Breastfeeding

The physical closeness, skin-to-skin touching, and eye contact all help your baby bond with you and feel secure.

Breastfeeding burns extra calories, so it can help you lose pregnancy weight faster. It releases the hormone oxytocin, which helps your uterus return to its pre-pregnancy size and may reduce uterine bleeding after birth. There are continued benefits from breastfeeding beyond 1 year, and up to 2 years, especially in the parent. Breastfeeding also lowers your risk of breast and ovarian cancer. It may lower your risk of osteoporosis, too.

As you don't have to buy and measure formula, sterilize nipples, or warm bottles, it saves you time and money. It also gives you regular time to relax quietly with your newborn as you bond.

Signs Your Baby Is Hungry

One of the most common ways your baby will let you know they're hungry is to cry. Other signs that indicate your baby is ready to be fed include:

• Licking their lips or sticking out their tongue
• Rooting, which is moving their jaw, mouth, or head to look for your breast
• Putting their hand in their mouth
• Opening their mouth
• Fussiness
• Sucking on things

How do I start breastfeeding?

You can begin nursing your baby within an hour of birth. Hold your breast in your hand and -- with your baby's head slightly tipped back and their mouth open wide -- squeeze your nipple and guide your baby to your breast. If your baby is properly latched, you'll feel a tug when they begin nursing.

If you're nonbinary or were assigned male at birth (AMAB), you may need to take additional steps to begin lactating, which may include taking a hormone suppressor such as spironolactone to lower testosterone levels. Talk with your health care provider on how to prepare for nursing your baby.

Things to consider before breastfeeding

It may take time to establish a nursing routine with your baby. Some parents struggle to achieve a good latch with their newborn. Latch quality can affect things such as pain levels, milk supply, and even how long you breastfeed. Not getting a proper latch can lead to discomfort and sometimes force new parents to stop breastfeeding before they’re ready. Even if your baby isn’t properly latching at first, you can develop a good latch with time and practice.

Additionally, there are certain foods you should avoid while breastfeeding, which include:

• Alcohol. If you drink, you'll need to wait to nurse until the alcohol levels have cleared from your breast milk. Typically, this takes 2-3 hours per drink that you've had. If you're planning to have a few drinks, it might be a good idea to store some milk beforehand.
• Caffeine. Try not to drink more than two cups of caffeinated beverages a day while breastfeeding. The excess caffeine in your breast milk could disrupt your baby's sleep schedule.
• Fish. Seafoods such as swordfish and king mackerel contain high amounts of mercury that could be transferred to your baby through your milk.

What should I expect when I start breastfeeding?

At first, your breasts will make a thick, yellowish substance called colostrum that is packed with important nutrients that your baby's immune system needs early on. After about 3 days, your milk will start to come in, though this may take longer for first-time parents. You may notice your breasts becoming firmer as this happens, and they might leak sometimes. If your breasts become too full with milk, you may experience some discomfort. Your nipples can become sore or cracked early on.

As you and your baby figure out your routine for nursing, breastfeeding shouldn't be painful. But don't hesitate to reach out to your health care provider if you are struggling to get a good latch or having a lot of pain. They can help you figure out the issue or connect you with a lactation consultant, a specialist in breastfeeding education.

Will You Make Enough Milk to Breastfeed?

The first few days after birth, your breasts make an ideal “first milk” called colostrum. There’s not a lot of it, but there's plenty to meet your baby's nutritional needs. Colostrum helps a newborn's digestive tract develop and prepare itself to digest breast milk.

Colostrum is the first phase of breast milk, which changes over time to give your baby the nutrition they need as they grow. The second phase is called transitional milk. You make this as your colostrum is gradually replaced with the third phase of breast milk, called mature milk.

You’ll start to make transitional milk a few days after giving birth. By 10-15 days after birth, you’ll make mature milk, which gives your baby all the nutrition they need.

Most babies lose a small amount of weight in the first 3-5 days after birth. This is unrelated to breastfeeding.

Even if you breastfeed less than the recommended 6 months, it's better to breastfeed for a short time than no time at all. You can add solid food at 6 months but also continue to breastfeed if you want to keep producing milk.

What to Do If Your Breast Milk Supply Is Low

Before taking steps to try to increase your breast milk supply, talk with your doctor. Low milk supply can be difficult to self-diagnose, and your doctor can let you know if you should take steps to increase it. Some common approaches include:

• Relaxation techniques. Massage and meditation can help, and so can skin-to-skin contact and warm compresses.
• Drinking more water. Nursing parents need to increase their water intake, both due to their child’s fluid consumption and increased caloric intake.
• Changing your contraception. Top contraceptive options for maintaining breast milk production include nonhormonal IUDs or barrier methods. 
• Feeding and pumping often. With new babies, feed very frequently, as many as 8-12 times a day for the first few weeks. If you miss a session, pump to ensure your production keeps up.
• Getting support. Reduce your stress and ease other factors impacting milk production. This may mean obtaining extra help around the house from family members or therapy for parents struggling with postpartum depression.

What's the Best Position for Breastfeeding?

The best position for you is the one where you and your baby are both comfortable and relaxed, and you don't have to strain to hold the position or keep nursing. Here are some common positions for breastfeeding your baby:

• Cradle position. Rest the side of your baby's head in the crook of your elbow with their whole body facing you. Position your baby's belly against your body so they feel fully supported. Your other “free” arm can wrap around to support your baby's head and neck or reach through your baby's legs to support the lower back. This position can be convenient for older infants but is often hard for newborns, as it offers limited support. Still, it might be worth trying if you haven’t had much success with other positions.
• Football position.If you’re recovering from a C-section, this position will help you find an ideal latch while avoiding pressure on your belly. It also works well for twins and premature babies. Line your baby's back along your forearm to hold your baby like a football, supporting their head and neck in your palm.
• Side-lying position. This position is great for night feedings in bed. Side-lying also works well if you're recovering from an episiotomy, an incision to widen the vaginal opening during delivery. Use pillows under your head to get comfortable. Then, snuggle close to your baby and use your free hand to lift your breast and nipple into your baby's mouth. Once your baby is correctly “latched on,” support the head and neck with your free hand so there's no twisting or straining to keep nursing. The side-lying position is often recommended if you're dealing with fast milk flow. Like the football position, this method may also promote greater comfort after a C-section.
• Cross-cradle hold. A go-to for many new parents, this approach works best in a glider or comfortable chair. Sit straight in a chair that has armrests. Hold your baby in the crook of your arm that's opposite the breast you will use to feed them. Support their head with your hand. Bring your baby across your body so your tummies face each other. Use your other hand to cup your breast in a U-shaped hold. Bring your baby's mouth to your breast and cradle them close, and don't lean forward.
• Laid-back position. Try this position if you have an oversupply or milk that comes quickly, as it will limit the flow of the milk and, in turn, reduce the chances of your baby pulling off or becoming fussy. It's meant to tap into the natural breastfeeding instincts you and your baby have. Lean back, but not flat, on a couch or bed. Have good support for your head and shoulders. Hold your baby so that your entire fronts touch. Let your baby take any position they're comfortable in as long as their cheek rests near your breast. Help your baby latch on if they need it.

How to Get a Good Breastfeeding Latch

A variety of factors can affect latch quality, including positioning and timing. Some things, such as nipple shape, may be beyond your control. However, some strategies can help promote a better latch.

Choose the right position. Breastfeeding positions affect the quality of the latch, but what works for some parents and babies might not be ideal for others. If latching is a struggle in one position, try a few others until you find a comfortable option.

Position your baby facing you so that your baby is comfortable and doesn't have to twist their neck to feed. With one hand, cup your breast and gently stroke your baby's lower lip with your nipple. Your baby's instinctive reflex will be to open the mouth wide. With your hand supporting your baby's neck, bring the mouth closer around your nipple, trying to center your nipple in the mouth above the tongue. Additional tips include:

• Try a nipple shield. If you have flat or inverted nipples, it might be hard to secure a proper latch. A nipple shield may help by giving a clearer shape. It could also make breastfeeding more comfortable if you’re dealing with cracked nipples or other sources of pain.

• Wait until your baby’s mouth is open wide. You may have a shallow latch if your baby’s mouth doesn’t open wide enough. It needs to cover both the nipple and a large part of breast tissue. Encourage this by gently placing your nipple against your baby’s lips.

• Don’t be afraid to gently unlatch and try again if you struggle to get the timing right at first. You can do this by putting a finger into your baby’s mouth and softly breaking the suction.

• Check for tongue-ties. Also known as ankyloglossia, tongue-tie is a condition that happens when the cord that attaches the tongue and the bottom of the mouth is unusually tight. It happens in up to 11% of newborns and can limit tongue mobility, leading to a form of breastfeeding compression, which can be painful for new parents and make it hard for a baby to gain weight in the crucial first few days. A procedure called a tongue-tie revision can correct the problem.

You'll know your baby is “latched on” correctly when both lips are pursed outward around your nipple. Your infant should have your entire nipple and most of the areola, which is the darker skin around your nipple, in their mouth. While you may feel a slight tingling or tugging, nursing shouldn't be painful. If your baby isn't latched on correctly and nursing with a smooth, comfortable rhythm, gently nudge your pinky between your baby's gums to break the suction, remove your nipple, and try again. Good “latching on” helps prevent sore nipples.

Pumping and Hand Expressing

There are many situations in which you may need to express that breast milk yourself instead of letting your baby nurse. These situations may arise when:

• Your baby is too premature to breastfeed
• Your baby is in the neonatal intensive care unit (NICU) and you're unable to stay with them
• Your baby is ill
• Your baby is teething
• Your baby has latching difficulties
• Your baby has a condition such as a tongue tie or cleft palate
• You're away from your baby for a long period (like going back to work)
• You’ve consumed a high amount of alcohol or recreational drugs or taken a medication that's not safe for your baby

Going too long without emptying your milk can lead to engorgement, or overly full breasts. A painful condition on its own, engorgement can also lead to complications such as clogged milk ducts or mastitis, in which the milk ducts become inflamed or infected. Hand expressing or pumping can help you empty your milk.

To prepare for hand expressing milk:

• Wash your hands to avoid contaminating your milk.
• Find a clean container to collect the milk. If you’re expressing colostrum, the thick, nutritious milk released immediately after birth, you may only need a teaspoon. 
• Relax and get comfortable. If you’re tense, it will be more difficult to produce milk.
• To encourage letdown, it may help to have your baby nearby. If that’s not an option, try looking at photos of your baby or keeping a piece of clothing near you that smells like your baby.
• Gently massage your breasts to encourage letdown.

When you're ready, hold your breast with your hand in a C-shape. Your thumb should be on the underside of your breast, and your fingers along the top. Your fingers and thumb should rest near, but not on, the areola. Supporting your breast with your hand, apply pressure to the milk ducts by pushing toward your chest. Compress your breast between your fingers and your thumb to encourage the milk toward the nipple. Repeat the pressure and compression rhythmically until milk flow stops. Rotate your hand and repeat the movement until milk flow stops again.

Breastfeeding Tips

Some things can help you prepare for breastfeeding: 

• Get regular prenatal care to help you avoid preterm birth.
• Tell your doctor you plan to breastfeed and ask what support the facility you plan to deliver in offers to help you breastfeed after birth.
• Take a breastfeeding class.
• Ask your doctor to connect you with a lactation consultant, who can teach you breastfeeding basics and help you if have issues.
• Talk to your doctor about any health conditions you have or medications you take that could interfere with breastfeeding.
• Tell your doctor and hospital health care providers that you want to breastfeed as soon as possible after delivery.
• Talk to friends who breastfeed or join a support group for breastfeeding.
• Stock up on the supplies you need for breastfeeding, such as nursing bras and other items.

The following tips, known as the ABCs of breastfeeding, will help you and your baby get comfortable with the process:

1. Awareness. Watch for your baby's signs of hunger, and breastfeed whenever your baby is hungry. This is called “on-demand” feeding. In the first few weeks, you may be nursing 8-12 times every 24 hours. Hungry infants move their hands toward their mouths, make sucking noises or mouth movements, or move toward your breast. Don't wait for your baby to cry. That's a sign they are too hungry.
2. Be patient. Breastfeed as long as your baby wants to nurse each time. Don't hurry your infant through feedings. Infants typically breastfeed for 10-20 minutes on each breast.
3. Comfort. This is key. Relax while breastfeeding, and your milk is more likely to “let down” and flow. Get yourself comfortable with pillows as needed to support your arms, head, and neck, and a footrest to support your feet and legs before you begin to breastfeed.

Are There Medical Considerations With Breastfeeding?

In a few situations, nursing could cause a baby harm. You should not breastfeed if:

• You are HIV-positive. You can pass the HIV to your infant through breast milk.
• You have active, untreated tuberculosis.
• You're receiving chemotherapy for cancer.
• You're using an illegal drug, such as cocaine or marijuana.
• Your baby has a rare condition called galactosemia and cannot tolerate the natural sugar, called galactose, in breast milk.
• You're taking certain prescription medications, such as some drugs for migraine headaches, Parkinson's disease, or arthritis.

Talk with your doctor before starting to breastfeed if you're taking prescription drugs of any kind. Your doctor can help you make an informed decision based on your particular medication.

Having a cold or flu should not prevent you from breastfeeding. Breast milk won't give your baby the illness and may even give antibodies to your baby to help fight off the illness.

Also, the AAP suggests that infants should be exclusively breastfed starting at 4 months of age, and infants who are partially breastfed and receive more than half of their daily feedings as human milk, should be supplemented with oral iron. This should continue until foods with iron, such as iron-fortified cereals, are introduced into the diet. The AAP recommends checking iron levels in all children at age 1.

Discuss supplementation of both iron and vitamin D with your pediatrician. Your doctor can guide you on recommendations about the proper amounts for both you and your baby, when to start, and how often the supplements should be taken.

Common Breastfeeding Challenges

There are some common concerns or challenges that you could face when breastfeeding. They include:

• Sore nipples. You can expect some soreness in the first weeks of breastfeeding. Make sure your baby latches on correctly, and use one finger to break the suction of your baby's mouth after each feeding. That will help prevent sore nipples. If you still get sore, be sure you nurse with each breast fully enough to empty the milk ducts. If you don't, your breasts can become engorged, swollen, and painful. Holding ice or a bag of frozen peas against sore nipples can temporarily ease discomfort. Keeping your nipples dry and letting them “air dry” between feedings helps, too. Your baby tends to suck more actively at the start. So begin feedings with the less-sore nipple.
• Dry, cracked nipples. Avoid soaps, perfumed creams, or lotions with alcohol in them, which can make nipples even more dry and cracked. You can gently apply pure lanolin to your nipples after a feeding, but be sure you gently wash the lanolin off before breastfeeding again. Changing your bra pads often will help your nipples stay dry. If possible, only use cotton bra pads.
• Worries about producing enough milk. A general rule of thumb is that a baby who's wetting six to eight diapers a day is most likely getting enough milk. Never give your infant plain water. Your body needs the frequent, regular demand of your baby's nursing to keep producing milk. Some women mistakenly think they can't breastfeed or produce enough milk if they have small breasts. But small-breasted women can make milk just as well as large-breasted women. Good nutrition, plenty of rest, and staying well-hydrated all help, too.
• Pumping and storing milk. You can get breast milk by hand or pump it with a breast pump. It may take a few days or weeks for your baby to get used to breast milk in a bottle, so begin practicing early if you're going back to work. Breast milk can be safely used within 2 days if it's stored in a refrigerator. You can freeze breast milk for up to 6 months. Don't warm up or thaw frozen breast milk in a microwave. That will destroy some of its immune-boosting qualities, and it can cause fatty portions of the breast milk to become super hot. Thaw breast milk in the refrigerator or a bowl of warm water instead.
• Inverted nipples. An inverted nipple doesn't poke forward when you pinch the areola, which is the dark skin around the nipple. A lactation consultant can give you tips that allow women with inverted nipples to breastfeed successfully.
• Breast engorgement. Breast fullness is natural and healthy. It happens as your breasts become full of milk, staying soft and pliable. But breast engorgement means the blood vessels in your breast have become congested. This traps fluid in your breasts and makes them feel hard, painful, and swollen. Alternate heat and cold, for instance, use ice packs and hot showers, to relieve mild symptoms. It can also help to release your milk by hand or use a breast pump.
• Blocked ducts. A single sore spot on your breast, which may be red and hot, can signal a plugged milk duct. This can often be relieved by warm compresses and gentle massage over the area to release the blockage. More frequent nursing can also help.
• Breast infection (mastitis). This occasionally happens when bacteria enter the breast, often through a cracked nipple after breastfeeding. If you have a sore area on your breast along with flu-like symptoms, fever, and fatigue, call your doctor. Antibiotics are usually needed to clear up a breast infection, but you can most likely continue to breastfeed while you have the infection and take antibiotics. To relieve breast tenderness, apply moist heat to the sore area four times a day for 15-20 minutes each time.
• Stress. Being overly anxious or stressed can interfere with your let-down reflex. That's your body's natural release of milk into the milk ducts. It's triggered by hormones released when your baby nurses. It can also be triggered just by hearing your baby cry or thinking about your baby. Stay as relaxed and calm as possible before and during nursing. It can help your milk let down and flow more easily. That, in turn, can help calm and relax your infant.
• Premature babies may not be able to breastfeed right away. In some cases, parents can release breast milk and feed it through a bottle or feeding tube.
• Warning signs. Breastfeeding is a natural, healthy process. But call your doctor if:
  • Your breasts become unusually red, swollen, hard, or sore.
  • You have an unusual discharge or bleeding from your nipples.
  • You're concerned your baby isn't gaining weight or getting enough milk.

Where Can I Get Help With Breastfeeding?

Images of parents breastfeeding their babies make it look simple, but many people need some help and coaching. It can come from a nurse, doctor, family member, or friend, and it helps new parents get over possible bumps in the road.

Reach out to friends, family, and your doctor with any questions you may have. Most likely, others in your life have had those same questions.

When to Stop Breastfeeding

Deciding when to stop breastfeeding is a personal decision. The AAP recommends feeding your baby only breastmilk for the first 6 months. Once you begin to introduce solid foods, the AAP advises continuing to nurse for the next year and a half, if this is desirable for both you and your baby.

But some new parents may want to stop nursing earlier. You may choose to stop breastfeeding if you're returning to work, pregnant with another baby, or seeking more independence. Whatever your reason, deciding to stop breastfeeding is always your choice.

It can be easier to stop breastfeeding if your child initiates the weaning process. Some parents begin by transitioning their baby to bottle-feeding first. Once you begin to introduce other foods to your baby, they may naturally turn away from breastfeeding around their first birthday. If your baby is eating three solid meals a day, they're likely getting the nutritional content they need from solid foods alone.

Weaning can be an emotional process for both you and your baby. Take extra time to cuddle your baby to make sure you still have all the skin-to-skin contact you had while nursing.

Talk with your health care provider if you have questions about when you can stop nursing.