A Good Start to Breastfeeding

Philippa
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By Philippa Pearson-Glaze IBCLC
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For many mothers breastfeeding is easy—baby is born, attaches to the breast on his own, milk flows and baby grows. However it is not so straightforward for some mothers. Problems can include baby not wanting to breastfeed, low milk supply, painful breastfeeding and more. Most problems can be prevented or overcome with a little prior knowledge and some skilled support. This article discusses how to get a good start to breastfeeding and is a companion article to Breastfeeding Tips for Newborns.

#1 Find out what to expect

Find out as much about breastfeeding as you can before your baby arrives so you know what to expect. Knowing the answers to common questions can help avoid any problems. How do I position my baby to breastfeed? What if breastfeeding hurts? Do babies have one breast or two per feed? How often do babies breastfeed? How do I know if my baby has had enough milk? Do I need a breast pump or any other equipment? Why did I have difficulties breastfeeding my first baby? For answers to these questions and more:

#2 Birth matters

Birth practices can promote or undermine breastfeeding 12. Where possible, having an unmedicated, active birth can help to get a good start to breastfeeding because:

  • Pain killing drugs and epidural drugs can and do find their way to the baby to make him drowsy and less interested in breastfeeding, sometimes for several days.
  • Instrumental deliveries such as forceps or ventouse can leave a baby feeling bruised and uncomfortable.
  • Having intravenous (IV) fluids (a drip) can also interfere with latching (the way baby attaches to the breast) if extra fluids enter your breast tissue (see Engorged Breasts).
  • Some birth practices can delay milk coming in see No Breast Milk After Delivery.

If a baby is sleepy, stressed or in pain they may not be able to tap into their natural instincts to breastfeed—they may not want to breastfeed at all at first. Not breastfeeding as soon as possible (in the first hour after birth is ideal!) could delay getting breastfeeding established and could interfere with your milk supply later (see #3 and #6 below). For more information see Birth and Breastfeeding by LLLGB and When Baby Won’t Breastfeed.

#3 The power of skin-to-skin

Your baby wants and expects to be held close in skin-to-skin contact after birth. The first hour after birth is particularly important for your baby to rest undisturbed in skin-to-skin contact and have their first breastfeed3. When your baby is in the right place next to his food source (the breast), a baby can use his senses of touch, smell, sight and taste to find the nipple himself—just as other mammal babies find their mother’s teat on their own after birth. Skin-to-skin contact helps your baby latch, promotes the hormones needed for milk production, regulates your baby’s heartbeat, temperature and breathing and makes him feel safe. Skin-to-skin contact includes letting a baby use their hands—take off any scratch mittens and see Why Skin-to-Skin? for more benefits of skin-to-skin contact.

Breastfeed in the first hour after birth

Jane Morton of Stanford University explains the benefits of breastfeeding in the first hour after birth (sometimes called the golden hour) in Successful Breastfeeding Begins Right at Birth. Benefits include:

  • Strong feeding instincts. All baby mammals’ instincts and feeding reflexes are primed to help them find their mother’s teat straight after birth
  • Birth hormones (e.g. oxytocin) help to push milk forward and make breastfeeding or hand expression easiest during the first hour 4
  • Sends a strong signal to the milk factory to start milk production.
Close up of baby breastfeeding
Babies have a strong instinct to latch for many months

#4 Comfortable breastfeeding—position and latch

The way a baby attaches to the breast is often called their attachment or latch. The way a baby is held to the breast (their positioning) also affects how they can latch on. Getting a comfortable latch where baby has a big mouthful of breast tissue as well as the nipple is important so they can get plenty of breast milk when they suckle. The more breast milk your baby takes away from the breast at each feed the more milk will be made to replace it. See “How to Breastfeed” in Breastfeeding Tips for Newborns for more information on getting started or see Breastfeeding Positions for Newborns, Latching Tips and Breastfeeding Videos.

#5 Frequent feeds

Babies have small tummies and breast milk is digested quickly. Newborns therefore need to feed very often day and night, at least 8-12 times per 24 hours can be expected. How often milk is removed from the breasts is important both for a baby’s next feed and for your milk volume later because:

  • Milk is made on demand, the more milk that is taken by a baby (or pump) the more will be made to replace it
  • Frequent breastfeeds in the early weeks helps calibrate milk production later as baby grows

See How Often Should a Newborn Feed? and Breastfeeding Tips for Newborns for more reading.

#6 If baby won’t breastfeed

Be prepared that if your baby doesn’t latch straight away it isn’t because he doesn’t like breastfeeding, it’s because he can’t… yet. Plenty of skin-to-skin contact (#3) and good breastfeeding support (#10) can help with this. If your baby isn’t latching:

Hand express

Start hand expressing your colostrum (the first breast milk) straight away after the birth. The sooner you can start this the better for your milk supply. Starting in the first hour after birth is ideal and is discussed in Stanford University’s video Successful Breastfeeding Begins at Birth. Your midwife can also help you if needed and see Hand Expressing Breast Milk. Colostrum can be collected in a small spoon or syringe (it will just be small volumes at first) and fed to your baby. Hand expressing as often as your baby would be breastfeeding—at least every two hours—will stimulate your milk supply and keep your baby well fed.

Pump

Once the volume you can express increases as your milk comes in, you can use a breast pump. Using an electric pump every couple of hours during the day and every four hours at night will protect your milk supply until your baby can latch.

Frequent feeds—keep your baby well fed

Feed your baby all your expressed breast milk by syringe, cup, small spoon or bottle until baby is ready to latch. Avoid letting your baby sleep for long periods—feed your baby at least every two hours at first. A baby might be having 30ml breast milk per feed by day three, 30‑60ml per feed by day four, 60‑90ml per feed in the second and third weeks of life and 90‑150ml per feed in months one to six567. Your health professional or IBCLC lactation consultant may recommend specific volumes of milk for your baby based on their weight.

Provide opportunities to latch

Hold your baby in skin-to-skin contact as much as possible to give them an opportunity to latch using their natural reflexes. There can be lots of reasons why a baby doesn’t latch straight away; lactation consultant Diane Wiessinger gives examples in My Baby Just Doesn’t Get It. For one to one help contact a breastfeeding specialist to help you and see When Baby Won’t Breastfeed and How to Get Baby Back to Breast.

Don’t panic if you can’t get your baby to latch on. Babies have a strong instinct to latch for many months, there is plenty of time yet to work on attachment with your breastfeeding specialist. Do pump though! It is very important to protect your milk supply if your baby can’t latch by removing any breast milk from the breasts. By frequently removing colostrum (the first milk) and breast milk by hand expression and pumping, your milk supply will be protected and you will have a supplement to keep your baby well fed.

baby held in skin to skin contact
Skin-to-skin contact helps your baby latch

#7 Avoid artificial teats

A baby needs to use a different sucking technique at the breast to that used with an artificial teat. Some babies can get confused between the two techniques (nipple confusion) or begin to prefer the bottle teat over the breast (nipple preference). Avoiding dummies and bottle teats can help to get a good start to breastfeeding by avoiding nipple preference or confusion. Avoiding formula, unless it is medically indicated, will mean all your baby’s sucking is at the breast to stimulate your milk supply. If needed, alternative ways to give small volumes of milk to your baby include using a spoon, syringe or cup feeding. For larger volumes you could consider supplementing at the breast with a supplemental nursing system. If you do need to use a bottle, there are ways to make bottle-feeding more like breastfeeding to help avoid nipple confusion. For more reading see:

#8 Special situations

Certain situations may need individualised support to achieve a good start to breastfeeding. Perhaps your baby has been born earlier than expected, or you have inverted nipples, perhaps you have had breast reduction surgery, breast implants or have a medical condition that could affect milk supply. Perhaps you found breastfeeding a previous baby didn’t work out and wonder if it will happen again. If you have any concerns it’s a good idea to chat with a breastfeeding specialist before your baby is born, or as early as possible afterwards, so that you know exactly how to get breastfeeding off to the best start for your situation. Some parents may be interested to find out more about expressing colostrum antenatally which can be helpful in several situations.

#9 Know when help is needed

Getting help at the earliest sign of breastfeeding difficulty from a breastfeeding specialist is important. The longer problems are left, the more difficult they can be to put right. Painful nipples, lack of poop, jaundice, poor weight gain and prolonged engorgement are all potential red flags that breastfeeding is not going as well as it could be.

Pain

Does breastfeeding hurt? Painful, sore nipples are a sign that something is wrong. Breastfeeding should not hurt, even in the first few days. Breastfed babies feed very often8 as their tummies are small and breast milk is quickly digested. They might feed every couple of hours or more often. With such frequent feeds, a mother could quickly become sore and have cracked or damaged nipples if the latch is painful. Not only this, if a baby is latched to the nipples without a big mouthful of breast, it will be harder for them to get enough milk. For more reading see Why Does Breastfeeding Hurt? and Causes of Sore Nipples.

Dirty nappies

Is baby having plenty of dirty nappies? A lack of dirty nappies in the first few weeks could be a sign that baby isn’t getting enough breast milk. When a baby is getting enough milk in the first week, there will usually be a clear sequence of colour changes of their poo. The colour of poop will gradually change from black to mustard in the first five days and will increase in volume. After the first five days, at least three to four dirty nappies with yellow or mustard poop every day are a good sign that feeding is going well. The number of wet nappies will also increase. See Breastfed Baby Poop for further information.

Jaundice

Is your baby jaundiced? Increasing yellowing of the skin (jaundice) may be an indicator of poor transfer of breast milk in the early days after birth. A certain amount of jaundice is normal, and is caused by a breakdown of excess red blood cells which makes yellow bilirubin that leaves the body through baby’s poop. If your baby isn’t feeding well and consequently isn’t doing plenty of poops to excrete the bilirubin, jaundice will take longer to clear. Check with your heath professionals and see Jaundice in Breastfeeding Babies for further information.

Poor weight gain

Is your baby gaining weight? After the initial weight loss in the first few days of life, your breastfed baby will start to gain 30-40g per day if breastfeeding is going well. See Is My Baby Getting Enough Milk? and Understanding Your Baby’s Weight Chart for more information about normal weight gain. If your baby is not gaining much or any weight, don’t wait, get good breastfeeding help as soon as possible to get back on track. There is no advantage to waiting around hoping weight gain might get better on its own. For more reading see:

Engorgement

Are your breasts very full and swollen? A little engorgement when your milk comes in on the second or third day is to be expected but if breastfeeding is going well this engorgement will normally resolve quite quickly. Prolonged or unexpected engorgement could reduce your milk supply, see Engorged Breasts for information on relieving engorgement.

#10 Know who to call

Just one piece of bad advice can sabotage a breastfeeding relationship so it is important to know who is helping you and whether you can trust what they say. The training your helper may have had and hence the quality of breastfeeding help they might give can vary a great deal. Your doctor, health visitor or midwife may have had very little training. They may not know the answers to basic breastfeeding management questions.

  • Breastfeeding peer supporters may have only had 12 hours of training in basic breastfeeding management. They may not have breastfed their own babies.
  • Breastfeeding counsellors with one of the breastfeeding charities such as La Leche League, Association of Breastfeeding Mothers or National Childbirth Trust will usually have had 12 months training and will have personal experience breastfeeding.
  • IBCLC lactation consultants have the highest skilled professional qualification in breastfeeding. They have demonstrated at least 1000 contact hours helping mothers with breastfeeding, at least 90 hours intensive lactation study and passed a rigorous international exam. They have to stay up-to-date by recertifying every five years and taking an exam every ten years. See Why Hire an IBCLC?

Summary

There are several ways to help breastfeeding get off to a good start. Knowing how breastfeeding works and what to expect, understanding the role of skin-to-skin, and avoiding the early use of artificial teats can all be helpful for successful breastfeeding. At the first sign of any problems, it is important to find the right skilled help to get breastfeeding back on track. Sore nipples, lack of poop, jaundice and poor weight gain are all potential red flags that breastfeeding may not be going as well as it could be. An IBCLC lactation consultant or breastfeeding specialist can help to get breastfeeding running smoothly.

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