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Breastfeeding and Birth Control

Breastfeeding can be used as a method of birth control but only if you follow these rules:

  • Your baby is under six months old.
  • Your monthly periods have not returned.
  • Your baby is fully or nearly fully breastfed.

If you answer “NO” to any of these statements, begin another method of contraception.  Keep breastfeeding as often as you can for your baby’s health

  • Fully breastfed means your baby gets all food from suckling at the breast.
  • Nearly fully breastfed* means, in addition to breastfeeding, vitamins, minerals, juice, water or any other foods are given infrequently (no more than one or two mouthfuls a day).
  • To be fully breastfed or nearly fully breastfed, your baby should go no more than four hours between breastfeeding during the day.  At night your baby should go no more than six hours between breastfeedings.

This method of birth control is called Lactational Amenorrhea Method (LAM).
L= Lactational means breastfeeding
A= Amenorrhea (no menstrual period)

To use LAM effectively, you need additional information.  For more information on LAM and other methods of birth control, call: Ottawa Public Health at 613-580-6744 or visit

If you are breastfeeding and don’t want to get pregnant, here are your options. Speak to your health care provider to choose a method that is right for you.  Side effects are different for each method of birth control. Please note that for all hormonal methods there was no proven effect on infant from hormones.  It is recommended to wait 6-8 weeks before taking progestin containing contraceptives and up to 6 months for combined hormonal contraception (estrogen and progestin).  Effectiveness of each method varies upon use (T=Typical and P= Perfect use). (SOGC)

Method of Birth ControlEffecton BreastfeedingEffectiveness
Breastfeeding as birth control, or LAM (Lactational Amenorrhea Method)
Effective only if:
1. Your monthly periods have not returned.
2. Your baby is fully or nearly fully breastfed.*
3. Your baby is less than 6 months old.
Condoms (Male)
Thin covering of latex (or polyurethane) that is rolled onto the erect penis to stop sperm from going into the vagina.
No effect
T = 85%
P = 98%
Condoms (Female)
Polyurethane sheath that lines the vagina to stop sperm from going into the vagina.
No effect

T = 79%
P = 95%

Spermicides (Foam, Gel, Film, Sponge)
All contain chemicals that kill sperm. These methods are inserted into the vagina before intercourse.
No effectT= 68%-71%
P= 80%-82%
IUD (Intra-Uterine Device)
A small piece of plastic, usually wrapped with copper that is inserted into the uterus preventing the sperm from reaching the egg.   An IUD is inserted by a health care provider.
No effect99.1%
IUS( Intra-Uterine System)
A small piece of plastic containing a hormone (progestin), that thickens cervical mucus, prevents sperm from reaching an egg and may stop an egg from being released. A health care provider inserts this into the uterus.
No adverse effects on breast milk supply if breastmilk supply is well established.99.8%
Fertility Awareness Methods
These methods require special teaching and are difficult to use before your periods start again.
No effectT= 80%
P= 91%-99%
Combined hormonal contraceptive methods (Birth Control Pill, Contraceptive Patch, Vaginal Contraceptive Ring)
Contain hormones (progestin and estrogen) that stop an egg from being released each month and thicken cervical mucus. These methods are taken orally (“the Pill”), worn on the skin (“the Patch”) or inserted into the vagina (“the Ring”).
Studies have shown that estrogen may reduce breastmilk supply.T= 92%
P= 99.7%
Mini Pill
A pill containing progestin, which is a hormone that thickens cervical mucus and may stop an egg from being released.
No adverse effects on breast milk supply if breastmilk supply is well established.T= 92%
P= 99.7%
Injectables (Depo Provera)
A hormone injection given by a health care provider every three months. It contains progestin, which thickens cervical mucus and may stop ovulation.
No adverse effects on breast milk supply if breastmilk supply is well established.T= 97%
P= 99.7%
Vasectomy (Male Sterilization)
A doctor cuts the tubes that carry sperm from the testicles. This may be done in a doctor’s office. This is a permanent method.
No effect99.9%
Tubal Occlusion (Female Sterilization)
A doctor cuts or blocks the tubes that carry the eggs to the uterus. This is done in a hospital and is a permanent method.
No effect99.5%
Emergency Contraceptive Pills (ECP)
You must take these pills as soon as possible and within 5 days (120 hours) of unprotected sex. ECP contains progestin.  This is an emergency method.
May reduce breastmilk supply temporarily. Effectiveness varies
decreases over time

Information provided by the Society of Obstetricians and Gynecologists of Canada, (SOGC).

Adapted with permission from Toronto Public Health

PDF for print purposes [2.92 MB]

Breastfeeding basics

breastfeeding basics


Good for Baby:

  • Always fresh and ready
  • Reduces risk of overweight and obesity
  • May increase protection against illnesses such as childhood diabetes
  • Increases protection against ear, chest and stomach infections
  • May increase protection against Sudden Infant Death Syndrome (SIDS), also called crib death
  • Helps to prevent constipation

Good for Mom:

  • Promotes closeness and touching with baby
  • Helps the uterus to return to its normal size after birth
  • Helps to control bleeding after birth
  • Helps to protect against cancer of the breast and ovary
  • Saves money; formula is expensive
  • Saves time; there is no need to prepare formula and bottles
  • Does not produce any garbage; there are no formula and bottle packages to throw out

Breast Care

Taking care of your breasts

  • When bathing, wash nipples and breasts with water only. Soap can dry the skin. 
  • Dry the nipples gently after bathing, or let them air dry. Extra rubbing will not toughen the nipples. 
  • Glands in the areola, the darkened part around the nipples, produce natural oils to keep nipples soft and clean. Avoid creams or ointments which may interfere with the natural oils unless recommended by your health care provider or lactation consultant. 
  • During the early days of breastfeeding allow colostrum or breast milk to dry on your nipples. Expose your nipples to the air for several minutes after each feeding. 
  • Many women are more comfortable wearing a nursing bra even at night, as the breasts are larger and heavier. Choose one that fits well and has wide shoulder straps. Avoid plastic liners. 
  • Make sure your hands are clean when handling your breasts. 

Stop milk leaking from your breasts between feedings

  • Leaking is common when you are just starting to breastfeed. 
  • To stop the leaking put pressure on the nipple until the tingling feeling in your breast stops. Use your hands or forearms. 
  • Cotton or paper breast pads (without plastic backing) may be used to absorb the milk. Change breast pads whenever they are wet. 

Relieving hard breasts

This is called engorgement which occurs when your milk is first coming in around three days post partum. It may last 1 to 2 days. Later on you may still experience engorgement if breastfeeding sessions are missed.

  • Feed your baby at least 8 times in 24 hours least every 3 hours during the day. Continue night feedings.
  • To soften breasts and increase comfort, try taking a gentle, warm shower or putting warm wet towels on your breasts before breastfeeding. 
  • Gentle massage and hand expression of a small amount of milk may make it easier for baby to latch on. 
  • Covered ice packs may provide comfort between feedings. 
  • If you have a fever, flu-like symptoms and/or notice a reddened painful area on your breast, you may have a breast infection or mastitis. Rest as much as possible. Breastfeed your baby frequently on the affected side. Consult your health care provider within 6-8 hours, if symptoms persist. You may need an antibiotic. Continue to breastfeed your baby frequently while you are on antibiotics. 

Sore nipples

Make sure your baby is well latched on the breast to avoid sore nipples.

  • Try different breastfeeding positions. 
  • Begin breastfeeding on the less sore breast first. 
  • Try breastfeeding more frequently, as soon as your baby is interested (Get to know your baby’s early feeding cues. If pain continues or the baby does not let go of the breast at the end of the feeding, remove baby from the breast by placing your little finger between the baby’s gums to break the suction. 
  • Do not let your baby sleep at the breast. Leave a small amount of milk on the nipple after feeding. 
  • Air dry your nipples after breastfeeding. 
  • Only use nipple creams or ointments that have been recommended or prescribed by a health care professional or lactation consultant. 
  • Change breast pads if they become wet. 
  • Have someone who is knowledgeable about breastfeeding watch you nurse your baby. A public health nurse or a lactation consultant can give you more information.

Avoid: Using nipple shields, without consulting a breastfeeding expert. Nipple shields reduce the direct stimulation to the breast and may affect milk production.

Changes in breasts after delivery

After birth your breasts will go through several changes:

  • At first, your breasts will stay soft and will produce colostrum. Colostrum is a clear yellow milk which is rich in protein. It helps protect your baby from infection. 
  • A creamy white milk will "come in" on the second to fourth day after delivery. For a few days, your breasts will feel full and heavier over the next few weeks, the milk turns to a bluish white colour. Your breasts will return to being soft and less heavy. This is normal and does not mean you are making less milk.


Thrush is caused by yeast that grows in the baby’s mouth and on mother’s nipples. Symptoms can appear in both mother and baby or only one or the other.
The mother may experience breast pain during and between feedings and may have itchy red nipples. It can appear as a white coating on your baby’s tongue and white patches in the mouth. Your baby may also have a diaper rash.

  • See your health care provider. 
  • Both mother and baby should always be treated at the same time. Follow-up if you or your baby’s symptoms do not clear up. 

For more information, please contact the Ottawa Public Health Information Line at 613-580-6744 to speak with a public health nurse.

How much and how often?

Feeding your baby often will help increase your milk supply. The more your baby breastfeeds the more milk you will produce – the principle of supply and demand. Most mothers will produce as much milk as their baby wants. The amount of milk made depends on the amount of milk removed from the breast by feeding or expressing.

Is my baby getting enough milk?

Babies need to feed  frequently because breast milk is digested quickly. In the first few months, a well fed baby:

  • Is feeding well at least 8 times in 24 hours. More frequent feeds are normal. Listen for swallowing or quiet “caw” sound
  • At 1 day old has at least 1 wet diaper and at least 1 to 2 sticky dark green/black stools
  • At 2 days old has at least 2 wet diapers and at least 1 to 2 sticky dark green/black stools. 
    ** This is easier to notice urine in cloth diapers. A facial tissue can be placed inside disposable diapers, if you are not sure.
  • At 3 days old has at least 3 heavy wet diapers and at least 3 brown/green/yellow stools. Occasional “red brick coloured” staining is normal until day 3.
  • At four days old at least 4 heavy wet diapers and at least 3 brown/green/yellow stools.
  • As the milk supply increases, baby has at least 6 heavy wet diapers and at least 3 large soft yellow seedy stools per day.
  • Is back to birth weight by 2 weeks of age

Get help if any of the above signs are not present or:

  • Your baby is very sleepy and hard to wake for feedings
  • Your nipples are sore and do not start to get better
  • You have fever, chills, flu symptoms or a red painful area on your breast

If you have these symptoms: nurse often, apply warm wet towels and get lots of rest. Phone your health care provider if you do not feel better in 6 to 8 hours. 

Length of feeding

  • The length of time your baby feeds at the breast depends on your baby.
  • If your baby is latched on correctly and is actively sucking and swallowing, she can feed for as long as she wants.
  • Your breasts are never empty of milk. As baby breastfeeds, more milk is produced.
  • Feed the baby on the first breast until your baby seems satisfied and sucking and swallowing slows down, stops or baby unlatches.
  • Offer both breasts at each feeding. Your baby may seem less interested in the second breast
  • For the next breastfeeding session start breastfeeding on the side that the baby finished on.

Frequency of feeding

Babies should be fed whenever they seem hungry. Initially this is at least 8 times in 24hrs. Night feeds are important too. In the early days baby may need to be wakened to feed.

  • At 6 to 12 weeks, babies will feed at least 6 times or more per 24hrs.
  • At 3 to 6 months, babies will feed at least 5 times or more per 24hrs.

Your baby may start to tell you she is hungry by waking up, sucking on fists or fingers, rooting (opening mouth and searching for the nipple), smacking her lips and by crying. These signs are known as feeding cues.

Generally babies should be fed before they are crying.  Crying is a late sign of hunger

Many babies have periods, especially in the evening, when they feed more frequently, usually a series of short frequent feeds over a few hours. This is called cluster feeding, it is normal and can occur at any time. Many mothers feel that babies are fussier and not satisfied but it does not mean that you don’t have enough milk.

During a growth spurt, babies grow quickly.  They will feed more often to increase their mother’s milk supply. These growth spurts commonly occur at 3 and 6 weeks, and at 3 and 6 months.  . These periods of more intense feeding will last from 24 to 72 hours.

Baby weight gain

Babies usually lose some weight during the first few days.

  • Early and frequent feedings minimize weight loss.
  • Most babies regain their birth weight by 2 weeks of age.
  • In the first 6 months, babies usually gain 4 to 8 oz (112 to 224 grams) per week and double their birth weight by 5 to 6 months. Growth in length is about 1 inch (2.5 cm) per month.
  • From 6 to 12 months, weight gain usually is 3 to 5 oz (84 to 140 grams) per week.
  • By one year, baby usually triples his birth weight.

Baby’s growth will often reflect family growth patterns. 

Tips for breastfeeding twins or multiples


  1. If you run into any difficulties breastfeeding, get help right away. Speak to a public health nurse or lactation consultant who may be able to help you solve the problem. 
  2. Milk can be produced for two or more babies. Milk production is based on supply and demand. Frequent breastfeeding stimulates breasts to meet breastfeeding demands.
  3. Simultaneous feedings help get babies on the same schedule and saves time. Most mothers of multiples either feed simultaneously or one after the other. Your babies will let you know which method works best for them.
  4. Alternate breasts at each feed. It will be helpful to have a plan to remember who fed at which breast and when. One baby may be a stronger feeder than the other thus stimulating the breast differently. Alternating breasts encourages both breasts to produce milk.
  5. It isn’t unusual to have one baby who is a stronger feeder. When settling down for a simultaneous feeding, put the stronger feeder to the breast first then spend time settling and arranging the second baby. There is an automatic letdown from the second breast when the first baby latches on. Simultaneous feeding allows the second baby to take advantage of the automatic letdown and may encourage him/her to latch.
  6. For triplets or more - A helpful idea for increasing breast milk with triplets is to feed the first two babies simultaneously, then feed the third baby on both breasts. Such a routine provides the best opportunity to increase milk supply to meet the demand. Some mothers feed two babies simultaneously at the breast and will give a bottle of expressed breast milk to the remaining baby(ies). It is important to alternate which baby is receiving a bottle to ensure they will have equal opportunity at the breast. A written record may be helpful.
  7. If additional milk is required, you can pump after feedings. Collect and freeze expressed breast milk for bottle feeding. Be sure to label and date the bottles. 
  8. Never microwave breast milk. This can create hot spots and there is a risk of burning the baby’s mouth. Breast milk defrosts quickly in a bowl of very warm water. The milk should not be hot – room temperature is preferred.
  • Using a twin nursing pillow is a real advantage. This larger pillow can comfortably cradle two babies at a time.
  • Babies have many growth spurts. As a result, they may feed more often. This is normal and does not mean a low milk supply. Continue to breastfeed according to the babies changing needs.
  • Colostrum is the thick milk available for the first 2-4 days following birth. It is loaded with nutrition and antibodies to benefit babies. It is not recommended to pump colostrum as it is thick and may stick to the sides of the bottles and tubing. Breastfeed each baby or, if necessary, hand express into a spoon to feed to the baby. Even a few drops are beneficial to babies.

Adapted from Lynda P. Haddon, Multiple Birth Educator

Where can you get more information?

If you have multiples, contact the Multiple Births Families Association at 613-860-6565 for further information and support.

Vitamin D for your baby

All babies need vitamin D in order to meet their nutritional requirements. Health Canada and the Canadian Pediatric Society recommend Vitamin D supplements for breastfeeding babies.
It is recommended that all exclusively breastfed, healthy term infants receive a daily vitamin D supplement of 400 IU. Supplementation should begin at birth and continue until the infant’s diet includes at least 400 IU per day of vitamin D from other dietary sources or until the breastfed infant reaches one year of age.
For infants not exclusively breastfed, the recommendation for vitamin D supplementation will depend on the amount of formula the baby is receiving as all infant formulas are fortified with vitamin D.
For more information on vitamin D supplementation requirements for your baby please speak with your health care provider.

Medication and breastfeeding

Most medications are compatible with breastfeeding, consult your health care provider, a pharmacist or Motherisk to ensure it is safe to take while breastfeeding. Check with a professional before taking any over-the-counter medications.

Smoking and breastfeeding

Even if you smoke, it is still better to breastfeed your baby. Studies have proven that breastfed babies are healthier than formula fed babies even when they get the chemicals from smoking or second-hand smoke.
There are ways you can cut down the effects of smoke on your baby. The information below shows what you can do:

  • Smoke outside: This will reduce exposure to second-hand smoke
  • Cut down on the number of cigarettes you smoke. The more you smoke the higher the impact on your breast milk as well as the health of you and your baby. Nicotine may be in your breast milk and may cause fussiness and low milk supply.
  • Smoke after breastfeeding your baby. The amount of nicotine in your breast milk decreases over time. And smoking just before you breastfeed can interfere with your milk letdown.

Breastfeeding positions

There are severalpositions you can use to breastfeed your baby. Use these links to find  a few techniques that may help you in your situation. We encourage mothers to become familiar with several positions and alternate positions regularly.

Getting started

mother's posture

Check for the following each time you are preparing to breastfeed:

  • You are comfortable and relaxed with good posture and correct body alignment.
  • Your back and arms are well supported - use a pillow at your back if needed. 
  • Baby’s head and body are supported.
  • Baby’s head is at the level of your breast.
  • Baby’s ear, shoulder and hip are in a straight line.
  • You and baby are chest-to-chest.
  • Baby’s nose is facing your nipple and chin is touching your breast.

Supporting your breast 

First place your fingers flat on your ribs under your breast tissue at the junction of your breast and ribs. Then move your middle and index fingers forward slightly to support the underside of your breast, making sure fingers are well back from your areola. Your thumb rests on top of your breast well back from your areola.

Baby-Led Latching

“Baby-led latching is a natural and simple way for your baby to find your breast...” (Best Start, 2011). Once latched mother and baby can reposition themselves to a more comfortable position.

  • Hold your baby skin-to-skin with your naked baby, placed tummy-down on your bare chest
  • Your baby will start to move her head up and down in search of your breast
  • Support baby’s neck and shoulders with one hand and her bottom with the other while she moves towards your breast.
  • Baby will find and latch on to your nipple.

Latching Baby On

  • baby latching onWhen baby is well positioned, gently touch the baby’s lips with your nipple. 
  • Aim baby’s bottom lip as far from the nipple as possible; when she opens her mouth widely, she’ll scoop in lots of breast tissue. 
  • Push the heel of your hand gently on her shoulders so that her head is slightly tilted back as she is brought to the breast. 
  • Once baby opens her mouth as wide as a yawn, quickly bring her onto the breast. 
  • Her chin and lower jaw reach the breast first 

When baby is well latched:

  • Takes more areola on the underside of your breast than on top - nipple is NOT centered; 
  • Is positioned so that some areola shows above the top lip; 
  • The lips will be rolled outward 
  • Baby’s nose and chin will be touching the breast 
  • The whole jaw will move 
  • Is calm while feeding, sucks rhythmically and swallowing can be seen and heard. 
  • The only sound you should hear is the baby swallowing (a quiet "caw" sound).

When baby is not well latched:

  • Persistent pain with latching can be a sign of an incorrect latch
  • Baby should be removed from breast and re-latched
  • To interrupt the latch break suction by trying one of these ideas:
    • Slip your finger into corner of baby’s mouth and between the gums
    • Press down on the area of your breast closest to the baby’s mouth
    • Bring the baby in closer to the breast so that the nose is covered with breast tissue
    • Pull down on the baby’s chin

Alternate Arm Cradle Hold

Alternate Arm Cradle HoldThis position may work well:

  • If you are learning to breastfeed:
  • If your baby is premature or small

Position before the feeding starts

  • Hold baby with the arm opposite the breast you’re feeding from with her body and legs wrapped around you.
  • Wrap baby’s lower arm around your breast before starting to feed, then bring her closer to the breast. 
  • Hold baby so that her nostrils (rather than mouth) are in line with the nipple before the feeding starts. Support baby’s back with your arm tucked around her. 
  • The heel of your hand supports her neck and shoulders. 
  • Keep your thumb behind her ear and let your fingers support her jaw bone.

Conventional Cradle HoldConventional Cradle Hold

This position may work well:

  • Once you and your baby are comfortable with breastfeeding

Position before the feeding starts

  • Support your breast with the hand opposite the side that the baby is feeding, with your thumb and fingers well back from the areola. 
  • Use your arm on the same side the baby is feeding to support the baby’s head and body and to keep her close to you

Football Holdfootball hold

This position may work well:

  • If you are learning to breastfeed
  • If you have a small baby
  • If you have large breasts
  • If you had a Caesarean birth
  • If you are breastfeeding both twins at the same time

Position before the feeding starts

  • Mother lies baby at her side. A pillow may be used to raise baby to breast level. Position baby’s bottom against the back of the chair. 
  • Flex baby’s legs up behind your arm so that her feet don’t push. Place your nipple on bridge of baby’s nose to make sure baby’s mouth is well under breast before you start. 
  • Support her back with your arm. 
  • Your hand supports her neck and shoulders. 
  • Keep your thumb behind her ear and let your fingers support her jaw bone. 

Helpful Hints 

If you have a preferred side to hold your baby try holding her in the football hold on the other side (least preferred side).
For example: if it’s easier holding baby with your right arm than your left, use your right arm to hold baby at both breasts:

  • When baby is at your left breast, use the alternate arm cradle hold. 
  • When baby is at your right breast use the football hold. 
  • If you prefer your left arm, use your left arm to hold baby at both breasts: 
  • When baby is at your right breast, use the alternate arm cradle hold. 
  • When baby is at your left breast, use the football hold. 

Lying Down

lying down positionThis position may work well:

  • If you find it too painful to sit
  • If you want to rest when you breastfeed
  • If you had a Caesarean birth

Position before the feeding starts

  • Lie on your side with pillows to support your head and your back.
  • Place the baby completely on her side with her mouth at the level of your nipple and her nose, chin, tummy and knees touching you.
  • Use the upper hand to support the breast.
  • Your lower arm may be tucked in under your head, or curled around your baby’s back.
  • A small rolled towel or blanket placed behind baby’s back will keep her on her side.

Positions for multiples

  • It may not be necessary to change breasts during a feed, but it may be a good idea to alternate breasts between babies, from feed to feed, depending on each baby’s strength of suck.
  • It is easier to feed two babies together when they are young and feeding frequently.

Alternate Arm Cradle Hold

Cross Cradle Hold

 Alternate Arm Cradle Hold

 Cross Cradle Hold

Clutch Hold

Breastfeeding in Bed

Clutch Hold

Breastfeeding in bed

*Mothering Multiples: Breastfeeding & Caring for Twins & More, by Karen Kerkhoff Gromada, La Leche League International, 1999

Breastfeeding Challenge

A woman breastfeeding while outdoors

The Quintessence Breastfeeding Challenge, began in 2001 as part of World Breastfeeding Week, an international celebration of breastfeeding. It’s a friendly competition that brings together mothers from around the world by challenging them to set the record for the most babies’ breastfeeding at one time.

Ottawa Public Health has participated in the event since 2002. Last year there were 4,569 children in 10 countries who took part in the Breastfeeding Challenge.

Breastfeeding in Public

Anytime, Anywhere

Breastfeeding mothers have the right to breastfeed anytime, anywhere. This right is protected by the Ontario Human Rights Commission. No one should prevent you from breastfeeding your child simply because you are in a public area. They should not ask you to “cover up,” disturb you, or ask you to move to another area that is more “discreet.”

If you feel your breastfeeding rights are not being respected, you can:

  • Inform the individual, business or community agency of your right to breastfeed your baby in public
  • Consult with The Human Rights Tribunal of Ontario or by phone at 1-866-598-0322.
  • Contact groups such as La Leche League Canada or INFACT Canada for support
  • Discuss with Ottawa Public Health at 613-580-6744

Ottawa Public Health Supports Breastfeeding

Ottawa Public Health (OPH) supports breastfeeding anytime, anywhere however, there is an additional option for mothers who wish to have more privacy All OPH sites, including dental offices and the Sexual Health Centre, have identified areas available upon request for OPH staff, volunteers, students and members of the public to breastfeed or express breast milk.

Breastfeeding symbol

These areas will be identifiable by the Baby-Friendly logo.
As part of their role in protecting, promoting and supporting breastfeeding, Ottawa Public Health has worked with other city departments to provide a breastfeeding room at City Hall and 255 Centrum Blvd. for staff and the public to use.

Breastfeeding When You're Back at Work or School

Mothers and babies both benefit from ongoing breastfeeding.  The longer mother continues to provide breast milk the more protection they both receive as a result.

It is recommended to breastfeed exclusively for the first 6 months with continued breastfeeding after the introduction of complementary foods to two years and beyond.  

Some women have to return to work or school soon after their baby is born. You can continue to provide breast milk once you go back.

Here are some tips to help you prepare to return to work or school:

  • Learn more about your rights as a breastfeeding mother from the Ontario Human Rights Commission.
  • Choose a caregiver that shares and supports your beliefs about breastfeeding
  • Discuss your plans and need for accommodation with your employer.
  • Talk with your health care provider or public health nurse about adjusting your feeding routines and your options regarding expressing breast milk.

Now that you’re back at work or school:

  • Breastfeed as soon as you get up in the morning and when you return home from work or school.
  • Use breastfeeding times as a break and a chance to rest, particularly after work and in the evening. Lie down to breastfeed whenever possible.
  • Depending on your baby’s age, you may need to find a quiet area to express your breasts for comfort, to help maintain your milk supply and to provide milk for the following day.
  • Store your expressed breast milk in a refrigerator or cooler bag with ice pack.

Plugged Ducts or Mastitis

Changes to your child’s breastfeeding pattern may cause increased breast fullness. This can lead to plugged ducts or mastitis.

Plugged ducts - A lump in the breast which may be tender, red and warm. Mother feels generally well otherwise.

Mastitis - Breast is red, hot swollen and painful. Mother has flu-like symptoms and fever.


  • Apply a warm wet towel to the sore breast and gently massage.
  • Breastfeed the baby often (every 2 to 2½ hrs.) when at home and express when at work starting with the sore side until the soreness subsides.
  • Rest more.
  • If you think you have mastitis, consult your health care provider within 6-8 hours, if symptoms persist.  

For more information about breastfeeding and returning to work or school please call the Ottawa Public Health Information Line at 613-580-6744. 

Expressing Breast Milk

Learning how to express breast milk is important for all mothers.

Hand expressing

You may need to express breast milk if:

  • Your breasts are too hard (engorged) for your baby to latch on
  • You want your baby to have breast milk when you are away from your baby
  • You need to increase your breast milk supply

For a healthy baby, use a clean glass or plastic container in which to express your breast milk. Refrigerate breast milk if it will not be used within 6 to 8 hours. For a premature or sick baby: use a sterile container and refrigerate milk within one hour of expressing.

How to express breast milk by hand:

  1. Wash your hands with soap and water
  2. Label container with date before expressing milk. "Clean" means to wash in hot soapy water, rinse well with hot water and leave to air dry.
  3. To help breast milk flow, apply a warm wet towel to your breasts for a couple of minutes or take a shower. Massage your breasts for a few minutes then...
  4. Place your thumb and first 2 fingers about 1 to 1.5 inches (2.5 - 3.75 cm) away from nipple.
  5. Push your thumb and 2 fingers straight back toward your chest.
  6. Roll your thumb and 2 fingers together.

1. Wash your hands with soap and water; 2. Label container with date before expressing milk. "Clean" means to wash in hot soapy water, rinse well with hot water and leave to air dry; 3. To help breast milk flow, apply a warm wet towel to your breasts for a couple of minutes or take a shower. Massage your breasts for a few minutes then...; 4. Place your thumb and first 2 fingers about 1 to 1.5 inches (2.5 - 3.75 cm) away from nipple; 5. Push your thumb and 2 fingers straight back toward your chest; 6. Roll your thumb and 2 fingers together.

  • Continue to repeat steps 4, 5 and 6 until the flow of milk slows down, then switch to the other breast. It will probably take 10-15 minutes to remove most of the milk from each breast.
  • Switch breasts whenever the flow of milk slows down. Be sure to move your thumb and two fingers along all areas around the nipple.
  • Many mothers find it easier to express in the morning when their breasts feel fullest, or after breastfeeding the baby.
  • You may only get a few drops when first learning to express. Expressing breast milk will get better and easier with practice.

Feeding expressed breast milk:

  • Avoid using bottles to feed your baby in the first four to six weeks of life, or until your baby is breastfeeding well. 
  • Instead of using a bottle, you can feed expressed breast milk to your baby from a cup or spoon.
  • If you are using a cup to feed your baby, or if you would like to request the fact sheet on Feeding and Storing Expressed Breast Milk, contact the Ottawa Public Health Information Line at 613-580-6744 to speak with a public health nurse.

PDF for print purposes [ 234KB ]

Storage and handling of breast milk

Wash your hands before expressing or handling breast milk.


  • It's best to store breast milk in glass or hard plastic bottles. Fewer antibodies are lost when freezing breast milk in glass bottles.
  • For healthy term infants, containers should be washed in hot soapy water, rinsed in hot water and allowed to air dry then stored  in a clean, covered container.
  • Disposable plastic bottle liners are not designed for long-term storage of breast milk
    • Individually sterilized breast milk freezer bags are designed to store breast milk for freezing
    • Breast milk tends to lose some of its immune properties when stored in plastic bags which should not be a problem for a healthy baby who is getting only an occasional bottle of breast milk

Fresh breast milk

  • Can be kept at room temperature (less than 25°C) for 6 to 8 hours
  • Can be kept in the fridge for 5 days for healthy full term babies. Place breast milk at back of fridge where it is coldest.
  • Freshly expressed breast milk, once cooled, can be added to the same bottle as breast milk expressed on the same day.

For a premature or hospitalized baby

  • Use a sterile container
  • Refrigerate milk within one hour after pumping
  • Use or freeze the milk within 48 hours

Freezing breast milk

  • Breast milk can be frozen in small amounts (2 to 4 oz/ 30 to 60 ml) and labelled with the date.
  • Store in back of freezer on upper shelf in separate refrigerator freezer for 3 to 6 months (bottom shelf warms during defrost cycle)
  • Keep up to 6 to 12 months in a deep freezer

Thawing breast milk

  • Check the date on the container to make sure that it has not expired. Use the container with the earliest date first.
  • Breast milk is best thawed under warm running water. Once frozen breast milk has come to room temperature, it must be used right away or discarded.
  • Frozen breast milk can be thawed in the refrigerator and must be used within 24 hours of being taken from the freezer. Do not thaw breast milk at room temperature.
  • Frozen breast milk separates into low and high fat layers. Gently swirl or shake to mix.
  • Do not heat on the stove or in a microwave. There is a risk of mouth burns as well as loss of immune components. A bottle heated in a microwave may feel cool but can contain pockets of very hot liquid.

Choosing and using a breast pump

Types of breast pumps

Do not use pumps with rubber bulbs (bicycle horn).

Automatic cycling electric pumps

  • Designed for frequent pumping or double pumping capability.
    • Ensures an on-going adequate supply of breast milk.
    • Collection kits must be purchased
    • An electrical outlet is usually necessary, although some pumps have battery capability.

Small electric/battery-operated breast pumps

  • Designed for short-term separation and occasional use e.g. an evening out, a missed feeding or working part-time. Will not sustain mother’s milk supply over a long period of time.
    • Moderately priced (not available for rental), and are small and portable.
    • They cycle automatically (simulate rate of baby’s suckling).

Manual pumps

  • Simple to operate
    • Designed for short-term and occasional use, it will not sustain mother’s milk supply if used over a long period of time.

Using a breast pump

  • Always read and follow manufacturer’s instructions on proper use and care of your breast pump
  • Wash your hands with soap and water before every pumping session.
  • Choose an appropriate flange for your nipple size and breast shape.
  • Use lowest level of suction needed to maintain flow.
  • Turn your electric pump off before removing the flange from your breast.

Tips for pumping

  • When using a double electric breast pump, you pump both breasts at the same time until milk flow slows down.
  • For small electric and manual pumps, breasts are pumped one at a time. Switch breasts when milk flow slows down. You can switch back and forth several times as it may stimulate multiple let down reflexes resulting in more milk being collected. Stop pumping when milk flow is minimal or has stopped.

Renting or buying a pump

  • Pumps can be purchased orrented from a lactation consultant (IBCLC- International Board Certified Lactation Consultant), drug stores and baby supply stores
  • The best place to rent or purchase breast pumps is from an IBCLC because they are most knowledgeable about breast pumps and can give you the best advice on how to use them. Your hospital may provide a list of IBCLCs when you are discharged or you can call the Ottawa Public Health Information Line at 613-580-6744 for information.
    • Some insurance companies may cover costs
    • Pumps that are designed to simulate the rate of baby's sucking (automatic cycling breast pumps) are typically the most useful.

Cleaning your breast pump

  • Read and follow directions that come with pump.
  • Rinse removable parts first with cool water, then wash with hot soapy water, rinse again and let parts air dry.
  • If you are unable to wash your breast pump well at work, at least rinse it after each use with cool water, and wash it well when you get home. Sterilizing your breast pump once per day is advisable.
  • Store items in a clean, covered container between each use.

Alternate ways to provide breast milk

Some reasons for alternative feeding methods include:

  • Baby or mother’s health and medical condition
  • Insufficient milk supply due to breast injury, surgery and glandular insufficiency
  • Separation of mother and baby (i.e.: illness, surgery)
  • Use of necessary medication that is incompatible with breastfeeding

Spoon feeding

Expressed breast milk can also be offered using a spoon. This method works best if it is baby-led and baby controls the pace of the feeding.

  • Put a bib on the baby, because some breast milk may spill.
  • Sit the baby up on your lap using one hand to support baby’s upper back and neck.
  • Bring spoon to baby’s mouth and tip so that the breast milk just touches the baby’s lips. It should NOT be poured into the baby’s mouth.
  • The baby will lap the breast milk up by moving his tongue forward.
  • Allow baby time to swallow before refilling spoon and offering more breast milk which will allow baby to control pace of feeding.

Cup feeding

Babies of all ages are able to drink from a cup (even small premature babies). You can start offering expressed breast milk in a small plastic or glass cup such as a medicine cup.

  • Put a bib on the baby, because some breast milk may spill.
  • Sit the baby up on your lap using one hand to support baby’s upper back and neck.
  • Place edge of cup gently against baby’s bottom lip and tip so that the breast milk just touches the baby’s lips.  It should NOT be poured into the baby’s mouth. The baby will lap the breast milk up by moving his tongue forward.
  • Keep cup tipped during feeding so that the breast milk is always in contact with baby’s lips which will allow baby to control pace of feeding.

Paced Bottle Feeding

The way a baby sucks on a bottle nipple or pacifier is very different from how a baby sucks at the breast. For this reason it is best to avoid introducing any bottles for 4 to 6 weeks after your baby is born as it can interfere with breastfeeding including the development of your milk supply. 

Paced bottle feeding is when the caregiver controls or paces the flow of milk to resemble breastfeeding. It also helps baby maintain breastfeeding behaviours while he feeds from the bottle. Here is how to pace feeds:

  • Hold your baby in an upright position, supporting their head and neck with your hand.
  • Feed baby skin-to-skin if possible.
  • Use a wide-based, slow-flow nipple.
  • Touch baby’s upper lip with the bottle nipple until baby opens mouth wide.
  • Tip bottle horizontally and allow baby to pull the nipple into his mouth so his lips close on the wide base of the bottle nipple.
  • Keep nipple partially full as it will help baby control flow better. A baby will naturally swallow air during feeds.
  • If baby gets tense or gulps, stop feed by tilting bottle down to stop flow but keeping bottle nipple in contact with baby’s lower lip so that baby can pull nipple back into mouth.
  • Baby will learn to take breaks and 3 to 5 second pauses on his own usually after the fourth or fifth suck and as needed.
  • When you think baby is nearly full, twist and remove bottle keeping the nipple laying on baby’s lip as described above. If baby takes bottle again, allow baby to feed for a short period (i.e.: 5-10 swallows) and repeat process. When baby is done feeding he will not open mouth when bottle is offered. This is one sign (satiety cue) a baby uses to let parents know he is full.
  • Throw away any breast milk left in the bottle after the feeding.

For more information on expressing and storing breast milk call the Ottawa Public Health Information Line at 613-580-6744 to speak with a public health nurse.

Get help with breastfeeding

Parenting in Ottawa Drop-ins and Breastfeeding Support Drop-ins 

Free breastfeeding and well baby support in your community.

Ottawa Public Health Information Line

The Ottawa Public Health Information Line (OPHIL) offers free confidential information and advice on breastfeeding and caring for your infant.  You will have access to Public Health Nurses Monday to Friday from 9 am to 4 pm.  The nurses can help by providing information on how to improve

  • Latch
  • Positioning
  • Assessing if your baby is getting enough to drink
  • Engorgement
  • Much more

The nurses will be able to link you to other services such as Healthy Babies Healthy Children program and other breastfeeding support groups found in the community – call 613-580-6744.

Nutrition and Breastfeeding

Nutrition Tips

Good nutrition is just as important while breastfeeding as it was during pregnancy. Enjoy a variety of nutritious foods. See Canada's Food Guide for more examples of serving sizes and advice on choosing healthy foods. Choose foods from the 4 food groups that are prepared with little or no added fat, sugar or salt. It is important that mothers have a healthy diet and lifestyle to ensure their own wellbeing.

Emphasize vegetables and fruits

  • 7 or 8 servings every day
  • eat at least one dark green and one orange vegetable each day. Examples of one Food Guide serving: half a cup of fresh, frozen or canned vegetable; 1 medium fruit

Emphasize whole grain cereals, breads, and other grain products

  • 6 or 7 servings each day
  • examples of one Food Guide serving: 1 slice of bread, ½ cup (125 mL) of cooked rice, pasta; 3/4 cup (175 mL) of hot cereal; 30 g of breakfast cereal

Choose 2 servings of milk or fortified soy beverages each day

  • examples of one Food Guide serving: 1 cup (250 mL) of milk or fortified soy beverage; 3/4 cup (175 g) of yogurt, 1 1/2 oz (50 g) of hard cheese
  • if you are 18 years old or less, add 1or 2 extra servings of dairy products each day

Choose 2 servings of meat and alternatives each day

  • examples of one Food Guide serving: 2 ½ ounces (75 g) of cooked fish, poultry, lean meat; ¾ cup (175 ml) of cooked legumes; 2 eggs, 2 tablespoons (30 mL) of peanut butter.
  • Breastfeeding women can still enjoy the benefits of eating a variety of fish if they choose carefully. Use this guide to help choose fish.

Breastfeeding women need more calories

  • include an extra 2 to 3 servings each day of foods from any of the above food groups
  • for example, have a fruit and a yogurt for a snack
    • Milk Products, which include yoghurt, cheese and milk, are good sources of calcium. Other calcium rich foods include sardines, salmon with bones, almonds, sesame seeds, cooked soybeans and other dried peas, beans and lentils, tofu made with calcium sulfate, vegetables like kale, bok choy and broccoli as well as dried fruit, especially figs.


  • all breastfeeding women should take a multivitamin containing folic acid

Drink enough fluids

  • drink enough fluids, especially water, to satisfy your thirst.
  • many mothers find they need more fluids than usual. It is a good idea to have something available to drink each time you breastfeed
  • drink water regularly, and even more in hot weather or when you are more active

Oils and Fats

  • include a small amount - 2 to 4 Tbsp (30 to 45 mL) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise. Limit butter, hard margarine, lard and shortening

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Thoughtful Reminders

  • Limit alcohol and caffeine.
    • limit your consumption of caffeine to a maximum of 2 cups of coffee per day
    • caffeine is passed in your breast milk and can be found in coffee, tea, colas, chocolate and may make your baby irritable
    • Alcohol consumed by the mother passes into her bloodstream and her breast milk. The safest choice is not to drink alcohol while you are breastfeeding. If you choose to drink alcohol you  can protect your baby from the adverse effects of alcohol by scheduling your occasional alcohol consumption around breastfeeding. For example, drink alcohol after breastfeeding not before. For more information visit Best Start.

Dieting and breastfeeding

Breastfeeding moms should not try to lose weight through strict dieting as it can decrease milk supply. Breastfeeding should help you gradually lose some of the weight you gained while you were pregnant. Sensible eating and exercise is recommended for breastfeeding mothers.

Continue to follow Eating Well With Canada's Food Guide while you are breastfeeding. You will gradually lose weight as your body uses up some fat to supply the energy required to make milk.