Research reveals new information about the importance of breastfeeding and breast milk, but what we know about breastfeeding basics is pretty uniform. There’s no shortage of parenting websites and books, or even videos on YouTube, that will tell you why breastfeeding is best for babies and show you tips and techniques to get breastfeeding off to a good start. So what makes this DVD special?

It’s all about the presentation. The tone. The message: There is no singular right way to breastfeed; you are not alone in your concerns, worries, obstacles; you can do this. That’s where this DVD shines. Helped by the fact that it features real moms breastfeeding and talking about it, giving the video a refreshing sense of authenticity.

It starts out with the encouraging suggestion that breastfeeding is simply the next part of what you’ve already been doing:

“For nine months, you’ve been making a miracle,” says the narrator Alyson Steel). “…And your decision to breastfeed your baby will continue the brilliant work you’ve already done, because breastfeeding is the single most important step you can take to ensure your baby’s continued growth, health and well-being.”

The moms who appear in the video look like people you know, of various ethnicities, ages, body sizes and shapes, and tattoo preferences. Sometimes they talk directly to the camera, but most of the time they are busy having genuinely sweet interactions with their babies—snuggling, gazing in adoration, and of course breastfeeding.

And this is real-life breastfeeding: you see it all. Sometimes the moms are completely shirtless, sometimes they are only partly exposed, but either way the viewer gets what she needs the most—seeing what a real-time breastfeeding latch looks like, not some drawing that bears little to no relation to what you see when you look down at your snuffling and gaping child. The material might sound explicit to some with more modest tastes, but it’s a DVD about breastfeeding, for heaven’s sake. And everything is presented in a matter-of-fact way—a glimpse into what life would be like if breastfeeding was more visible in this country, with partners and siblings alike comfortably hanging about while mom and baby do their thing.

The DVD’s script offers sound information and the latest research on breastfeeding, but delivers the facts in a conversational tone. I was happily surprised to see that it included footage of a Breast Crawl—something never discussed with me when my son was born just five years ago. In the clip, a brand new baby wriggles his way up his mother’s naked torso and instinctively finds a breast, crying just a little until finally latching on, nearly unassisted.

“The fact is that babies come into the world already knowing how to breastfeed,” intones the narrator. This is something all mothers at least inherently suspect, even when experiencing breastfeeding problems, but seeing it in action like this is quite moving.

Another pleasant surprise was the take on different breastfeeding positions. “Until a few years ago, we made a very big deal about positions for you and your baby,” says the narrator. These days, however, the best thing is “whatever works best for both of you.” The DVD does illustrate different common holds like the cradle, cross cradle, football, and side-lying positions, but it also encourages simply lying down with your baby on top of you, with as much skin-to-skin contact as possible. “In this position, you don’t have to do a thing, because your body supports your baby completely, and gravity does the rest.”

The nuts and bolts of the DVD (how breastfeeding works, why it’s important, how to do it) aren’t that surprising, but they are thorough, taking you from the first days after birth to the experience of weaning (the narrator does remind us of the AAP’s recommendation to breastfeed exclusively for six months, then at least one year or beyond).

There are also sections that discuss the partner’s role (“Simply put…to nurture you, so you can nurture your baby”) and frequently asked questions. Before you hear the expert answers to those FAQs, you first get moms sharing their individual experiences on the issue, which means you get a lot of different answers, sometimes with overlap, but mostly showing you that there is often no “one answer fits all” solution to common breastfeeding questions. This technique illustrates the idea that while breastfeeding has some universal qualities, it’s a highly individual experience.

The FAQ section also makes a case for finding a support network, reminding the viewer that every problem you might experience while breastfeeding has absolutely been experienced before by someone else, and there’s a solution to that problem. A tight circle of real-life buddies can get you through a lot. Lactation consultants and other experts can move mountains, but sometimes you just need to hear another tired mom like you say, “I hear you. It will get better.” You reach the credits feeling less isolated as you begin to navigate the world of breastfeeding.

The DVD’s production values are solid. Everything is brightly lit, glowing with lots of white backgrounds—a nice, refreshing reprieve for sleep-deprived eyes. I was a little surprised to learn that filmmaker David Stark has no children of his own. My initial reaction was, “Why was a man with no direct connection to breastfeeding compelled to make a breastfeeding DVD?” If you are wondering the same thing, he does address that here, while paying heartfelt tribute to his own mother. And while the DVD makes it very clear that it’s not a substitute for medical advice, it does credit six breastfeeding experts who support the medically sound advice.

Of course, mothers are the experts of their own experiences, and some of the most poignant, stick-with-you moments come from moms speaking (seemingly) off-the-cuff about what breastfeeding means to them.

“When I nurse, it is the most amazing feeling…together he and I are growing and I am giving him what he needs to be a strong, healthy young man…[it’s] like nothing I ever thought I would experience,” says one emotional mom. “And I wouldn’t trade it for the world. I would never trade that for anything.”

Mary Jessica Hammes is an Athens, Georgia-based writer, trapeze instructor, knitter, gardener, comic book enthusiast, and hula hooper. She is mom to Tommy.

Weaning begins when solid foods or liquids other than breast milk are introduced into your baby’s diet, and continues until breast milk has been completely replaced by other foods. Some children begin to turn to other sources of liquid nutrition at around 1 year of age, when their diet is varied and they are able to drink from a cup. Others wean from the breast during the toddler years, as increased physical activity curtails their desire to sit still long enough to breastfeed. As you move forward with weaning, replace one daily breastfeeding at a time with solids or liquids, depending on your baby’s age and ability. Choose the feedings in which your baby is the least interested and times when your baby is most easily distracted from the breast.

Even with gradual weaning, your breasts may continue to make some milk for weeks or months. As a result, you may have some fullness and mild discomfort. It will gradually resolve, but in the meantime, there are steps you can take that will help relieve the fullness and ease the discomfort:

Drink sage tea. Anecdotal reports claim that drinking 2-6 cups of sage tea each day can reduce milk production. Sage is known to reduce sweating in cases of excessive sweating, so it’s easy to see why it might have a similar effect on the milk-producing cells. The nasal decongestant, pseudoephedrine (Sudafed), can also reduce milk supply. One study reported a 25 percent reduction in milk supply with a single does of pseudoephedrine.

Use cabbage leaves. As crazy as it may sound, cabbage can help. But don’t eat it—wear it! Place fresh, clean, refrigerated cabbage leaves on your breasts (nipples uncovered), inside your bra. Change them when they wilt, and repeat until your breasts feel soft. Avoid red cabbage leaves that are more apt to stain your clothing. Whether it’s the cool temperature of the cabbage leaves or something in the leaves themselves that reduces swelling is unclear.

Take pain medication. Over-the-counter medications, such as acetaminophen or ibuprofen, can ease discomfort by reducing inflammation and relieving pain.

Wear a supportive bra. A supportive bra can help reduce discomfort by providing firm support during weaning.

Hand express or pump (not too much). If your breasts are painfully full, you might want to hand express or pump once a day, removing as much milk as possible. After that, express only enough milk to prevent engorgement. This approach may lengthen the period of weaning, but it will relieve engorgement and reduce the risk of a breast infection (mastitis).

Check for other causes of pain. Sometimes a plugged duct or breast infection (mastitis) may cause breast pain wrongly attributed to engorgement. Make sure to check your breasts for lumps and tender, reddened areas. Watch out for other signs of mastitis, too, such as fever and flu-like symptoms. If these develop, call your health care provider right away.

Additional information about weaning, not weaning, and engorgement is available from the American Academy of Pediatrics, or learn more here.

The incidence of allergic disease has increased dramatically in recent years. Although genes play an important role, the reasons for the increase are unclear. If the mother has a strong family history of allergic disease, she might be encouraged to follow certain guidelines in an effort to limit the onset and reduce the severity of allergic symptoms in her baby.

The importance of breastfeeding for all moms and babies cannot be overstated. Admittedly, breastfeeding will not prevent the occurrence of allergic disease in babies with a strong family history of allergy, but exclusive breastfeeding for the first six months and continued breastfeeding for at least the first year may delay the onset of allergic symptoms (gas, diarrhea, vomiting, fussiness, and skin rashes) and reduce their severity.

Research shows that food proteins can appear in human milk in small amounts. In extremely sensitive babies, the amount of protein can be large enough to cause allergic symptoms. Parents of high-risk babies have long been cautioned not to introduce solid foods too soon. However, recent studies suggest that delaying the introduction of foods other than human milk beyond six months may actually increase the risk for allergic disease. It appears that when the immune system is exposed to foreign proteins (antigens) during a specific time period (not too early, not too late), a tolerance to the antigens rather than sensitivity may actually develop.

Because our understanding of allergic disease is constantly changing, mothers of high-risk babies (especially those with a family history of peanut sensitivity) should be advised to talk with their baby’s doctor before introducing any foods other than human milk.

Rodale begins with the customary compliment, “…breastfeeding is better for Baby and Mother,” and follows with the inevitable, but, which in this case is however. Which effectively makes everything before the but (however) irrelevant. Or as my Dad would indelicately say, “It makes everything before the but, bullshit.”

“…breastfeeding is better for Baby and Mother… However, having done it three times, I think it’s time to tell the truth about it so moms know what they are getting into,” says Rodale.

She then goes on to list 11 “unvarnished, unfiltered truths about breastfeeding.” While I agree with many of the items on Rodale’s list—and applaud her efforts to give mothers realistic expectations—several of her truths (#s 1, 2, 3, 4, and 11) are short on facts.

#1 “Your milk will not “come in” for two to four days after the baby is born.”
Fact: Mothers begin to produce milk around the 20th week of pregnancy. The fact that small amounts of milk are produced in the first days after birth reflects the physiologic needs of newborns as they adapt to life outside the uterus. No one consumes a five-course meal after running a marathon. Athletes choose small, frequent meals instead. The same is true of newborns. Small, frequent feedings will ensure that newborns get the nutrients they need in the first days after birth, and reduce the risk of babies getting formula supplements. Rodale cautions mothers not to “let the baby over-suck.” What she fails to recognize is that nipple damage occurs when babies are poorly latched, regardless of how often they breastfeed. Mothers are urged to keep their babies close at hand, and to respond to every request to breastfeed. This is your chance to practice while there is expert help available.

#2 “Be careful what you wish for because when your milk finally does “come in,” it will come in with a vengeance, and it will hurt like hell for two to three days and your boobs will feel like giant rocks and you may even want to cry.”
Fact: Milk production will increase dramatically around day 2–4. Milk removal is key to preventing engorgement (rock-like boobs). Responding to your baby’s every request to breastfeed will ensure that your baby breastfeeds at least 8 times in each 24 hours, and that your breasts remain soft, albeit full. Cool compresses (bags of frozen peas covered with a wet cloth) will reduce the swelling so that your baby can latch on well. While the supportive bra recommended by Rodale may be helpful, the bra should be removed for several feedings during the day and at night, so that milk can be removed from all parts of the breast.

#3 “You will start to leak. And you will leak for months, or maybe even years…”
Fact: Leaking is cause for celebration. Yes, I’ve got milk! Now the only challenge is getting the milk out of your breast and into your baby. Once your baby settles into a routine (around 6–12 weeks) and your breasts know how much milk to make and when to make it, leaking will become less of an issue. Leaking rarely lasts more than 3–6 months. Breast pads can be used to protect your clothing. Some pads are meant to be used only once, while others can be washed and used over and over. Remember to change pads frequently, and avoid pads with waterproof liners that trap moisture against the skin.

#4 “Your nipples will probably hurt. A LOT. For a good two to three weeks.”
Fact: During the first week or two of breastfeeding, you may feel pain at the start of a feeding, when your baby first latches on to your breast. If your baby is positioned well, the pain should stop after a few seconds. If the pain persists, slide your finger into your baby’s mouth, release the latch, remove your baby from the breast, and try again. If your baby is positioned poorly and continues to breastfeed, you can damage your nipples. Don’t ignore breast or nipple pain.

#11 “Finally, one day your boobs will return to normal size, and even though the shape might have changed and they might sag a bit more, they will still be beautiful and loved by all the people in your life who loved your breasts to begin with.”
Fact: Breasts may change shape, but before you assign breastfeeding as the culprit, know that breast changes occur in women who bottle-feed as well. Why? It’s a result of weight gain and weight loss—something every pregnant woman, and many never pregnant women, experience.

As for the remaining six items on Rodale’s list, my favorites are #10 “Breastfeeding is free” in which she dispels the myth that breastfeeding moms need to follow a special diet, and reminds readers that even in a toxic world, a mother’s own milk is still a better choice “than whatever mystery is in formula.” And #6 “Once the pain goes away, it is totally easier,”—although I would downplay the pain and emphasize the convenience. But I particularly like Rodale’s use of the word “easier,” because the fact is breastfeeding isn’t always easy. Like any new skill, it often requires patience, persistence, and practice. But it does get easier. Plus, as Rodale aptly states, in the end, “It’s worth it!”

Older people or those with weakened immune systems, however, are at greater risk for thrush. People with diabetes who have high blood sugar levels are also more likely to develop the condition because the excess sugar in their saliva is breeding ground for Candida. Taking antibiotics for an extended period of time can also lead to thrush, since the drugs kill off some of the good bacteria that help keep Candida in check.

Babies are at increased risk for thrush because their immune systems are still developing, which may allow Candida to grow more rapidly. In fact, thrush is so common among infants the National Institutes of Health notes the condition is not considered abnormal unless it lasts more than two weeks.

How do I know if my baby has thrush?
Babies affected by thrush will have distinct white patches or velvety sores in their mouth, particularly their inner cheeks and on their tongue, according to the American Academy of Pediatrics (AAP). Unlike the white milky coating that can be seen on babies’ tongues after a feeding, the AAP points out the white patches caused by Candida cannot be washed away or wiped off easily.

Beneath the white substance there may be inflamed or red tissue that bleeds easily. If left untreated, the sores can get bigger and increase in number.

Although thrush can be uncomfortable for babies, it is rarely serious. A baby with thrush may be reluctant to breastfeed or bottle-feed because sucking irritates the sores in her mouth.

In addition to the patches in the mouth, babies with thrush may also have a diaper rash caused by the excess yeast.

If you suspect that your baby has thrush, you should contact your child’s health care provider. He may be able to diagnose thrush just by looking in your baby’s mouth, but a culture of the white patches in the baby’s mouth can confirm whether or not Candida is the culprit.

How is thrush treated?
Thrush is not contagious and infants with the condition may require no treatment at all, the AAP explains. The condition often clears up on its own within a couple of weeks.

If your infant has had thrush-like sores for at least two weeks or is not eating well due to the sores in her mouth, her doctor may prescribe an antifungal or other medication to treat the infection.

For toddlers, eating yogurt that contains live cultures of Lactobacillus acidophilus encourages the growth of good bacteria and discourages the growth of yeast.

Is it safe to continue breastfeeding if my baby has thrush?
Yes. Although thrush can pass back and forth between a mother and her baby, stopping breastfeeding will not clear up the infection once it has developed, the AAP says. For this reason, however, it is important for breastfeeding mothers and infants with thrush to be treated at the same time.

Breastfeeding mothers will know if Candida is present because their nipples may become inflamed or red, shiny, oozy, or crusty. Nursing mothers may also feel a burning or itching sensation in their nipples during or after nursing.

Mothers who are breastfeeding an infant with thrush must take extra precautions to prevent future infections. But even babies who are bottle-fed can develop thrush. The AAP says there are a number of steps mothers can take to prevent this type of infection, including:

• Keep your nipples clean and dry.
• Change your nursing pads when they become damp.
• Wash your hands well and often with warm, soapy water.
• Throw out all bottle nipples and buy new ones.
• Sterilize or discard any pacifiers.
• Sterilize or discard teething rings and other teething toys.

Is it safe to store breast milk for later use?
Studies show that freezing deactivates yeast, but doesn’t kill it. Since milk expressed during a thrush outbreak could be a source of infection, some sources recommend that mothers being treated for thrush not freeze milk for later use. Other sources cite the fact that human milk contains ingredients (lactoferrin and immunoglobulins) that inhibit the growth of yeast. Moreover, human milk supports the growth of lactobacillus, “good bacteria” that limit the growth of yeast.

Milk containing yeast is unlikely to be a problem for healthy babies. Mothers concerned about safety can either not freeze milk expressed during a thrush outbreak, or heat treat (scald or boil) thawed milk expressed during a thrush outbreak.

• Your baby is less than six months old.
• Your baby is breastfeeding at least every 4-6 hours during the day and at night.
• You are breastfeeding fully, offering no breast milk substitutes and using pacifiers only at bedtime.
• You have not resumed menstrual periods (monthly bleeding).

Women who supplement with formula or other foods, follow a rigid feeding schedule (routinely limiting the frequency or length of breastfeedings), or breastfeed less than 4-6 hours during the day and at night are more likely to become pregnant.

The absence of menstrual periods makes pregnancy unlikely, however, ovulation (egg release) can occur before the start of menstruation. So don’t assume that you are protected (safe) because you haven’t had a menstrual period. You can become pregnant, while breastfeeding, before you resume menstrual periods.

If you don’t wish to become pregnant, you may want use another method of contraception in addition to breastfeeding. Birth control options include natural family planning, cervical cap, female condom, diaphragm, intrauterine device, tubal ligation, male condom, vasectomy, and spermicidal cream, foam, or jelly.

In the past, breastfeeding women were told to avoid birth control pills containing estrogen and progesterone (combination pills), and to use birth control pills (minipills), implants (Implanon, Norplant), or injections (Depo-Provera) containing only progesterone instead.

The Centers for Disease Control and Prevention issued new guidelines in 2010 that allow for the use of combined oral contraceptives as early as 4-6 weeks and the use of contraceptives containing only progesterone within days of birth. Given reports by some women of a drop in milk supply after starting hormonal contraceptives, some makers of hormonal contraceptives recommend that breastfeeding women wait until their milk supply is well established, at least 4-6 weeks after birth, before starting hormonal birth control.

Planned Parenthood provides additional information about a variety of birth control methods—including breastfeeding.

Many babies have short, fussy periods each day, but 10 to 20 percent cry inconsolably for many hours for no clear reason. Colic usually appears around 2-4 weeks of age. Crying spells can occur at any time, but are most common in the evening. Colicky babies often show signs of gastrointestinal distress, such as altered posture (extending or pulling up their legs), gas, and swollen stomach (distended with gas).

There is no clear explanation for colic. (You can read more about colic on baby gooroo here.) Colic usually disappears by the baby’s third or fourth month, but it may last until 6 months of age. Time may be the only solution, but if your baby has colic, here are some things you can do that may improve the situation:

• Offer one breast at each feeding. The result will be a low-volume, low-sugar, high-fat meal rather than a high-volume, high-sugar, low-fat meal. Sugar produces more gas and may trigger colicky behaviors. This approach can also help prevent overfeeding.
• Burp your baby often. Pause in mid-feeding to burp your baby, using a combination of gentle pats and strokes on his back.
• Make dietary changes. If your baby is consuming any infant formula, avoid those with cow’s milk. Eliminate potentially irritating foods from your diet as well, including milk products, eggs, nuts, and wheat. Some mothers also eliminate caffeine and spicy or gassy foods, like onions and cabbage.
• Use a baby carrier or sling. Being snuggled against your body and feeling the motion of your movement can provide some comfort to your baby, even if his discomfort persists. In cultures where babies are carried in slings for much of the day, colic is rare. To learn more about breastfeeding in a carrier, click here.
• Use “white noise” during feedings. Constant sounds or vibrations may help. Some babies are soothed by the sound of the vacuum cleaner, a fan, an untuned television, a white noise machine, or a clothes dryer (never place your baby on top of the washer or dryer). Some websites now offer white noise.
• Massage your infant before a feeding. Gentle massage may help calm your baby. Try clockwise motions on his tummy or lay him tummy-down across your knees and gently pat his back.

No one knows why some babies have colic while others don’t, and no parent anticipates having a colicky baby. But rest assured you’re not alone. The 16 or less weeks of colic may feel like 16 years, but soon your baby will be through this phase and onto the next—sitting, crawling, talking, walking, and more.

Common causes include:

• Pain or discomfort. Whether the pain is in the baby’s mouth (such as from teething) or elsewhere (such as from a vaccination), discomfort can cause the baby to avoid breastfeeding.
• Illness. A stuffy nose or a cold can make it hard for your baby to breathe while breastfeeding. Constipation or diarrhea can cause her to lose interest in breastfeeding.
• Strange tastes or odors. Occasionally, menstruation (your monthly period) or something in your diet will change the taste of your milk. Some babies have nursing strikes when their mothers use a new deodorant, perfume, or lotion.
• Distractions. Overstimulation from a busy environment may distract your baby from breastfeeding.

Whatever the cause, remember that a nursing strike doesn’t mean your baby is ready to wean. She will typically resume breastfeeding within a few days.

You will want to maintain your milk supply and continue to nourish your baby during this time. To keep up your milk supply and avoid the discomfort of engorgement, hand express or pump. The following strategies will help you maintain your baby’s usual feeding routine:

1. Continue to offer the breast. Try expressing a few drops of milk onto your nipple or your baby’s mouth as encouragement. Do not try to force her onto the breast. Stop if she seems frustrated. Give her your expressed milk by teaspoon, eye dropper, hollow-handled medicine spoon, or cup until she resumes breastfeeding.

2. Avoid giving any more bottles than necessary. Bottles can be introduced after breastfeeding is well established—about six weeks after birth. However, babies use different techniques for sucking at the breast versus from a bottle and you’ll want to nurture breastfeeding skills during a nursing strike.

3. Offer the breast when your baby is hungry or sleepy. Watch for early signs of hunger and offer the breast at those times, before providing any other foods. If your baby is relaxed or sleepy, she may be more apt to latch on and breastfeed.

4. Change positions. If your baby is congested, try a more upright position. If she has had vaccinations, try to avoid contact with any sore spots. Similarly, if teething is the problem, rub her gums with a clean finger or clean, cool washcloth before feeding.

5. Avoid distractions. Limit noise and other distractions during feedings. A quiet, dimly lit room might help.

6. Soothe your baby. Give your baby your undivided attention. Hold her and cuddle her before attempting to breastfeed. Use gentle stroking, a soothing voice, and skin-to-skin contact.

The most important strategy of all is to be patient and relax. Nursing strikes seldom lead to weaning. With time and attention, your baby will happily return to the breast.

• Babies with galactosemia. Galactosemia is a rare genetic disease. Babies with galactosemia are unable to digest galactose, a sugar found in breast milk, and must be fed galactose-free formula. Knowing that early diagnosis leads to early treatment, babies are screened for galactosemia at birth. Although galactosemia is a permanent condition, it is easily managed with a galactose-free diet.

• Babies with phenylketonuria. Phenylketonuria (PKU) is a metabolic disease similar to galactosemia. Babies with PKU cannot digest the amino acid, phenylalanine, and must be fed phenylalanine-free formula. Unlike babies with galactosemia who must be formula-fed, babies with certain types of PKU can partially breastfeed. However, the amount of phenylalanine in the baby’s blood must be periodically measured to ensure that it is below a certain level.

• Mothers with active, untreated tuberculosis. Tuberculosis (TB) is a disease caused by bacteria. It usually infects the lungs (pulmonary tuberculosis), but can infect other body parts as well, including the breast. When a mother with pulmonary tuberculosis sneezes or coughs, the bacteria can spread to her baby. Keeping babies disease free is a top priority. In the past, mothers with active, untreated TB were routinely separated from their babies until the mother was no longer contagious (about two weeks after the start of treatment). Today, every effort is made to keep mothers and babies together while being treated. But given the many different scenarios, each case must be evaluated individually. If both mother and baby are infected, they can be isolated together and continue to breastfeed while both are treated. If only the mother is infected, the mother and baby may be separated until treatment is started or longer (up to two weeks after the start of treatment) if the mother is highly contagious. The bacteria that cause TB do not transfer into breast milk, so a mother with active TB who is separated from her baby can express her milk and have it fed to her baby until she is able to resume breastfeeding.
• HIV-positive mothers. HIV-positive mothers living in developed countries are advised not to breastfeed. In contrast, those living in developing countries where sanitation, clean water, and adequate supplies of breast milk substitutes are unavailable or limited are urged to breastfeed exclusively, since the risk of babies dying from infectious disease is greater than the risk of HIV infection. The use of antiretroviral drugs has reduced the risk of mother-to-child HIV transmission during pregnancy and while breastfeeding. Nonetheless, HIV-positive mothers living in developed countries are urged to talk with their health care provider about the benefits and the risks before deciding to breastfeed.

• Mothers with HTLV type I or II infection. Human T-cell leukemia virus type 1 (HTLV-1) is spread through sexual contact, bodily fluids, blood transfusions, breastfeeding, and from mother to fetus during pregnancy. Many people infected with HTLV-1 develop T-cell leukemia and lymphoma as adults. Studies comparing transmission rates based on infant feeding type show that 30 percent of exclusively breastfeeding babies born to mothers infected with HTLV-1 become infected, as opposed to only 10 percent of mixed-feeding infants. No formula-fed infants developed the disease. Because only 1–5 percent of those infected with HTLV-1 develop leukemia, mothers with this disease are urged to discuss infant feeding options with their health care providers. Similar to HIV recommendations, HTLV-infected mothers who live in developing countries, where the risk of not breastfeeding may be greater than the risk of breastfeeding with the disease, are often urged to breastfeed their infants.
• Mothers using or dependent on illegal drugs. The risks of breastfeeding by mothers using illegal drugs are twofold: whether the drugs will negatively affect the infant, and whether the drugs will impair the mother’s ability to adequately care for her baby. Drugs such as cocaine, LSD (and other hallucinogenic drugs), heroin, marijuana, and amphetamines (taken in larger than prescribed doses) are all contraindicated while breastfeeding because of the effects on the baby’s developing nervous system. Mothers participating in methadone treatment programs can breastfeed, but their babies should be carefully observed for adverse effects. The Academy of Breastfeeding Medicine’s protocol on Breastfeeding and the Drug-Dependent Woman lists criteria for when breastfeeding should or should not be supported.

• Mothers receiving cancer chemotherapy. Chemotherapy drugs are designed to kill rapidly producing cells such as cancer cells. Since babies are one big bundle of rapidly producing cells, chemotherapy drugs are not compatible with breastfeeding. The length of time these drugs remain in the mother’s system (and her milk) varies from drug to drug. Mothers who would like to resume breastfeeding after their cancer treatment ends, should talk with their cancer doctor as well as their baby’s doctor to ensure that it is safe to breastfeed. (Read one woman’s amazing story here.)

• Mothers receiving radiologic tests and treatments. Only a small amount (less than 1 percent) of the contrast material used for radiologic tests passes into a mother’s milk. The baby absorbs even less, so there is no need to interrupt breastfeeding. While contrast agents used for testing are considered safe, those used for treatment purposes, such as radioactive iodine (RAI), can be extremely toxic. Because RAI concentrates in breast milk, mothers receiving RAI are cautioned to wean several weeks prior to treatment to limit breast exposure. Exposing the breasts to RAI increases a mother’s risk for breast cancer. X-ray treatment, even for breast cancer, is not considered a contraindication to breastfeeding. Mothers can continue to breastfeed on the non-radiated breast, as long as they are not receiving chemotherapy. Because the safety of radiologic tests and treatments varies with the contrast agent used, it’s essential that mothers talk with their health care provider as well as their baby’s health care provider before making a decision about breastfeeding.

The importance of human milk for human babies is illustrated by the fact that there are very few conditions that preclude breastfeeding. Babies breastfed exclusively for 6 months are healthier, not just in infancy, but for many years to come compared to formula-fed babies or babies fed a combination of formula and breast milk. Fortunately the breastfeeding challenges many mothers experience in the early weeks, such as nipple pain and breast engorgement, are short-lived and easily managed. Mothers who are unable to breastfeed for any reason can still bond with their babies by holding them skin-to-skin during feedings.

Additional reporting by Melissa Clark Vickers

To become an IBCLC, an individual must meet eligibility requirements in education and experience. They also must pass an independent exam administered by the International Board of Lactation Consultant Examiners (IBLCE).

Once they pass the exam, lactation consultants are granted the IBCLC credential. Still, they are responsible for maintaining and enhancing their knowledge and skills through breastfeeding-focused continuing education at seminars and professional conferences. Five years after their exam, they may apply for recertification based on continuing education credits. Every 10 years, lactation consultants are required to retake the IBLCE exam in order to recertify.

IBCLCs work in many different settings, including hospitals, neonatal care units, health care clinics, doctor’s offices, private practices, WIC offices, and human milk banks. To find an IBCLC in your area, you can use the International Lactation Consultant Association (ILCA)’s lactation consultant database.

Not all providers who call themselves “lactation consultants” are IBCLCs. Some complete CLC (certified lactation consultant) programs instead. The CLC program is not accredited by the National Commission for Certifying Agencies (NCCA), and does not require the same level of education, experience, and examination that IBCLC does. While some CLCs may be knowledgeable, to ensure the best quality of care, choose an individual who has been certified by an internationally recognized certification organization such as IBLCE. In choosing a provider, note the acronym at the end of your provider’s name. “CLC” denotes one is a certified lactation consultant, while “IBCLC” is reserved for those who have certified through IBLCE’s process. You can always verify a lactation consultant’s credentials through the IBCLC Registry of IBLCE.