed video provides new mothers with the facts they need in order to make an
informed decision about returning to work while breastfeeding. Includes commentary from
health professionals and real breastfeeding mothers. Discusses the benefits of continued
breastfeeding, how a mother can plan her return to the workplace, how a mother can talk to
her employer, and answers to common questions. Available in English or Spanish. Also
available for rental at www.amazon.com. (12 minutes)
Breastfeeding Comprehensive (2006)........................................................................$147.00

Mother of 7, Inc.: 1-877-790-BABY (2229), www.motherof7.com
Discusses the benefits of breastfeeding, exclusive breastfeeding, getting off to the right start,
positioning, latch-on, the suckling reflex, let-down technique, how the breast makes milk, fore
milk and hind milk, medications and human milk, problems and solutions, breastfeeding and
special situations, maximizing supply, a father's role, attachment parenting, weaning, politics
and the law, and more. Available in English. (135 minutes) Excerpts of this video,
“Breastfeeding Basics” and “Breastfeeding Intensive”, are also available for purchase.
Dr. Jack Newman’s Visual Guide to Breastfeeding (2005) ...........$90.00 institutional license
Cinemedic Distributors Inc.: $45.00 professional use
877-607-8234, www.cinemedic.com $30.00 home use
This video helps both new parents and health professionals understand how breastfeeding
works and cuts through all the confusing and contradictory information on breastfeeding. Jack
Newman and Edith Kernerman answer a wide variety of questions, from how to ensure that a
baby is getting milk to helping overcome some of the most common problems associated with
breastfeeding. Available in English. (45 minutes)
32
Dr. Lennart Righard’s Delivery Self Attachment (1995) .............................................$22.95
Geddes Productions: 323-344-8045, www.geddesproduction.com
This video depicts a newborn’s ability to crawl up to a breast immediately after birth and attach
without assistance. Available in English, Spanish, French, Chinese, and Japanese. (6 minutes)
A Premie Needs his Mother: First Steps to ...............................................................$125.00

Breastfeeding Your Premature Baby (2001)
Jane Morton, MD
Breastmilk Solutions: 888-JMORTON (566-7866), www.breastmilksolutions.com
This comprehensive guide to learning how to breastfeed premature babies from the perspective
of mothers of premies is designed for preterm mothers, lactation consultants and neonatal staff.
Part I is for moms about to or who have just delivered premature babies. (35 minutes) Part II is
designed to be watched when the baby is ready to be held. (21 minutes) Available in English.
ONLINE VIDEOS
Hand Expression of Breast Milk
Stanford School of Medicine, Newborn Nursery at LPCH
http://newborns.stanford.edu/Breastfeeding/HandExpression.html
Until recently, hand expression of milk has been an under-utilized skill. There are many benefits of
knowing how to express milk from the breast without the use of expensive or cumbersome pumps.
In this video, Dr. Jane Morton demonstrates how easily hand expression can be taught to mothers.
Also available to download. (8 minutes)
Initiation of Breastfeeding by Breast Crawl

The Mother and Child Health Education Trust
http://breastcrawl.org
UNICEF, WHO, and WABA, along with the scientific community, strongly recommend initiating
breastfeeding within a half-hour of birth. Evidence shows that early initiation can prevent 22% of all
deaths among babies below one month in developing countries. Every newborn, when placed on the
mother's abdomen soon after birth, has the ability to find its mother's breast all on its own and to
decide when to take the first breastfeed. This is called the 'Breast Crawl'. Available in multiple
languages. (7 minutes)
Ten Steps to Successful Breastfeeding

The Mother and Child Health Education Trust
http://tensteps.org/ten-steps-successful-breastfeeding.shtml
This sequence of ten videos, which provides step-by-step evidence for the Ten Steps for Successful
Breastfeeding, is meant as a guideline to facilitate implementation of the Baby-Friendly Hospital
Initiative (details on page 5). Available in multiple languages.
33
BOOKS FOR THE NURSING MOTHER
L O C A L A N D N AT I O N A L R E S O U R C E S : B O O K S F O R T H E N U R S I N G M O T H E R
Books may be available through these and other online sources:
La Leche League International: 847-519-7730, www.llli.org
These books and others may also be available at Rhode Island Public Libraries
100 Questions & Answers About Breastfeeding............................................................$24.95

Karin Cadwell, Cynthia Turner-Maffei, and Anna Cadwell Blair (2008)
ABCs of Breastfeeding: Everything a Mom Needs.........................................................$14.95

to Know for a Happy Nursing Experience
Stacey H. Rubin (2008)
Adventures in Tandem Nursing .......................................................................................$14.95

Hilary Flower (2003)
Breastfeeding: A Parent’s Guide (9th Edition)..................................................................$12.50

Amy Spangler (2010). Available in English and Spanish.
Breastfeeding an Adopted Baby and Relactation..........................................................$10.95

Elizabeth Hormann (2007)
The Breastfeeding Book: Everything You Need to Know .............................................$14.95

About Nursing Your Child from Birth Through Weaning
Martha and William Sears (2000)
Breastfeeding: Keep It Simple ...........................................................................................$5.25

Amy Spangler (2006). Available in English and Spanish.
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers......................$18.95

Kathleen Kendall-Tackett and Nancy Mohrbacher (2010)
Breastfeeding With Confidence: A Practical Guide........................................................$10.00

Sue Cox (2006)
Defining Your Own Success: Breastfeeding ...................................................................$24.95

After Breast Reduction Surgery
Diana West (2001)
34
Exclusively Pumping Breastmilk ......................................................................................$23.50
L O C A L A N D N AT I O N A L R E S O U R C E S : B O O K S F O R T H E N U R S I N G M O T H E R
Stephanie Casemore (2004)
How Weaning Happens....................................................................................................$34.97

Diane Bengson (2000), Available in English and French.
Mothering Multiples: Breastfeeding and Caring............................................................$18.95

for Twins or More (3rd Edition)
Karen Kerkhoff Gromada (2007)
Mothering Your Nursing Toddler (Revised Edition)...........................................................$14.95

Norma Jane Bumgarner (2000). Available in English and French.
New Mother’s Guide to Breastfeeding .............................................................................$6.99

American Academy of Pediatrics (2005)
Nonprescription Drugs for the Breastfeeding Mother ..................................................$19.95

Frank J. Nice (2007)
The Nursing Mother’s Companion (6th Edition)...............................................................$14.95

Kathleen Huggins (2010)
The Nursing Mother’s Guide to Weaning (Revised Edition) .............................................$11.95

Kathleen Huggins and Linda Ziedrich (2007)
Nursing Mother, Working Mother (Revised Edition).........................................................$12.95

Gale Pryor (2007)
The Ultimate Breastfeeding Book of Answers: The Most.............................................$19.95

Comprehensive Problem-Solution Guide to Breastfeeding
from the Foremost Expert in North America (Revised Edition)
Jack Newman and Teresa Pitman (2006)
The Womanly Art of Breastfeeding (8th Edition). ...........................................................$20.00

La Leche League International (2010).
Available in English, Dutch, Italian, and Spanish.
Working without Weaning: A Working Mother’s Guide ..............................................$24.95

Kirsten Berggren (2006)
2 | CLINICAL INFORMATION & RESOURCES
3
36
CRITERIA FOR BREASTFEEDING REFERRAL
C L I N I C A L I N F O R M AT I O N A N D R E S O U R C E S : C R I T E R I A F O R B R E A S T F E E D I N G R E F E R R A L
Developed by the Physicians’ Committee for Breastfeeding in Rhode Island and the Rhode Island
Breastfeeding Coalition and utilized by the Rhode Island Department of Health Information Line.
REFERRAL TO MEDICAL DOCTOR

» Breast infections (temperature above 101 degrees, possibly along with localized redness and
heat and/or plugged duct symptoms of localized pain and firmness)
» Slow weight gain of infant (as perceived by mother)
» Jaundiced infant (yellowish tinge to skin as perceived by mother)
» Fewer than 6 wet diapers in 24 hours for infants from 4 days to 4 months old
» Fewer than 3 stools in 24 hours for infants from 4 days to 3 weeks of age
R E F E R R A L T O L A C TAT I O N C O N S U LTA N T
Make referrals through Breastfeeding Warm-Lines (page 10) or Lactation Consultants in Private
Practice (page 12).
» Sore nipples
» Plugged ducts (localized pain and firmness)
» Premature infants
» Sick or hospitalized mother or infant
» Infants who refuse to nurse
» Infants with special health care needs (i.e., developmental disorder)
» Mothers on medications*
* Medication information on breastfeeding is available in the resource guide “Medication and

Mothers’ Milk” by Thomas Hale, PhD, 2010 (14th Edition). Additional breastfeeding
pharmacology resources are listed on page 37 of this directory.
37
INFORMATION LINES/WEBSITES FOR PROFESSIONALS
C L I N I C A L I N F O R M AT I O N A N D R E S O U R C E S : I N F O R M AT I O N L I N E S / W E B S I T E S F O R P R O F E S S I O N A L S
BREASTFEEDING PHARMACOLOGY
The Lactation Study Line, University of Rochester.........................................585-275-0088
(Ruth A. Lawrence, MD)
For physicians and lactation consultants.
Also provides general breastfeeding information.
LactMed
toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
A peer-reviewed and fully referenced database of drugs to which
breastfeeding mothers may be exposed. Provided through the United
States National Library of Medicine, Toxicology Data Network (TOXNET).
Newport Hospital Pharmacy.............................................................................401-845-1566

7:00 a.m. – 11:00 p.m. daily
For physicians and lactation consultants.
Texas Tech University School of Medicine

(Thomas W. Hale, RPh, PhD) neonatal.ttuhsc.edu/lact/
Provides articles and information on breastfeeding and medication use.
Women & Infants Hospital Warm-Line ............................................................800-711-7011

Saturday and Sunday, 9:00 a.m. – 5:00 p.m.
Leave a message and an RN/IBCLC will return your call within 1 hour.
Yale-New Haven Hospital Drug Information Services....................................203-688-2248

Leave a message and a pharmacist will return your call.
DISCUSSION BOARDS
Lactnet
community.lsoft.com/archives/LACTNET.html
Lactation information and discussion for health care professionals.
38
L O C A L P R O F E S S I O N A L O R G A N I Z AT I O N S
C L I N I C A L I N F O R M AT I O N A N D R E S O U R C E S : I N F O R M AT I O N L I N E S / W E B S I T E S F O R P R O F E S S I O N A L S
Physicians’ Commitee for Breastfeeding in Rhode Island
www.health.ri.gov/partners/committees/physiciansforbreastfeeding
A group of health care professionals working to protect, support, and promote breastfeeding
in Rhode Island. Serves as the official Breastfeeding Committee of the Rhode Island Chapters
of the American Academy of Pediatrics and the American Academy of Family Physicians.
Rhode Island Breastfeeding Coalition

www.health.ri.gov/partners/coalitions/breastfeeding
A coalition of community organizations including local birthing hospitals, health insurance
companies, WIC, visiting nurse organizations, La Leche League, and others working to protect,
promote, and support breastfeeding in Rhode Island.
N AT I O N A L P R O F E S S I O N A L O R G A N I Z AT I O N S
Academy of Breastfeeding Medicine
www.bfmed.org
Provides clinical guidelines for the care of breastfeeding mothers and infants.
American Academy of Pediatrics

www.aap.org/breastfeeding
Provides clinical guidelines on breastfeeding and other tools for health care
professionals plus information and resources for families and communities.
International Board Lactation Consultant Examiners

www.iblce.org
Certifies and evaluates the competency of International Board Certified Lactation Consultants.
International Lactation Consultant Association

www.ilca.org
Promotes the professional development, advancement, and recognition of lactation consultants
worldwide for the benefit of breastfeeding women, infants, and children.
United States Breastfeeding Committee

www.usbreastfeeding.org
National breastfeeding protection, promotion, and support resources and publications.
39
RESOURCE TEXTS FOR PROFESSIONALS
C L I N I C A L I N F O R M AT I O N A N D R E S O U R C E S : R E S O U R C E T E X T S F O R P R O F E S S I O N A L S
Books may be available through these or other online sources:
La Leche League International: 847-519-7730, www.lalecheleague.com
Best Medicine: Human Milk in the NICU.....................................................................$32.95

Nancy E. Wight, Jane A. Morton, and Jae H. Kim (2008)
Breastfeeding: A Guide for the Medical Profession (7th Edition)...............................$89.00

Ruth A. Lawrence and Robert M. Lawrence (2007)
Breastfeeding and Diseases .........................................................................................$24.95

E. Stephen Buescher and Susan W. Hatcher (2008)
Breastfeeding and Human Lactation (4th Edition).....................................................$124.95

Jan Riordan and Karen Wambach (2009)
The Breastfeeding Answer Book (3rd Edition) .............................................................$68.00

Nancy Mohrbacher and Julie Stock (2003)
Also available in Spanish (1997) and other translations.
Pocket Guide available in hard copy and PDA format.
Breastfeeding Answers Made Simple: .......................................................................$79.95

A Guide for Helping Mothers
Nancy Mohrbacher (2010)
The Breastfeeding Atlas (4th Edition) ...........................................................................$59.00

Barbara Wilson-Clay and Kay Hoover (2007)
Breastfeeding A-Z: Terminology and Telephone Triage.............................................$52.95

Karin Cadwell and Cynthia Turner-Maffei (2006)
Breastfeeding Management for the Clinician: ..........................................................$59.95

Using the Evidence (2nd Edition)
Marsha Walker (2011)
40
Breastfeeding Medicine ........................................................................subscription rates vary
Edited by Ruth A. Lawrence (print and online)
Mary Ann Liebert, Inc. Publishers: www.liebertpub.com
The Breastfeeding Mother’s Guide to Making More Milk ........................................$17.95

Diana West and Lisa Marasco (2009)
Breastfeeding Special Care Babies (2nd Edition)..........................................................$51.95

Sandra Lang (2002)
Breastfeeding the Newborn: Clinical Strategies ........................................................$54.95

for Nurses (2nd Edition)
Marie Biancuzzo (2003)
Case Studies in Breastfeeding .....................................................................................$43.95

Clinical Therapy in Breastfeeding Patients (2nd Edition) ............................................$29.95

Thomas W. Hale and Pamela Berens (2002)
Clinics in Human Lactation: Breastfeeding after Breast and.....................................$18.95

Nipple Procedures: A Guide for Healthcare Professionals
Diana West and Elliot M. Hirsch (2008)
Clinics in Human Lactation: History and Assessment: ...............................................$18.95

It's All in the Details
Denise Altman (2008)
Core Curriculum for Lactation Consultant Practice (2nd Edition) ...............................$68.95

Rebecca Mannel, Patricia J. Martens, and Marsha Walker (Editors) (2007)
Counseling the Nursing Mother: A Lactation.............................................................$87.95

Consultants Guide (5th Edition)
Judy Lauwers and Anna Swisher (2011)
Feeding and Nutrition in the Preterm Infant .............................................................$53.95

Elizabeth Jones and Caroline King (2006)
41
Hale and Hartmann's Textbook of Human Lactation ................................................$62.97
Thomas W. Hale and Peter Hartmann (2007)
Human Milk in the NICU: Policy Into Practice ............................................................$60.95
Lois Arnold (2009)
Impact of Birthing Practices on Breastfeeding (2nd Edition) ......................................$49.95

Linda J. Smith (2010)
Implementing Continuity of Care in Breastfeeding...................................................$46.95

Journal of Human Lactation .................................................................subscription rates vary

Edited by M. Jane Heinig (print and online)
Sage Publications: www.sagepub.com
The Latch and Other Keys to Successful Breastfeeding ............................................$24.95

Maternal and Infant Assessment for Breastfeeding and ..........................................$47.95

Human Lactation: A Guide for the Practitioner (2nd Edition)
Karin Cadwell, Cynthia Turner-Maffei, Barbara O’Connor,
Anna Cadwell Blair, Lois D. W. Arnold, and Elyse M. Blair (2006)
Medication and Mothers’ Milk (14th Edition) ..............................................................$34.95

Thomas W. Hale (2010)
Pocket Guide for Lactation Management...................................................................$36.95

Reclaiming Breastfeeding for the United States:.......................................................$39.95

Protection, Promotion and Support
Karin Cadwell (Editor) (2002)
Supporting Sucking Skills in Breastfeeding Infants...................................................$53.95

Catherine Watson Genna (2008)
Ultimate Breastfeeding Book of Answers: The Most ................................................$19.95

Comprehensive Problem-Solution Guide to Breastfeeding
from the Foremost Expert in North America (Revised Edition)
42
CONTINUING EDUCATION IN LACTATION
C L I N I C A L I N F O R M AT I O N A N D R E S O U R C E S : C O N T I N U I N G E D U C AT I O N I N L A C TAT I O N M A N A G E M E N T
MANAGEMENT/BREASTFEEDING
PHONE FAX
Breastfeeding Support Consultants/..................................630-547-5057

Center for Lactation Education
44 North Cornell, Villa Park, IL 60181
www.bsccenter.org
La Leche League International ...........................................847-519-7730 847-969-0460

PO Box 4079
Schaumburg, IL 60168-4079
www.llli.org
Lactation Education Consultants........................................630-260-4847 630-260-8879

618 North Wheaton Avenue
Wheaton, IL 60187
www.lactationeducationconsultants.com
Lactation Education Resources ...........................................703-868-1849 443-607-8898

5614 Dover Street, Churchton, MD 20733
www.LERon-line.com
Health Education Associates Inc.........................................508-888-8044 508-888-8050

327 Quaker Meeting House Road
East Sandwich, MA 02537-1300
www.healthychildren.cc
The Lactation Institute & Breastfeeding Clinic..................818-995-1913 818-995-0634

3441 Clairton Place, Encino, CA 91436
www.lactationinstitute.org
Wellstart International........................................................619-295-5192 619-574-8159

PO Box 80877
San Diego, CA 92138-0877
www.wellstart.org
2 | BREASTFEEDING TOOLS & GUIDELINES
4
44
GUIDELINES FOR MANAGING COMMON
BREASTFEEDING TOOLS AND GUIDELINES: GUIDELINES FOR MANAGING COMMON BREASTFEEDING CONCERNS
BREASTFEEDING CONCERNS
The following section has been adapted with permission from The Mississippi State Department
of Health WIC Program.
Protocols for Breastfeeding Management

Keitha Whitaker, BS, IBCLC, Camille Foretich, BS, IBCLC, CHES, Cathy Carothers, BS, IBCLC
January 2001
Breastfeeding mothers should contact a lactation consultant or their primary care

provider as recommended in the Criteria for Breastfeeding Referral (page 36) to
discuss and receive treatment for the following concerns.
ENGORGEMENT
RATIONALE » The mother who experiences engorgement is at risk for sore nipples, plugged
ducts, breast infections, and/or breast abscess.
» The infant who is unable to latch on to the breast because of engorgement
is at risk for poor feeding behaviors and slow weight gain.
POSSIBLE » Delayed initiation of breastfeeding

CAUSES » Hospital schedules which delay or limit infant’s access to the breast
» Limiting the amount of time baby nurses at the breasts, or scheduling feedings
» Poor positioning and improper latch-on techniques
» Sleepy baby
» Inadequate milk removal of the breast
» Routine supplementation or complementary feedings
» Previous breast surgery
» Baby with a weak suck (babies with anatomical challenges such as cleft lip/
cleft palate or Down’s Syndrome)
EDUCATION/ » Educate mothers on the importance of:

INTERVENTION » Initiating breastfeeding within the first hour after birth
» Recognizing the baby’s hunger cues
» Allowing the baby to finish the first breast first
» Breastfeeding frequently – at least 8 times a day, preferably
10 to 12 times – or every 2 to 3 hours
» Avoiding the use of pacifiers, bottles, and nipple shields
45
ENGORGEMENT (CONTINUED)
EDUCATION/ » Observe the mother breastfeeding and assist with latch-on and positioning
INTERVENTION problems.
» Ask the mother if she has had breast reduction surgery. Check the mother’s
breast, if possible, for signs of scarring from previous breast surgery.
» To treat engorgement:
» Apply heat and massage the breasts before breastfeeding
» Breastfeed frequently
» Use cold compresses between feedings to reduce swelling
» As needed, pump or hand express just enough milk to relieve over
fullness without encouraging milk production
» Have the mother wear breast shells for 30 minutes before nursing to
soften the areola and bring out the nipple
» Before each feeding, have the mother express a little milk or pump 2
minutes to assist the baby in latching on to the breast
» If the mother is very uncomfortable suggest that she ask her doctor
about pain medication, such as Tylenol or Ibuprofen
» If the baby is not feeding well and the mother is unable to relieve her
engorgement with any of the techniques above, use an electric breast
pump to fully express the mother’s breasts once or twice
» If engorgement is unrelieved after 48 hours using the described treatments,
suggest that the mother see her doctor to rule out other problems.
» Binding the breast to suppress lactation or decrease engorgement is an
outdated practice that may result in plugged ducts, mastitis, abcess, and
tissue damage. The above listed treatments for breast engorgement are the
standard of practice used by Health Care Professionals knowledgeable in
breastfeeding management.
FOLLOW-UP » Contact the client within 24 hours to answer questions and provide further
assistance or information as needed.
» Maintain daily contact until the engorgement is resolved, thereafter as often
as needed by the client.
RESOURCE » Mohrbacher & Stock, The Breastfeeding Answer Book, Third Revised Edition.
Schaumburg, IL: La Leche League International, 2003, pp. 28, 109, 218, 457.
46
SORE NIPPLES IN THE BREASTFEEDING WOMAN
RATIONALE » The mother who has sore nipples is at risk for engorgement due to her
reluctance to latch the baby on because of the pain. Sore nipples can lead
to a negative breastfeeding experience and, ultimately, premature weaning.
» The infant whose mother has sore nipples is at risk for possible slow weight
gain and being prematurely weaned.
» Breastfeeding should not hurt. Sore nipples are not a normal part of
breastfeeding. If a woman’s nipples are tender beyond a few seconds when
the baby latches on or are so painful that she cannot breastfeed she is at risk
for mastitis, plugged ducts, and low milk supply.
POSSIBLE LACTATION-RELATED
CAUSES » Improper position and latch
» Unrelieved negative pressure
» Unresolved engorgement
» Improper use of milk expression, hand or pump
» Use of creams, lotions, soaps, etc.
» Infrequent changing of breast pads, resulting in nipples and areola staying wet
» Bottle feeding or feeding with a nipple shield
MEDICAL-RELATED
» Thrush
» Masitis
» Vasospasm of nipple
» Baby with high palate
» Baby with tongue-tie
EDUCATION/ » Start on least sore side first, or initiate milk ejection reflex before latching baby on.
INTERVENTION » Position and latch baby correctly.
» Shorter more frequent feedings are best because baby is less hungry and
sucks less vigorously.
» Apply expressed breastmilk to nipple after feeding.
» Apply warm water soaks to relieve transient soreness.
» Apply pure lanolin (such as Lansinoh® or PureLan®) generously to nipples and
areola, avoiding very tip of nipple.
» Apply hydrogel pads to reduce nipple pain (mixed research results).
» Vary nursing positions at each feeding.
47
SORE NIPPLES IN THE BREASTFEEDING WOMAN (CONTINUED)
EDUCATION/ » Wear breast shells in between feedings with the insert that has the larger
INTERVENTION hole. If the nipple/areola is cracked, fissured, or severely damaged, a medical
evaluation is warranted.
» Rarely is it helpful to take the baby from the breast and just pump while
allowing the nipples to heal. However, if the mother is in severe pain and will
not put the baby to the breast, pump with an electric pump and feed the
baby with an alternate feeding device, i.e. cup, syringe, finger feeding, etc.
FOLLOW -UP » Daily contact is needed to assess breastfeeding and to answer questions and
give further instructions until soreness is resolved.
» If comfortable latch cannot be established or soreness does not resolve with
these measures, seek further assistance for evaluation and management from
an IBCLC or breastfeeding specialist.
RESOURCES » Mohrbacher & Stock, The Breastfeeding Answer Book, Third Revised Edition.
Schaumburg, IL: La Leche League International, 2003, pp. 456-70.
» Riordan, Breastfeeding and Human Lactation, Third Edition. Sudbury, MA:
Jones & Bartlett Publishers, 2005, pp. 225-27.
SLOW WEIGHT GAIN & FAILURE TO THRIVE
RATIONALE » Infants who gain weight poorly are at higher risk for impaired growth,
intellectual performance, and malnutrition.
POSSIBLE LOW MILK TRANSFER

CAUSES » Poor latch, ineffective sucking
» Poor muscle tone
» Prematurity
» Oromotor dysfunction
» Breastfeeds are short and hurried or infant is removed from breast too soon
and does not receive enough hindmilk
» Not waking at night to feed
» Routine supplementation of water and artificial baby milk
» Infant is nipple confused due to introduction of bottle, nipples, and pacifier
LOW MILK PRODUCTION
» Medications, i.e., contraceptives, antihistamines
» Mother lacks confidence, embarrassed to feed, therefore infant feeds less often
» Use of a nipple shield
» Not finishing the first breast first
» Poor release of milk, i.e., medications, smoking, alcohol
» Feeding infrequently or by a rigid schedule
48
SLOW WEIGHT GAIN & FAILURE TO THRIVE (CONTINUED)
POSSIBLE OTHER CAUSES
CAUSES » Less common infant causes included excessive metabolic requirements
such as cardiac failure, infection, or medication withdrawal
» Less common maternal causes include endocrine abnormalities such as
hypoprolactinemia, Sheehan’s Syndrome, or retained placental fragments;
anatomic variants of the breast or previous breast surgery; stress; fatigue;
Illness; narcotic addiction
EDUCATION/ IF LOW MILK PRODUCTION IS THE PROBLEM, INCREASE MILK PRODUCTION

INTERVENTIONS WHEN FEASIBLE
» Mother is motivated and persistent.
» Increase stimulation to breast via more frequent feedings and/or use of an
electric breast pump with a dual pumping kit.
» Mother expresses milk between breastfeedings.
» Mother reduces supplementation slowly as her milk production increases.
» Baby receives supplement from cup, syringe, or spoon.
» Adjust maternal nutrition as needed by increasing food and fluids if intake
has been low.
» Offer both breasts at a feed, several times each.
» Quit or reduce smoking.
» Rest as much as possible, and relax during breastfeeds to help the milk flow.
» Consult a medical provider for possible medication treatment.
INFANT ISSUES
» Adjust positioning to maximize milk intake.
» Use a supplemental nutrition system filled with either expressed mother’s milk or
artificial baby milk. Follow manufacturer’s instructions on how to use.
» Nurse on one breast at a feeding (if the problem is low hindmilk intake).
» Use breast compression to stimulate active nursing.
FOLLOW-UP » Infants should be followed closely by the medical provider. Medical provider
and lactation consultant should work closely together. Check infant weight in
one week for 3.5-7 oz. gain. If less than 3.5-7 oz., then increase the amount
of supplement and review and adjust techniques. Instruct mother to keep a
breastfeeding log recording number of times she nurses and wet diapers /
bowel movements.
49
SLOW WEIGHT GAIN & FAILURE TO THRIVE (CONTINUED)
RESOURCES » Lactation Consultant Series, Inadequate Weight Gain in Breastfeeding Infants:
Assessments & Resolutions Unit 8 LLLI.
» Mohrbacher & Stock, The Breastfeeding Answer Book, Third Revised Edition.
» Breastfeeding Handbook for Physicians, AAP/ACOG, 2006, pp. 101-04.
MASTITIS – PLUGGED DUCT OR BREAST INFECTION
RATIONALE » The mother with mastitis (any inflammation in the breast) may have plugged
ducts and is at risk for developing a breast infection, which may lead to a
breast abscess.
POSSIBLE » Missed feedings; limiting the baby’s time at the breast

CAUSES » Poor latch-on and positioning
» A change in the baby’s breastfeeding pattern
» A tight bra with underwire, heavy purse, baby carrier, back pack, or diaper
bag that puts pressure on the breasts or surrounding tissues
» Mother restricting the flow of the milk by pressing on her breast to “make
an airway for the baby” (Babies breathe out of the sides of their noses; there
is no need to pull breast tissue away from the baby’s nose. Babies breathe
just fine pulled in close to mother’s breast with nose and chin touching the
breast in a good latch.)
» Mother overdoing activity too soon after baby’s birth
» Mother sleeping in one position all the time
» The use of nipple shields
» Any activity or device that puts pressure on the breasts
» Mothers with diabetes are at a slightly greater risk for mastitis
» Mothers who are anemic are at greater risk for recurrent plugged ducts
50
MASTITIS – PLUGGED DUCT OR BREAST INFECTION (CONTINUED)
EDUCATION/ » For a plugged duct (swelling that comes on gradually, little pain, little
INTERVENTION or no fever, may shift according to area affected, little or no warmth at
affected site):
» Apply heat (wet or dry compresses, warm shower, soak in warm tub,
immerse breasts in basin of warm water) and massage gently. (Some
mothers are able to work the plug out in this way. If the baby happens to
draw the plug out while breastfeeding, it will not harm him.)
» Breastfeed frequently, particularly on the affected side and with baby’s
chin pointed toward the plugged duct.
» Make sure the baby is positioned and latched well on the breast.
» Loosen any restrictive clothing.
» Vary nursing positions from feeding to feeding.
» Rest. Suggest the mother cut down on other activities until the plug is
gone. Increase fluid intake.
» For a breast infection (localized swelling, hot and painful to the touch, usually
comes on suddenly, accompanied by fever of 101° and flu-like symptoms):
» Apply heat and massage gently; breastfeed frequently, especially on the
affected side; make sure the baby is positioned and latched well; loosen
restrictive clothing; change nursing positions; and REST, as above.
» Refer the mother to her medical provider for diagnosis and treatment.
» Possible bacteria or germ transmission to the infant is of no
concern and the mother should be advised to continue breastfeeding.
» Continued breastfeeding comforts both mother and baby and results in
the breast infection healing faster.
» Increase fluid intake.
FOLLOW-UP » Contact the client within 24 hours to answer questions and provide further
assistance or information as needed.
» Maintain daily contact until the problem is resolved, thereafter as often as
needed by the client.
RESOURCE » Mohrbacher & Stock, The Breastfeeding Answer Book, Third Revised Edition.
51
THRUSH
RATIONALE » The mother who has a yeast infection on her nipples (often referred to as
nipple thrush, which is a fungal infection caused by candida albicans) is at
risk for getting extremely sore nipples and spreading the fungal infection to
other members of the family. In addition, the irritation caused by the thrush
infection can increase the likelihood that the mother will also contract a
bacterial infection. The mother with nipple thrush often experiences nipple
pain, itching, or burning or shooting pain toward the back wall of the breast
that persists or worsens after the feeding. The nipple or areola may be red
and shiny, have white patches, or appear normal.
» The baby with thrush may be gassy, fussy at the breast, and have a very
uncomfortable diaper rash.
POSSIBLE CONTRIBUTING FACTORS TO YEAST INFECTION

CAUSES » Previous or current vaginal yeast infection
» Use of antibiotics and other drugs, such as steroids, over a long period
» Cracked nipple
» Diabetes
» Use of oral contraceptives
» Nutritional deficiencies or high-sugar diet
» Infrequent changing of wet nursing pads
EDUCATION/ » Discuss the behaviors and environmental factors that promote the
INTERVENTION growth of yeast infections.
» Refer the mother and baby to their respective medical providers for diagnosis
and treatment. Treatment of breast infection due to candida albicans should
be undertaken by treating the mother and infant simultaneously when either
of them is symptomatic. The mother’s partner may also need treatment.
Evaluate the comfort and effectiveness of latch to address underlying
breast trauma.
» Use of breast shells during treatment can provide relief while allowing the
medication to work.
52
THRUSH (CONTINUED)
EDUCATION/ » For clinicians licensed to prescribe medication:
INTERVENTION » Nystatin ointment for the mother and nystatin oral suspension for the
baby are usually used to treat thrush. Follow the full course of treatment,
usually 10 days to 2 weeks. Mother should be encouraged to continue
breastfeeding.
» Some physicians recommend that women use over-the-counter vaginal
yeast preparations on their nipples. Anecdotal reports say that this can
be an effective treatment. The easy availability of over-the-counter
medications, however, should not lead women to self-treat. Nor should
lactation consultants who are not licensed to prescribe medications
recommend this treatment. They should encourage their clients to seek
treatment from qualified clinical care providers.
» The method of using the over-the-counter vaginal yeast preparations is
that the mother apply the cream or lotion to her nipples and breast before
and after each feeding, as well as around the infant’s entire diaper area
if there is any redness. The mother may also have vaginal yeast infection
and should simultaneously use an antifungal intravaginal preparation.
» Other treatments for thrush include: an oral prescription for the mother
if thrush recurs; gentian violet swabbed in the baby’s mouth and on
mother’s nipples. (See chart at the end of this section.)
» The mother should continue to breastfeed with a thrush infection and while
undergoing treatment.
» Remind the mother to wash her hands after going to the bathroom,
changing the baby’s diaper, breastfeeding, and handling any of the baby’s
toys or teething toys that he puts in his mouth.
» Wash the baby’s hands often if he sucks his thumb or fingers.
» Suggest that the mother boil any bottles, pacifiers, nipples, and teething
toys for 20 minutes once a day to kill the yeast. Replace all bottles, pacifiers,
nipples, and teething toys after one week of the thrush treatment. In addition,
toys or anything else that the baby puts in his mouth should be washed with
hot, soapy water frequently.
» Discard any breast milk that has been pumped during a thrush outbreak.
Freezing only deactivates the thrush; it doesn’t kill it.
» Reusable breast pads should be washed in hot, soapy water and dried
thoroughly after each use; disposable breast pads (preferable during a thrush
outbreak) should be discarded after each use.
» If the mother is using a breast pump, recommend that all parts that come in
contact with the milk be boiled for 20 minutes once a day.
53
THRUSH (CONTINUED)
FOLLOW-UP » Contact the client within 24 to 48 hours to answer questions and provide
further assistance or information as needed.
» Maintain contact 2 to 3 times weekly until the thrush is resolved, thereafter
as often as needed by the client.
» Remind the client of the importance of cleanliness and of taking the full course
of her medication in order to get rid of and prevent a recurrence of thrush.
RESOURCES » Mohrbacher & Stock, The Breastfeeding Answer Book, Third Revised Edition.
Schaumburg, IL: La Leche League International, 2003, pp. 127, 480-84, 564-65.
» Breastfeeding Handbook for Physicians, AAP/ACOG, 2006, pp. 135.
SELECTED ANTIFUNGAL PREPARATIONS
DRUG NAME PREPARATIONS USUAL DOSAGE*
Clotrimazole Creams Apply 2 times/day to mother’s nipples

(Lotrimin, Mycelex)
Gentian violet 0.25% or 0.5% diluted Pediatric: apply with Q-tip to coat
solution baby’s mouth 1 time/day for 2-3 days,
do not repeat treatment.
Fluconazole Oral tablets (adult) Adults: 400 mg loading dose, then

(Diflucan) Oral suspension (pediatric) 100 mg twice daily for at least 2
weeks until pain-free for a week
Pediatric: 6-12 mg/kg loading dose,
then 3-6 mg/kg
Length of treatment: not established
Ketoconazole Oral tablets Adults: single dose of 200-400 mg

(Nizoral) Pediatric: single dose of 50 mg/day
for children weighing less than 20 kg
or 100 mg for children weighing
20-40 kg
Miconazole Creams and lotions Skin cream or lotion: apply 3-4

(Monistat) times/day to mother’s nipples for
14 days or for several days after
symptoms resolve
* All medicines should be taken as prescribed by a doctor.

54
SELECTED ANTIFUNGAL PREPARATIONS (CONTINUED)
Nystatin Suspensions, creams, Resistance to nystatin is growing.
(Mycostatin) powders, and ointments Oral for adults: 1.5-2.4 million
units/day, divided into 3-4 doses
Oral pediatric: 400,000-800,000
units/day, divided into 3-4 doses
Topical: 1 million units applied 2
times/day to mother’s nipples
Length of treatment: 14 days or for
several days after symptoms resolve
Jack Newman’s Ointment mixed by a Apply sparingly to mother’s nipples

All Purpose compounding pharmacist: after each feeding, use until pain free
Nipple Ointment Mupirocin 2% ointment (10 g),
Nystatin 100,000 units/ml
ointment (10 g), Clotrimazole
10% vaginal cream (10 g),
Betamethasone 0.1%
ointment (10 g)
Clotrimazole can be left out
if 10% dosage not available
Substitutions may adversely
affect strength and efficacy
* All medicines should be taken as prescribed by a doctor.
JAUNDICE
RATIONALE » Infants with jaundice are at risk of brain injury, interrupted breastfeeding,
slow weight gain, nipple confusion, and premature weaning.
POSSIBLE IN THE FIRST WEEK OF LIFE

CAUSES » Jaundice associated with inadequate breast milk intake (can be caused by
delayed, infrequent, or timed feedings at the breast and results in
exaggerated physiologic jaundice, usually 3-5 days, but can persist)
» A disease or condition that results in increased red blood cell breakdown,
interferes with processing of bilirubin by the liver, and increases reabsorption
of bilirubin by the bowel
» Ethnic heritage
55
JAUNDICE (CONTINUED)
POSSIBLE AFTER TWO WEEKS OF AGE
CAUSES » Breastmilk jaundice-late onset, prolonged unconjugated hyperbilirubinemia in
otherwise healthy, thriving breastfed infant with no evidence of hemolysis,
infection, or metabolic disease (This type of jaundice is due to human milk
factor that increases intestinal absorption of bilirubin. The elevated bilirubin,
usually noted after the first week of life, can last for weeks.)
AMERICAN ACADEMY OF PEDIATRICS “CLINICAL PRACTICE GUIDELINES” FOR JAUNDICE

To decrease the burden of hyperbilirubinemia medical providers should:
1. Promote and support successful breastfeeding.
2. Establish nursery protocols for the identification and evaluation of hyperbilirubinemia.
3. Measure the total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) level on
infants jaundiced in the first 24 hours.
4. Recognize that visual estimation of the degree of jaundice can lead to errors,
particularly in darkly pigmented infants.
5. Interpret all bilirubin levels according to the infant’s age in hours (www.bilitool.org).
6. Recognize that infants at less than 38 weeks’ gestation, particularly those
who are breastfed, are at higher risk of developing hyperbilirubinemia and require
closer surveillance and monitoring.
7. Perform a systematic assessment on all infants before discharge for the risk
of severe hyperbilirubinemia.
8. Provide parents with written and verbal information about newborn jaundice.
9. Provide appropriate follow-up based on the time of discharge and the risk assessment.
10. Treat newborns, when indicated, with phototherapy or exchange transfusion.
EDUCATION/ IN THE FIRST WEEK OF LIFE

INTERVENTION » Evaluation by a pediatric practitioner who can order the appropriate lab work
and assess the infant is urgent when one encounters an infant in the first
week of life who appears jaundiced and/or dehydrated, malnourished, not
gaining weight, and lethargic. While awaiting medical evaluation, assist the
mother to nurse the baby effectively.
» Encourage the mother to breastfeed as soon after birth as possible so
that the baby receives the maximum beneficial effects of colostrum.
» Encourage the mother to breastfed 8-12 times daily, letting the baby
finish the first breast first and allowing the baby to determine both the
frequency and duration of feeds (as long as the baby is not sleepy or
skipping feedings).
56
JAUNDICE (CONTINUED)
EDUCATION/ IN THE FIRST WEEK OF LIFE (CONTINUED)
INTERVENTION » Teach the mother how to rouse a sleepy baby, as jaundice often makes
babies sleepy.
» Encourage the mother to talk with her doctor about her baby’s treatment,
if treatment is indicated.
» Encourage the mother to continue breastfeeding during the baby’s
treatment, if treatment is necessary.
» Stress the importance of frequent stooling in the jaundiced baby.
» Instruct the mother to avoid water supplements as research has shown
that water supplements have no effect on the type of bilirubin that
causes jaundice, and water supplements can actually increase bilirubin
levels by depressing the infant’s urge to breastfeed.
» Instruct the mother in proper positioning, latch, and the correct
suck/swallow behavior to look for as her infant feeds.
AFTER TWO WEEKS OF AGE
» Examine the infant to ensure good health. Consider evaluation of serum
bilirubin level. If jaundice persists longer than three weeks, consider
unconjugated hyperbilirubinemia. Consider other causes such as
galactosemia, hypothyroidism, UTI, pyloric stenosis, or low grade hemolysis.
» Encourage the mother to continue breastfeeding.
» Reassure the mother that breastmilk jaundice may last as long as 6-12 weeks.
If bilirubin levels continue to rise, breastfeeding may be interrupted for
24-48 hours. Assist the mother while maintaining her milk supply during this
interruption. Resuming breastfeeding after the levels have fallen should not
pose any risk.
FOLLOW-UP » Contact the client within 48 hours to answer questions and to provide further
assistance as needed.
» Maintain contact with the client until the jaundice is resolved and thereafter
as needed by the client.
RESOURCES » American Academy of Pediatrics (AAP) Subcommittee on Hyperbilirubinemia.

Management of Hyperbilirubinemia in the Newborn Infant 35 or more
Weeks of Gestation. Pediatrics, 2004, 114(1): 297-316.
» Mohrbacher & Stock, The Breastfeeding Answer Book, Revised Edition.
Schaumburg, IL: La Leche League International, 2003, pp. 27-30, 258-75.
» Breastfeeding Handbook for Physicians, AAP/ACOG, 2006, pp. 106-07.
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AGES AND STAGES:
B R E A S T F E E D I N G T O O L S A N D G U I D E L I N E S : A G E S A N D S TA G E S
BREASTFEEDING DURING
YOUR BABY’S FIRST YEAR
Adapted from “Ages and Stages: What to Expect During Breastfeeding”
by Vicki Schmidt, RN, IBCLC
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BREASTFEEDING YOUR 1-2 MONTH OLD
WHAT TO EXPECT!
During this time your baby may:

» Turn his head and eyes toward light
» Watch your face and try to respond to speech
» Become quiet at the sound of your voice and smile at you
» Hold his head up without wobbling
» Begin to make cooing sounds at 6-8 weeks
» Cry in different ways to say she is hurt, wet, or hungry
Things your baby may enjoy:

» Mobiles and wrist rattles
» Being rocked gently to a lullaby
» Wind-up musical toys
Breastfeeding during this time:

» First off, congratulations on your decision to breastfeed! Any amount of breastmilk you
provide for your baby helps get him off to a healthier start.
» Spend time with other breastfeeding mothers, but remember that all babies are different and
there is a wide range of normal newborn behavior.
» Your baby is learning to trust that you are there to feed and comfort him; he may seem
calmer and cry less.
» You might not feel the letdown reflex, or its intensity may have subsided.
» Continue to keep a flexible feeding schedule. Nighttime feedings are still expected, but your
baby might sleep for 4-5 hour stretches at night.
» The breast fullness you had the first several weeks is less, but this does not mean you don’t
have enough milk. Your body is just getting adjusted to its new role.
» If you are using any formula, your body may decrease the amount of milk it makes because
you are skipping a feeding.
» Take a nap each day, as fatigue is your worst enemy.
» Breastfeeding your baby frequently is the best way to have plenty of milk and a satisfied baby.
» Eat anything you want in moderation and drink plenty of water.
» You may find your pre-pregnant figure return as you burn calories making breastmilk.
Call your breastfeeding helper for advice or support if:

» Your nipples are still sore when your baby latches on and throughout the feeding.
» You don’t think you have enough milk for your baby.
» You have questions about pumping and storing milk.
» You are feeling overwhelmed and just need to hear a friendly voice.
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WHAT TO EXPECT!

» Sleep and cry less and spend more time learning about her world
» Start to reach for mobiles, rattles, and small toys, and grasp a rattle when it is handed to her
» Begin to drool, especially in the 4th month
» Roll over, usually from stomach to back first
» Start laughing and making sounds like “aaaaa” and “oooo”
» Begin sleeping through the night
» Watch you walk across a room

» Taking a bath and learning to splash
» A child-proof mirror on the edge of the crib
» Your singing!
» Playing pat-a-cake, by clapping her hands together
» Going for a ride in a stroller

» Breastmilk is all your baby needs to stay healthy and grow. Cereal is not necessary at this
time, and giving solids too soon will decrease your milk supply and may increase the
incidence of food allergies.
» Around 3 months, some babies experience a “growth spurt” and want to nurse more
frequently. If this happens, just breastfeed your baby more often, rest, and avoid the temptation
to give formula. This is nature’s way of increasing your milk supply as your baby grows. In a
couple of days, your milk supply will catch up with your baby’s demand.
» Your breasts may still leak at feeding times or during the night if your baby sleeps for a
longer stretch of time than usual.
» You should discuss birth control with your doctor/midwife at your postpartum check-up
because it is possible to become pregnant while breastfeeding. (see page 70 for details)
» It is normal not to be interested in sex the way you were before having your baby. Talk to
your partner because some partners may feel like they are in competition with the baby.
» Around 4 months or so, your baby may pat the breast lovingly while nursing.

» You are returning to work and have questions about pumping and storing breastmilk.
» You just need a friend or someone to tell you what a great job you are doing.
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WHAT TO EXPECT!

» Shake and bang things
» Roll over, tummy to back and back to tummy
» Sit with support
» Put things in his mouth
» Reach out to be picked up
» Turn his head when he hears your voice, even if you are across the room
» Become more aware of strangers

» A small ball to roll and hold onto
» Soft toys that he can put into his mouth
» An activity gym with things to reach for that move when hit
» Toys that make noises when they are shaken or squeezed

» Your baby will continue to get antibodies from you that will protect him from common illnesses.
» Your baby may become easily distracted while nursing but this does not mean he is not
interested in continuing to breastfeed. Babies are just very curious about their world, and this
is a healthy sign of normal development.
» Your baby may nurse for shorter periods of time because he is very efficient at breastfeeding
now, and he requires less time to satisfy his hunger needs.
» Drooling and sucking on fingers is common and may mean the start of teething. Nursing
may make your baby’s gums tender, and he may pull away from the breast abruptly.
» You will most likely begin feeding your baby solid foods now. Do this slowly, starting with
single grain cereals like rice or barley, then fruits, vegetables, and meats. Allow at least
several days to a week between each new food to check for different allergies.

» You just need someone to talk to who understands what it is like to have a baby.
» You have questions about any aspect of breastfeeding.
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WHAT TO EXPECT!

» Have her first tooth (7 months is the most common age)
» Drool and chew on everything
» Begin to crawl or just rock on hands and knees
» Reach for the spoon during feedings
» Sit alone without support
» Close her mouth and turn her head away when she is no longer hungry
» Show signs of anxiety when separated from parent

» Searching for toys hidden under a blanket or basket
» Dropping objects over the edge of the crib or high chair
» Following a ball rolling away from her
» Smiling at herself in the mirror

» If your baby reacts fearfully to a stranger, she may turn to you for comfort and reassurance
and increase her feedings. This need for closeness will eventually help your baby become
more independent, so do not view it as a step backwards or force her to go to others.
» This can be a time when mothers feel pressure from others to wean because the baby seems
so independent, but the security of nursing is still an important factor in the baby’s life.
» Biting during teething is common. If this happens, pull the baby in close to you or
immediately break the suction with your finger, take your baby off the breast, and wait for a
few minutes before trying to feed again. You may have to do this several times. Avoid yelling
at your baby. Yelling might make her refuse the breast.
» Nursing strikes (sudden loss of interest in the breast) can occur, and the reason is often
unknown. You may need to pump for comfort and to maintain your milk supply. Sometimes
mother-to-baby skin-to-skin contact helps the baby return to the breast.

» You need support, encouragement, and reminding that you are providing something no one
else can for your baby.
» You have questions about weaning your baby and need information and support.
62
WHAT TO EXPECT!

» Crawl or attempt to crawl
» Pull to standing position while holding onto furniture
» Play peek-a-boo or wave bye-bye after seeing you do it
» Look at the right person when someone says “mama” or “dada”
» Explore the home. Make sure it has been baby-proofed and that your baby is never left
unattended if not in a playpen or crib
» Understand if you say “no”

» Stacking rings or soft blocks
» Pop-up toys
» Inflatable rolls (never balloons)
» First books
» Safe household objects such as sauce pans, lids, and wooden spoons

» Your baby is still receiving important nourishment that only you can provide.
» Your baby may hold onto the breast with one or both hands while nursing.
» Babies become easily distracted at the breast and may interrupt their feedings frequently.
» Your baby enjoys finger foods at this time. They give him a sense of independence.
» Your baby can join the rest of the family for meals as he begins to develop a regular pattern
of three meals a day.
» Remember that if you wean your baby, he should receive formula. He is still too young
for cow’s milk. The American Academy of Pediatrics recommends breastmilk for at least the
first year of life.
» If breastfeeding is decreasing as you introduce table foods, you may see a change in your
baby’s bowel movements; they will become firmer and may at times be difficult to pass. If this
occurs, increase the time at the breast, and consult the baby’s doctor if the problem persists.

» Your breasts are unusually full and firm, and you think you might have an infection because
your baby is suddenly nursing less.
» You have questions about weaning your baby or continuing to provide breastmilk as your
baby reaches his first birthday.
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WHAT TO EXPECT!

» Hand you an object on request
» Follow simple directions, such as “clap hands,” and “give it to Mommy”
» Show affection towards familiar people
» Stand alone for a few seconds and even try to walk a few steps
» Help with dressing by putting out arms for sleeves and feet for shoes
» Shake her head “no”
» Pay attention to conversations

» Responding to music by dancing or bouncing
» Putting blocks in and out of a container
» Opening and closing cabinet doors
» Drinking from a cup
» Simple musical toys
» Push and pull toys

» You may want to keep a toy or a snack with you when you go out in case your baby gets
fussy and you are uncomfortable breastfeeding an older baby in public.
» It is normal and healthy to continue to breastfeed, and breastfeeding provides nutritional
advantages and emotional security for toddlers.
» It is also normal to sometimes feel irritated by your baby at the breast; this may help you
know that it may be time to wean your baby or to limit the number of feedings.
» Whatever you decide about continuing to breastfeed or not, it is your decision and should
be respected.
» Many babies will wean themselves down to just 2-3 feedings a day, depending on how
much solid food they are getting.
» Even nursing once or twice a day can be relaxing and enjoyable for you and your baby. It
encourages a slow and gradual weaning process and contines to provide great health
benefits to both of you.

» You are feeling pressured by anyone to stop breastfeeding your baby.
» You need someone to help educate others about the benefits of continued breastfeeding.
64
FREQUENTLY ASKED QUESTIONS ABOUT BREASTFEEDING
B R E A S T F E E D I N G T O O L S A N D G U I D E L I N E S : F R E Q U E N T LY A S K E D Q U E S T I O N S
Lactation consultants referred to throughout this section may be reached through WIC,
hospital breastfeeding warm lines, La Leche League of Rhode Island, and private practices.
Please see the Prenatal & Postpartum Support section of this directory (page 4) for details.
SOURCES
Answers to questions adapted from: The National Women’s Health Information Center:
Breastfeeding and An Easy Guide to Breastfeeding for African-American Women, Office of
Women’s Health, Department of Health and Human Services; New Mother’s Guide to
Breastfeeding, American Academy of Pediatrics; Rhode Island Breastfeeding Coalition
(answers may be adapted from Loving Support campaign materials).
OUTLINE
General Questions
Questions about Mother
» Breast Concerns
» Nutrition Concerns
» Social Concerns
» Birth Control Options
Questions about Baby
GENERAL QUESTIONS
Why should I breastfeed?
» Breastfeeding is something only a mother can do for her baby. Breastfeeding helps a mother
bond with her baby. Physical contact is important to newborns and can help them feel more
secure, warm, and comforted.
» Breastmilk is the most complete form of nutrition for infants. It’s always convenient, fresh,
and the right temperature. A mother’s milk has just the right amount of fat, sugar, water,
and protein that is needed for her baby’s growth and development. It is easier for babies to
digest than formula. Breastmilk also protects a baby’s digestive and immune systems.
» Breastfeeding helps a mother to recover from pregnancy and childbirth. It helps the uterus to
get back to its original size and reduces any bleeding a woman may have after giving birth.
It also uses up extra calories, making it easier to lose weight gained during pregnancy.
» Breastfed babies are healthier. They have fewer sick visits and are hospitalized less often.
» Breastfeeding lowers a mother’s risk of breast cancer and may lower her risk of ovarian cancer.
65
When should I start breastfeeding?
You should nurse your baby as soon as possible after birth, preferably within the first hour of
life when the baby’s sucking instinct is strong. Early and frequent feedings of your early milk,
called colostrum (a yellowish fluid full of antibodies), helps protect your baby from disease.
Your mature milk will come in within a few days after birth.
How long do I need to breastfeed?

Experts recommend that babies receive only breastmilk – no formula – for at least the first six
months of life. Continue to breastfeed for 12 months or longer, adding age appropriate solids
when the baby shows signs of readiness. The American Academy of Pediatrics recommends
breastfeeding for at least one year and the World Health Organization recommends at least
two years as closer to the biological norm.
How often do I need to breastfeed?

Newborns need to nurse often, at least 8 to 10 times in a 24 hour period, and not on a strict
schedule. This will help the mother’s breasts to produce plenty of milk. Breastfed babies eat
more often than bottle-fed babies. This is because breastmilk is digested more easily and
quickly than formula.
Is there any time when a woman should not breastfeed?

Sickness / Illness: Some women think that when they are sick, they should not breastfeed.
However, most common illnesses, such as colds, flu, or diarrhea, can’t be passed through
breast milk. In fact, if a mother is sick, her breast milk will have antibodies in it. These
antibodies will help protect her baby from getting the same sickness.
HIV: HIV, the virus that causes AIDS, can pass through breastmilk. Women in the United States
who are HIV positive should not breastfeed. An option for an HIV positive mother could be
donor milk from a milk bank. Ask your health care provider about donor milk, which must be
purchased.
Galactosemia: All babies born in Rhode Island are tested for a rare condition called
galactosemia. Babies with galactosemia should not be breastfed. If this condition runs in your
baby’s family, please talk with your doctor.
Tobacco: While it is best for your baby to have no exposure to tobacco smoke, the benefits to
your baby from breastfeeding outweigh some of the risks of tobacco exposure. Breastmilk will
help your baby stay healthier and lower the risk of crib death (SIDS). Please call 1-800-Try to
Stop and speak with your doctor to help you quit or cut down on smoking.
66
Street Drugs: Women who use drugs should not breastfeed. Drugs used by a breastfeeding
mother can affect her baby. Babies can become addicted to drugs and have serious side effects
such as irritability, poor sleeping patterns, tremors, and vomiting. Mothers on methadone or
other treatments for heroin addiction can breastfeed their babies.
Alcohol: When a breastfeeding mother drinks alcohol, it passes into the breastmilk. Once the
mother’s blood alcohol level returns to normal, the alcohol will leave the breastmilk. An
occasional drink timed to avoid a feeding will not harm the baby. Too much alcohol may affect
your ability to care for your baby. It may also decrease the amount of milk you make and cause
the baby to gain weight too slowly or have developmental delays.
Food Allergies: In families with a strong history of food allergies, mothers should talk to allergy
or breastfeeding experts about avoiding allergy-causing foods while breastfeeding. Sometimes
a baby may have a reaction (such as vomiting, diarrhea, or a rash) to something the mother
eats. This doesn’t mean the baby is allergic to the mother’s milk. If the mother stops eating
whatever is bothering her baby, the problem will usually go away.
If I decide to breastfeed, is there a right way to do so?

Here are several tips for making breastfeeding a good experience for both mother and baby.
» Nurse as soon as possible after birth and continue to breastfeed often.
» Make sure the baby has a good deep latch. Nurse with the nipple and some of the areola
(brown area surrounding the nipple) in the baby’s mouth, not just the nipple.
» Breastfeed on demand, whenever the baby seems hungry.
» Try a support group. Many women find they have an easier time when they meet other
breastfeeding moms.
When do I wean my breastfed child?

You can wean your child whenever and for whatever reason you and your child decide that the
time has come. The simplest, most natural way to wean is when your child starts the process.
Weaning begins naturally at six months, when iron-fortified solid foods are introduced. Some
children begin to turn gradually away from breastfeeding and toward other forms of nutrition
and comfort around one year of age. Others wean themselves during the toddler years as they
become more physically active and less willing to sit still to nurse. If your baby refuses the
breast but you are not ready to wean, or if you are ready to wean but are not sure how, a
lactation consultant may be able to help.
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QUESTIONS ABOUT MOTHER: BREAST CONCERNS
Does breastfeeding hurt?
Breastfeeding should not hurt. If your baby is latched on and positioned properly, you should
not feel pain. Your baby’s mouth should be wide open, with as much of the areola as far back
into his or her mouth as possible. This minimizes soreness for you. Your baby should not nurse
on the nipple only. If you feel pain, your baby is not latched onto your breast properly and you
will need to call a lactation consultant for help.
Will my breasts become engorged if I am breastfeeding?

It is normal for breasts to feel full a few days after delivery. This feeling goes away by the time
the baby is about 4 weeks old. Severe engorgement can be prevented by breastfeeding right
after birth and continuing to feed the baby whenever he or she seems hungry. Your baby’s
feedings should not be timed or delayed in any way in the first few weeks. Sleepy babies
should be awakened every 3-4 hours to feed until a normal feeding pattern is developed. If
your breasts are so full that the areola is hard, the baby may not be able to latch. Try warm
compresses and expressing some milk before feeding. Call a lactation consultant or a
breastfeeding warm-line for more help.
Will my breasts leak while I am breastfeeding?

It is common to have some leaking from one breast while the baby is nursing on the other
breast or when feeding time is getting close. This is much less common after 3 or 4 months
of nursing.
To prevent leaking:
» Press firmly against the nipple with your arm for about one minute.
» Wear nursing pads inside your bra.
» Change nursing pads often to allow the nipples to stay dry.
» Avoid use of breast pads that have a plastic coating.
Can I breastfeed if my breasts are small?

Of course! Breast size is not related to the ability to produce milk for a baby. Breast size is
determined by the amount of fatty tissue in the breast, not by the amount of milk-producing
tissue. Most women, regardless of breast size, can make enough milk for their babies.
68
Can I still breastfeed after breast surgery?
Plastic surgery to enlarge breasts does not usually prevent breastfeeding. However, plastic
surgery to reduce breast size is more likely to interfere with breastfeeding, especially if the
nipples have been moved and milk ducts have been cut. Many women who have had this type
of surgery are still able to breastfeed. Make sure that your doctor and your baby’s doctor know
about your surgery, because your baby will need to be watched closely to make sure he or she
is getting enough breastmilk.
Can I breastfeed if I have a pierced nipple?

Pierced nipples do not usually interfere with breastfeeding, but any jewelry should be removed
before a breastfeeding session to prevent your child from choking. If your piercing became
infected when it was pierced or later, inform your doctor. Infection or scarring may make
breastfeeding more difficult. Some of your breastmilk may leak through the pierced hole while
you are breastfeeding. This is usually not a problem. If you have any questions, be sure to ask
your pediatrician or a lactation consultant to check that your baby is nursing well.
QUESTIONS ABOUT MOTHER: NUTRITION CONCERNS

What foods do I need to eat while I am breastfeeding?
You can enjoy the foods you normally eat. It is best for you to eat a healthy, well-balanced
diet, including at least five fruits and vegetables a day, but your breastmilk will still be good for
your baby no matter what you eat. It is important to drink to fully satisfy thirst to replace the
fluids you are losing when you breastfeed. You do not need to drink cow’s milk to make good
breastmilk. You can continue to take your prenatal vitamins. Rarely, a baby may get fussy or
gassy after you have eaten a certain food because he or she is sensitive to that food.
Can I take medicine while I am breastfeeding?

Most medications will not enter breastmilk, but it is important to have your health care
provider, lactation consultant, or pharmacist check on the safety of any medicine or herbal
remedy you plan to take while breastfeeding.
Can I breastfeed and drink caffeine?

One or two cups (8 ounces = 1 cup) of a caffeinated beverage, such as coffee or soda, should
not cause any problems for your baby. Large amounts of caffeine can reduce the amount of
milk that you make or make your baby irritable.
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QUESTIONS ABOUT MOTHER: SOCIAL CONCERNS
Will breastfeeding tie me to my home?
Not at all! Breastfeeding is convenient no matter where you are because you don’t have to
bring along feeding equipment like bottles, water, or formula. Your baby is all you need. Even
if you want to breastfeed in private, you usually can find a woman’s lounge or fitting room. If
you want to go out without your baby, you can pump your milk beforehand and leave it for
someone else to give your baby while you are gone.
What do I do when I need to breastfeed outside my home?

You can breastfeed in public, without anyone knowing, by wearing clothes that allow easy
access to your breasts, such as button down shirts. By placing a receiving blanket over your
baby and your breast, most people won’t even know that you are breastfeeding. It’s helpful to
breastfeed before the baby becomes fussy so that you can get into a comfortable position for
feeding. You also can purchase a nursing cover or baby sling for added privacy. Many stores
have women’s lounges or dressing rooms, if you want to slip into one of those to breastfeed.
A Rhode Island law permits breastfeeding in any public place.
Will my partner be jealous if I breastfeed?

Share information about the important benefits of breastfeeding with your partner and other
close family members before the baby is born. Explain that you want and need their support.
Tell them that breastfeeding will give this child the best start at life, with benefits that last well
into adulthood. Mention how much money the family will save and that it will cost hundreds
of dollars a month to pay for formula – money that could go to bills, savings, shopping, or a
family vacation.
How can my partner help?

Your partner and other close family members can be there to support and encourage you while
you and the baby are learning to breastfeed. In the hospital, they can limit visitors so you can
rest and learn to feed the baby. Family members can hold and cuddle the baby and bring the
baby to you to nurse. They can help with changing and burping the baby, sharing chores, and
by simply sitting with you and the baby to enjoy the special mood that breastfeeding creates.
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Can I still breastfeed when I go back to work?
With careful planning, you can still breastfeed when you go back to work. If your job allows,
you can pump your breast milk a few times during the day and refrigerate or freeze it for your
baby to take in a bottle later. Or, some women nurse at night and on weekends and give their
babies daytime bottles of formula. A mother’s milk production can adapt to this type of schedule.
If your job does not have a lactation program, ask your supervisor or human resources
department to arrange for your needs. Working mothers who breastfeed need a clean, private,
and safe space other than a toilet stall where they can pump milk and need breaks during the
day to pump milk. Rhode Island has a Nursing Working Mother’s Law to encourage employers
to support breastfeeding women in these ways. To start a conversation about your
breastfeeding needs, give your supervisor copies of this law and the tips for supporting
breastfeeding employees posted at www.health.ri.gov/family/breastfeeding/workplaces.php.
Where can I rent a breast pump?

Talk to your health care provider or a lactation consultant about which breast pump will meet
your needs.
How much do breastfeeding pumps cost and what kind will I need?
Your health insurance plan may provide breast pumps or cover the cost of renting or buying a
breast pump. Breast pumps range in price from under $50 (manual/hand pump or battery
powered pumps) to several hundred dollars (electrical and hospital grade pumps). If you’re only
going to be away from your baby a few hours a week, then you can purchase a hand pump or
one of the less expensive ones. If you’re going back to work, it is worth investing in a good
quality electric pump. You can purchase these from some retail stores or online, but most are
available for purchase or rent through lactation consultants, at local hospitals, or from a
breastfeeding organization.
QUESTIONS ABOUT MOTHER: BIRTH CONTROL OPTIONS

Will breastfeeding keep me from getting pregnant?
When a woman breastfeeds, her ovaries can stop releasing eggs for a number of months,
protecting her from getting pregnant. A woman’s periods can also stop, but that does not
guarantee that she will not get pregnant while nursing. The only way to make sure pregnancy
does not occur is to use a method of birth control. Most birth control pills are not safe to use
when a woman is nursing. The only safe birth control pill to use is the "mini-pill", although it
may significantly reduce your milk supply. Talk with your health care provider about what birth
control method is best for you while nursing.
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QUESTIONS ABOUT BABY
How do I hold my baby when I breastfeed?
There are several different ways to hold your baby when you breastfeed: the Cradle hold, the
Football hold, the Side-Lying hold, and the Cross-Cradle hold. Talk to breastfeeding warm-line
staff or your lactation consultant to find out how to hold the baby in each of these ways.
How do I know my baby is getting enough breast milk?

Babies have different eating and diaper habits. The most common signs that babies are getting
enough milk are:
» The baby nurses well 8-12 times daily and seems satisfied when done.
» At least 4-6 wet diapers and 3-6 loose, yellow, seedy-looking stools a day, after 4 days of age.
» A 3.5-7 ounce weight gain weekly, after the first week of age.
Should I give my baby water or cereal while I am breastfeeding?

Breastmilk is all your baby will need for about the first 6 months of life. Giving your baby
water, juice, or infant formula can interfere with your milk supply in the early months. Solid
foods can be given when the baby is about 6 months old, but a baby can breastfeed or drink
pumped breastmilk for as long as mother and baby wish.
Can I give my baby a bottle or pacifier while I breastfeed?

Avoid bottle nipples until your baby gets used to feeding at your breast – when the baby is
about 4 to 6 weeks old. Also avoid using pacifiers, especially during the first 3 weeks of life.
Bottle nipples and pacifiers require a different sucking pattern than breastfeeding and some
babies become confused about how to suck at the breast and how to suck from a bottle
nipple or pacifier.
What are my baby’s stools supposed to look like?

A breastfed baby’s stool will change from a black, tarry, sticky substance to a loose, yellow,
seedy appearance in the first 4 days. If these changes do not happen, call your baby’s doctor.
After 8 to 12 weeks, your baby may not have a bowel movement every day. As long as your
baby is breastfeeding, his stool will be loose, unformed, and seedy. It’s usually yellowish green
in color and has almost no odor.
Can I breastfeed my teething baby?

Many babies with teeth never bite when breastfeeding. A baby cannot bite while actually
breastfeeding because her tongue covers her lower teeth. A baby who nips the breast as she
starts to pull away near the end of a feeding can be taught to stop. If your baby is teething
and you are afraid that she may bite you, keep your finger ready to break the suction and
remove your breast as soon as the rhythmic suckling stops.
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BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING RECORD FOR BABY’S FIRST WEEK
73
BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING RECORD FOR BABY’S FIRST WEEK
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BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING YOUR BABY

75
BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING YOUR BABY

76
BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING AND GOING BACK TO WORK OR SCHOOL
77
BREASTFEEDING TOOLS AND GUIDELINES: BREASTFEEDING AND GOING BACK TO WORK OR SCHOOL
78
BREASTFEEDING TOOLS AND GUIDELINES: TIPS FOR CHILDCARE PROVIDERS

79
BREASTFEEDING TOOLS AND GUIDELINES: TIPS FOR CHILDCARE PROVIDERS

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BIRTH WEIGHT CONVERSION TABLES
B R E A S T F E E D I N G T O O L S A N D G U I D E L I N E S : B I R T H W E I G H T C O N V E R S I O N TA B L E S
INFANT WEIGHT LOSS CHART (GRAMS)
BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS
2041 1878 2495 2295 2948 2712 3402 3130 3856 3548 4309 3964
2070 1904 2523 2321 2977 2739 3430 3156 3884 3573 4337 3990
2098 1930 2551 2347 3005 2765 3459 3182 3912 3599 4366 4017
2126 1956 2580 2374 3033 2790 3487 3208 3941 3626 4394 4042
2155 1983 2608 2399 3062 2817 3515 3234 3969 3651 4423 4069
2183 2008 2637 2426 3090 2843 3544 3260 3997 3677 4451 4095
2211 2034 2665 2452 3118 2869 3572 3286 4026 3704 4479 4121
2240 2061 2693 2478 3147 2895 3600 3312 4054 3730 4508 4147
2268 2087 2722 2504 3175 2921 3629 3339 4082 3755 4536 4173
2296 2112 2750 2530 3203 2947 3657 3364 4111 3782 4564 4199
2325 2139 2778 2556 3232 2973 3685 3390 4139 3808 4593 4226
2353 2165 2807 2582 3260 2999 3714 3417 4167 3834 4621 4251
2381 2191 2835 2608 3289 3026 3742 3443 4196 3860 4649 4277
2410 2217 2863 2634 3317 3052 3770 3468 4224 3886 4678 4304
2438 2243 2892 2661 3345 3077 3799 3495 4252 3912 4706 4330
2466 2269 2920 2686 3374 3104 3827 3521 4281 3939 4734 3455
INFANT WEIGHT LOSS CHART (POUNDS)

BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS BW 8% LOSS
4-8 4-2 5-8 5-1 6-8 6-0 7-8 6-15 8-8 7-13 9-8 8-12
4-9 4-3 5-9 5-2 6-9 6-1 7-9 6-15.5 8-9 7-14 9-9 8-13
4-10 4-4 5-10 5-3 6-10 6-2 7-10 7-0 8-10 7-15 9-10 8-14
4-11 4-5 5-11 5-4 6-11 6-2.5 7-11 7-1 8-11 8-0 9-11 8-15
4-12 4-6 5-12 5-5 6-12 6-3 7-12 7-2 8-12 8-1 9-12 9-0
4-13 4-7 5-13 5-6 6-13 6-4 7-13 7-3 8-13 8-2 9-13 9-1
4-14 4-8 5-14 5-7 6-14 6-5 7-14 7-4 8-14 8-3 9-14 9-2
4-15 4-9 5-15 5-8 6-15 6-6 7-15 7-5 8-15 8-3.5 9-15 9-2.5
5-0 4-10 6-0 5-8.5 7-0 6-7 8-0 7-6 9-0 8-4 10-0 9-3
5-1 4-11 6-1 5-9 7-1 6-8 8-1 7-7 9-1 8-5 10-1 9-4
5-2 4-11.5 6-2 5-10 7-2 6-9 8-2 7-8 9-2 8-6 10-2 9-5
5-3 4-12 6-3 5-11 7-3 6-10 8-3 7-9 9-3 8-7 10-3 9-6
5-4 4-13 6-4 5-12 7-4 6-11 8-4 7-10 9-4 8-8 10-4 9-7
5-5 4-14 6-5 5-13 7-5 6-12 8-5 7-11 9-5 8-9 10-5 9-8
5-6 4-15 6-6 5-14 7-6 6-13 8-6 7-11.5 9-6 8-10 10-6 9-9
5-7 5-0 6-7 5-15 7-7 6-14 8-7 7-12 9-7 8-11 10-7 9-10
81
THE RHODE ISLAND BREASTFEEDING COALITION
The Rhode Island Breastfeeding Coalition typically meets on the last Wednesday of every
month except December in the Beck Conference Room at the Rhode Island Department of
Health from 12:15 to 1:45 p.m. Professionals and those interested in promoting and supporting
breastfeeding are welcome to attend.
Contact the Family Health Information Line at 401-222-5960 or the

Rhode Island Department of Health Breastfeeding Web Pages at
www.health.ri.gov/breastfeeding for additional information.
Rhode Island Breastfeeding Coalition

Post Office Box 421, Jamestown, RI 02835
www.health.ri.gov/partners/coalitions/breastfeeding
Disclaimer: We have tried our best to include all local breastfeeding sources as of Fall 2010.
Representatives of other breastfeeding resources or services can contact the Family Health
Information Line at 401-222-5960 to be listed in the next published edition.

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RHODE ISLAND

BREASTFEEDING TOOLS & GUIDELINES

ABOUT THIS RESOURCE DIRECTORY

Erin E. Dugan, MPH, CLC

Emily Eisenstein, MPH, CLC

This resource directory and updated information are available at

THE RHODE ISLAND BREASTFEEDING COALITION

» 81.9% of mothers will breastfeed

THE WHO/UNICEF BABY FRIENDLY HOSPITAL INITIATIVE

The CDC 2010 Breastfeeding Report Card (www.cdc.gov/breastfeeding/data/reportcard.htm)

TEN STEPS TO SUCCESSFUL BREASTFEEDING

4. Help mothers initiate breastfeeding within one half-hour of birth.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers to breastfeeding infants.

SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR

Chad Brown Health Center

Children’s Friend and Service

Comprehensive Community Action Program, Inc.

East Bay Community Action Program

Westbay Community Action, Inc.

St. Joseph Health Services

Thundermist Health Center

Thundermist Health Center of South County

Tri-Town Economic Opportunity Committee

Women & Infants Hospital

Wood River Health Center

State WIC Office .......................................................................................................222-5960

PRENATAL BREASTFEEDING CLASSES

P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P R E N ATA L B R E A S T F E E D I N G C L A S S E S

Bellani Maternity ......................................................................................................234-1279

Healthy Babies, Happy Moms Inc............................................................................884-8273

Kent County Hospital ...............................................................................................684-2788

La Leche League of Rhode Island

Landmark Medical Center, Woonsocket Unit ..............................................769-4100 x2218

Memorial Hospital ..................................................................................... English: 729-2510

P R E N ATA L A N D P O S T PA RT U M S U P P O RT: P R E N ATA L B R E A S T F E E D I N G C L A S S E S

South County Hospital .............................................................................................792-2229

Westerly Hospital .....................................................................................................348-3365

Women & Infants Hospital..............................................................................276-7800 x100

Kent County Hospital................................................................737-7010 x3332 or 736-2229

Landmark Medical Center .............................................................................769-4100 x2218

Memorial Hospital ....................................................................................................729-2291

Newport Hospital .....................................................................................................845-1110

South County Hospital .............................................................................................788-1226

Westerly Hospital .....................................................................................................348-2229

Women & Infants Hospital ...............................................................................800-711-7011

OUTPATIENT LACTATION SUPPORT

P R E N ATA L A N D P O S T PA RT U M S U P P O RT: O U T PAT I E N T L A C TAT I O N S U P P O R T

Landmark Medical Center .............................................................................769-4100 x2218

Memorial Hospital ....................................................................................................729-2291

Newport Hospital .....................................................................................................845-1128

South County Hospital .............................................................................................788-1226

Westerly Hospital .....................................................................................................348-2229

Women & Infants Hospital ...............................................................................800-711-7011

P R E N ATA L A N D P O S T PA RT U M S U P P O RT: O U T PAT I E N T L A C TAT I O N S U P P O R T

Healthy Babies, Happy Moms Inc............................................................................884-8273

MIDWIFE BREASTFEEDING SPECIALISTS

PHYSICIAN BREASTFEEDING SPECIALISTS

Laura Viehmann, MD, FAAP.....................................................................................728-9201

Memorial Hospital ....................................................................................................729-2510