Getting Started with Breastfeeding

Instead of attempting to present a complete treatise on the art and science of breastfeeding, this discussion is intentionally lacking in scope. If you chose to breastfeed, it is too important to entrust your preparation to a website or even a single book on the topic………..if you have even small problems, you need a local expert to help you, one-on-one. Getting started well may determine whether or not you are successful.

If you have never breastfed, it may be a good idea to attend a brief course on preparation for breastfeeding. Many hospitals, birthing centers, community centers, parenting groups, and childbirth educuators sponsor classes for first-time breastfeeding mothers. Whether or not you attend one of these courses, the classic LaLeche League book, The Womanly Art of Breastfeeding, is an excellent source of breastfeeding information for a new mother.

Your body has been preparing your breasts for lactation since shortly after conception. Progesterone from the ovaries and later the placenta (in addition to other hormones) has been stimulating the preparation of your milk glands. In fact, most women are able to express milk from the breasts from about the midpoint of pregnancy. This fluid may not resemble any cow’s milk you’ve ever seen but it’s human milk just the same. This early milk is often clear or slightly white-blue. After the baby is born, this first-milk which is called colostrum, will be packed full of antibodies which can passively immunize your baby against a host of germs. Within a few days after birth, the true milk will come in. Sometimes the milk comes in so suddenly that the breasts swell up to their capacity. This is called engorgement, and can be quite painful.

Human milk usually appears thinner than whole cow’s milk…..more like skim milk. But it has plenty of fat and protein for human babies. Taste some…’s remarkably sweet.

For years clinicians thought that the breasts needed “preparation” for breastfeeding. Women would rub their nipples with dry washclothes to “toughen” them for their little barracudas…….and some kids are like that……and a lot of first time breastfeeding moms are pretty surprised when a seven-pound lump nearly sucks their nipple off for the first time. However, most women come well equipped and prepared for breastfeeding simply by being female mammals. The best preparation for breastfeeding is knowledge about the basics, assessment of the equipment, and a roadmap for solving problems quickly in the first hours, days and weeks after birth.

Contrary to popular notion, breast size has nothing to do with milk production. If you are a female mammal, you can produce milk…..and almost always in sufficient quantity to nourish your baby. Nipples are much more a factor than breast size in successful breastfeeding. Nipples come in a large variety of sizes and shapes. And whether or not your nipples evert, invert or are flat may be a important factor in your babies ability to latch-on easily.

If your nipples are flat or inverted, and especially if they will not become erect/everted when stimulated, you may need some help. Your midwife or doctor can assess your nipples and prescribe breast cups to help shape your nipples for more easy breastfeeding. It is probably advisable for every new breastfeeding mother to consult a lactation specialist before you give birth…..but, especially, those with flat or inverted nipples. Many midwives and Ob nurses are lactation experts, but not all. And very few physicians are. If your clinician does not have particular expertise in the field of breastfeeding, please ask for a referral to an experienced lactation counselor.

Fortunately and unfortunately, the science and study of breastfeeding and lactation is still more art than science. Dogma is dispensed as frequently as good scientific advice, and art is sometimes a poor substitute for evidence-based knowledge. On the other hand, when a breastfeeding mother is on the verge of switching to the bottle, whatever works is what works. Hopefully you will find a lactation specialist whom you like…… their help and advice needs to come in the form of friendly, gentle, encouraging support. If you don’t know where to find such a person, contact your local LaLeche League chapter.

Breastfeeding is not always easy. For some, it most definitely is. For those women, it can be much like those nature shows in which the baby mammal is born and nuzzles its way to a nipple and latches on instinctively. For others, breastfeeding can be a week of trial and tribulation culminating in a retreat to cow’s milk in a bottle……that doesn’t do much for boosting the confidence of a new mother recovering from labor and birth. For most, the initial ease or difficulty is somewhere in between. Mothers have breasts and babies are born with a reflex to suck…..however, the addition of the two does not equal successful breastfeeding. Learning how to get your baby to latch on to your nipple can take a bit of practice.

Some babies and mothers will experience problems which may preclude them from early breastfeeding. If you or your baby is having any significant problem preventing early latch-on and feeding, ask for assistance and do so as soon as possible if there will be any delay in initial breastfeeding. If your baby is able to feed, ask that the baby not be given a bottle or pacifier, and to feed the baby with your breastmilk only by whatever means necessary. These situations may require special attention, special accomodations, and special equipment. Most hospitals accomodate these situations well, but some do not. Insist on any reasonable efforts to assure that your baby gets your milk…..early and often. If barriers are placed in the way of this goal, find an advocate who can help you. If you have established a relationship with a lactation specialist, contact them.

Your baby is born with two reflexes common to all mammals…..sucking and rooting. Rooting is the instinctual search for a nipple on which to suckle. Your baby’s rooting reflex is exhibited by rolling/swaying head movements performed with an open mouth. If one strokes a baby’s cheek lightly, the baby will turn it his/her head to that side. Instinctively, the mouth opens. With mouth open wide, the nipple and most of the brown area around the nipple (the areola) can be placed in the baby’s mouth by lifting the baby’s head and placing the open mouth to the breast. The action is baby-to-breast; rather than breast-to-baby.

Feed your baby whenever they show any signs of hunger. Look for the rooting reflex, but don’t wait until your baby is crying. Generally, the breastfed baby should feed about 8-12 times in a 24-hour period, for about 10-15 minutes on each breast. One cannot overfeed a breastfeeding baby. The plumpness exhibited by almost all properly nourished, 3-12 month-old babies is NOT obesity.

Your first several attempts to breastfeed should be evaluated by an experienced clinician. If you are a new mother or a first-time breastfeeder you should keep a brief, descriptive log of your breastfeeding efforts for the first 3 days. In the event that you experience problems, this log will be quite valuable to your or your baby’s clinician. Include the following in your log:

  • time of day you begin feeding the baby
  • time on each breast
  • position of baby on each breast during that feeding (football hold, cradle
    hold, or lying down)
  • number of wet and soiled diapers

Your baby needs only breastmilk for the first 12 months of life. However, your nutritional needs are as important now as they were when you were pregnant. You will need more calories. And although the protein and fat content of breastmilk is relatively constant, the levels of vitamins varies with your intake of those vitamins. A multivitamin supplement is recommended. If the water in your community does not contain sufficient fluoride, both breastfed and bottlefed babies should start a fluoride supplement, but not until the baby is 6 month’s old (call your health department if you are unsure about your community’s water). Your calcium requirement is the same as it was during pregnancy (see Calcium).

You and your breastfed baby should be seen 2-4 days after birth to assure that you are both adjusting to your new life. All newborns should be seen by their pediatric health clinician at 1 week of age and again at 1 month.