It seems like we should have posted an article about this a long time ago. How to breastfeed seems like a very basic topic, but it might actually be one of the most complicated questions a person could ask! There really is so much to know, and each person’s experience is a little different. When you have never attempted to breastfeed before, it’s probably an obvious question: How do I do this? The answer is simple AND really complicated.

Your Body is Preparing During Pregnancy

Early in the first trimester of pregnancy, estrogen and progesterone levels increase significantly. Estrogen stimulates cell growth in the breast ducts and causes prolactin levels, another hormone, to increase. Prolactin makes breasts grow and is responsible for milk production. Progesterone supports the formation and growth of milk-producing cells within the glands of the breasts.

The areolas (darker area around the nipples) will enlarge and darken due to hormones that affect skin pigmentation, and the nipples will stick out more. This has an AMAZING purpose. When babies are first born, they don’t have great eyesight. They start looking for a nipple pretty quickly, and this darker and larger target is easier for them to see and grab!

The areolas may become covered with small white bumps. These are enlarged oil-producing glands called Montgomery’s Tubercles. They produce an antiseptic and lubricating oil. This oil keeps the nipples and breast milk clean and safe for your baby. It also helps keep your nipples from becoming too dry and irritated.

Early in the second trimester, the milk ducts stretch and enlarge as they begin to fill with milk. Around week 16 of pregnancy, the breasts are able to produce milk and feed a baby! At this time, your body begins to make colostrum. That’s the first milk that babies get. It’s extra special, and it’s made in very small quantities. Some people like to start collecting colostrum in the last few weeks of pregnancy to freeze and save for their babies. This can be a backup in case you have to be separated from your baby for any reason, or have trouble collecting it after the baby is born. Learn about hand expression and why you might want to collect milk while you’re still pregnant.

Babies Usually Know How to Breastfeed

Babies are born with some very special instincts that help them find a breast and get milk from it. Sometimes, they don’t need anything from us except a willingness to be still and let them do their thing! This is called THE BREAST CRAWL, SELF-ATTACHMENT, or BABY-LED LATCHING. Right after a baby is born, there are some behaviors you can look for that are pretty universal. This is the start of the instinctual process for getting milk. This process does NOT start with a mouth on a nipple though. There is some evidence now showing that allowing babies to go through these pre-feed behaviors can actually help them be more successful when they finally get to the nipple.

1. Skin-to-skin time first! Right after birth, it’s best to put the naked (or quickly diapered) baby onto your belly or chest, wherever is most comfortable. This is the time when we usually just want to rest for a little while and then start to look at and cuddle our babies.
2. The babies might be sleepy or tired or just relaxed at this point. The birth cry has stopped. They might be very alert, but relaxed.
3. Squirmy Baby – After a few minutes, babies will usually start to seem sort of restless. They might pick up their heads to look around, bob their heads up and down, start opening and closing their mouths.
4. Hungry Baby – Babies will start to look more like they are hungry. The “rooting reflex” might be obvious. The baby will open and close their mouth, make sucking movements, maybe even try to eat their fist!
5. Rest – After all the restlessness, the baby might take another quick break for rest!
6. Crawling – After a quick rest, a baby might intensify their efforts to find a nipple. You may see the “step reflex” where a baby begins to use their feet to propel them forward toward a nipple.
7. Finding a breast – Hopefully the baby has now found a nipple and begins to explore. They have the instincts to sniff it out, feel for it, see it. This is called the “rooting reflex”. Once they reach the nipple, they will prepare to eat. They may bob around to find just the right spot, lick the nipple, touch and grab for the nipple, massage the breast area. This might go on for a while, even 20 minutes or more!
8. Suckling – The baby is finally ready and able to latch onto the breast and start using the “sucking reflex”.
   This whole process can take over an hour, or it can be quicker. It does take some patience to let it all play out. It’s definitely ok to help the baby to the breast and encourage breastfeeding sooner if you prefer. While there is some evidence that letting the baby go through the instinctual process can benefit the breastfeeding relationship, it definitely does not mean that things won’t work well if it is interrupted!

At First, Only a Little

It’s important to note that in the first 2-5 days after birth, you may only produce a very small amount of milk called colostrum. This means that your breasts will look and feel mostly normal, and you won’t see your baby taking in and swallowing big mouthfuls of milk. This is how it’s supposed to be. The baby’s digestive system is full of Meconium for the first couple of days, and they have very tiny bellies which can’t hold much. Those drops or teaspoonfuls of milk are all they need at first.

Usually on day three after birth, you’ll notice some changes. Your breasts may start to feel and look fuller and heavier. Sometimes they even get VERY big and very firm, and even painful. This is called engorgement. You’ll probably start to notice that your baby is taking big gulps and you may even start to see milk leaking out of the side of the baby’s mouth. Sometimes babies let go because it’s too much, and then you might see a spray of milk shooting out across the room! All of these are signs that your milk has changed or “come in”.

Often you’ll hear about the milk “coming in”, but that is misleading. The milk has been there, just more concentrated and in much smaller amounts. Sometimes there is delay and it takes longer for the milk to change. This might be caused by severe stress, surgery (including cesarean), excessive bleeding after birth, other medical conditions or illness, separation from the baby. It’s very possible to overcome this delay with plenty of skin-to-skin time and LOTS of time with the baby at the breast. Sometimes people need to help out by using a breast pump, especially if they are separated from their babies for a significant amount of time.

The Basics of Breastfeeding

Preparation – While you’re getting the hang of breastfeeding, it’s a great idea to have some special areas in your home that you will use for feeding. That might be your bed, or a rocking chair, or somewhere else. You might have a couple of different areas that you use. It’s a great idea to set up some supplies where you feed your baby. You might have some diaper changing supplies, something to drink, snacks, a book or magazine, burp cloths, a nursing pillow, blanket, your phone, or anything else you might need to feel comfortable and stay put. Since you might be there a long time and sometimes it’s tricky to get the baby started right, it’s best to not have to get up until the feeding time is over. Someday you might be able to walk around, make a meal, or even use your computer while breastfeeding! But while you’re still getting the hang of it, it’s best to set yourself up for success.

Timing – After the first feeding, it’s important to continue to pay close attention to your baby’s hunger cues. When the baby gets alert and active and starts making funny mouth contortions or starts trying to eat a fist, you can offer a breast. It’s best to catch those hunger cues before a baby gets too frustrated and starts crying, because it usually means they will latch on more easily. If a baby gets beyond that point and is very upset, it’s best to try to calm the baby down first. Sometimes a frustrated baby just won’t latch on!

Feed your baby whenever she seems hungry. Newborns won’t have strict feeding schedules and shouldn’t be put on one. At the beginning especially, feeding “on-demand” is the best way to go because you need to set up a great milk supply. The more the baby suckles, the more milk gets made. There will be times when a baby seems to want to be at the breast constantly. This can be frustrating, but it’s a normal and critical part of the process. Allowing the baby to stay at the breast as long as they are asking for is how our milk supply increases. The baby is telling us that they are growing and NEED MORE. The body hears that message and increases the milk supply. Without that stimulation, the supply won’t grow to meet your baby’s bigger needs. Try to tell yourself that this is important work, everything else can wait, and let yourself relax. These “cluster feeding” phases pass within a day or two and you can go back to having more time for other things. Once your baby is out of the newborn phase, this will happen a lot less or not at all.

After about three months of age, most babies will only have a big “cluster feeding” growth spurt one more time at about six months. This is not precise and universal. Some babies have more or fewer of these and at different times, but it does eventually get better and stop. These times are hard! I remember feeling so frustrated about not being able to get anything done when my babies were cluster feeding. I worried that I wasn’t making enough milk. I wish I had known how important it was for our milk supply. I would have been able to find some peace with it and possibly even have relaxed and enjoyed that time with my babies. Fortunately, I was able to just let it happen and it passed quickly so our breastfeeding journey was not interrupted, but it makes such a big difference to understand “the why”.

Latch – Sometimes babies are very good at attaching to the breast, and sometimes you may need to help the baby get a good latch. The baby needs to get a big mouthful of breast tissue which should include more than just the nipple.

If the baby only grips on to the nipple, you might be able to help by taking hold of the breast behind the areola and flattening it as if you’re trying to flatten a sandwich that is too tall to fit into your mouth. Aiming the nipple up towards the baby’s top lip might also help your baby get a good latch. You can usually tell the latch is good when the baby has a wide open mouth (fish lips) around the breast, there is a significant amount or even ALL of the areola in the baby’s mouth, and you can feel a tugging or pulling sensation as your baby suckles, but not pain. Some discomfort in the first 30 seconds can be normal, but should feel better after that.

If there is a pinching sensation, it probably means your baby has a shallow latch. Release the suction by putting your finger into the corner of your baby’s mouth. You don’t want to just pull the breast out, because that hurts!

Position – At the first feeding if you are allowing the baby to self-attach, the baby’s position might seem awkward. You might be belly to belly with your baby doing a faceplant into the breast! That’s normal and may even be a great way to encourage the baby to have a very wide open mouth and great latch. Your baby might be straight up and down along your side or middle or sort of sideways across your belly. Allowing the baby to choose a position like this can be great anytime!

The more traditional cradle position might not be the most comfortable at first, but could be a great option later. The cross-cradle position might be a great option if your baby needs some extra support finding a good latch at first. And there are many other great breastfeeding positions. It’s important to understand that there are a lot of different ways to position a baby for breastfeeding and it can depend on your anatomy, your comfort, your baby’s preference and anatomy, and any latch issues you might have.

How much – Some babies will eat for five minutes on one breast and get enough, other babies will need more. Your milk is different from my milk. Your milk might be different tomorrow. It’s important to remember that breast milk changes and is individual to the person.

Five minutes might be enough if the baby is very good at getting the milk out fast and if the milk is very nutritionally dense. Most of the time babies need longer than five minutes to get enough nutrition and feel satisfied. Older babies need less time at the breast and feedings that are further apart because they’ve gotten better at getting the milk out and their bellies are bigger and can hold more at each feeding. Pay attention to what your baby is doing. If they are still very alert and suckling strongly, let them continue. If they seem to be tired, falling asleep, or barely suckling, that’s probably a sign that they got enough for now or that you could try switching to the other breast if you haven’t done that yet.

Both sides? Which side? – Whether you feed your baby at both breasts each time is up to you and your baby. Some babies don’t have the stamina to do that and that’s ok! You can use the left breast this time, and the right breast next time. As long as you’re trying to keep it pretty even, and both breasts are getting stimulated enough each day, they should both keep working.

If you ALWAYS use just one breast, the neglected breast could stop producing milk. Some babies show a preference for one side or the other. If this is the case, keep encouraging the baby to use both. Some people will offer the least favorite breast first when the baby is very hungry and more likely to take anything. Other people will try offering the least favorite breast after the baby has already gotten some milk from the favorite breast and is very relaxed, so maybe they won’t notice the change.

Skin-to-skin – The more time you spend holding your baby or lying down together skin-to-skin, the more the baby will be stimulated to feed. This is especially important when you have a newborn, since it’s the way our bodies learn to maintain a great supply of milk.

How to Know it’s Working

It’s hard to know if things are going well and your baby is getting enough breast milk when you’re feeding directly from your body. You can’t see it or measure it! Fortunately, it usually works out just fine. To be sure your baby is getting what they need, look at all of these factors:

• Plenty of wet and dirty diapers. This log can help you track and understand what is normal in the first week. Remember that this doesn’t necessarily have to be perfect! Sometimes breastfed babies can go for days without a poop and that can still be considered normal;
• A mostly contented baby;
• Weight gain – Your baby will be weighed in the hospital, at pediatrician visits, and at visits with a lactation consultant, if you have them. That’s usually enough to tell that your baby is gaining weight appropriately. If things change, and you’re concerned that your baby is not gaining enough weight, you can rent a scale or visit a clinic to get a weight check more often.

Breastfeeding Success is an amazing team of breastfeeding, baby, and birth experts and educators. We love it when everything goes just right and you don’t need us! Our goal as educators is to give people some tools to help birth, breastfeeding, and early parenting go smoothly so you can enjoy this time and move forward as a family. Sometimes things don’t go as planned, and we have a lot of understanding and compassion for this too.

We offer clinical, educational, and emotional support to help people overcome obstacles in breastfeeding and early parenting. Our mission is to provide the care that people need whether that’s education, clinical support, or even just comfort. We do recognize that breastfeeding is not something that most people know how to do. It is natural, but that doesn’t necessarily mean that it’s easy.

Most of the time, breastfeeding takes some practice and people often need some guidance. We want to acknowledge that fact, because too often people think there is something WRONG with them when things don’t go smoothly. That is very rarely true. You are not doing something wrong, you are not broken.

A lactation consultant should be able to help you understand what to expect, and the mechanics of good breastfeeding to help you get back on track with breastfeeding if that is your goal. A lactation consultant should also listen to your concerns and support you in whatever route you’d like to take with feeding your baby in a judgment-free way. We offer virtual breastfeeding education and lactation support in our clinics and by telehealth to help you along the way.

Also, don’t forget to join Bosom Buddies, our FREE virtual support group for new parents. Bosom Buddies is led by an IBCLC and is a great way to get some expert advice AND support from other families with new babies.

Resources

https://breastfeedingusa.org/content/article/baby-led-latch-how-awaken-your-babys-breastfeeding-instincts

https://www.magicalhour.org/aboutus.html

Widström AM, Lilja G, Aaltomaa-Michalias P, Dahllöf A, Lintula M, Nissen E. Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatr. 2011 Jan;100(1):79-85. doi: 10.1111/j.1651-2227.2010.01983.x. Epub 2010 Sep 14. PMID: 20712833.

Widström AM, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019 Jul;108(7):1192-1204. doi: 10.1111/apa.14754. Epub 2019 Mar 13. PMID: 30762247; PMCID: PMC6949952.