Breastfeeding

What is breastfeeding?

Breastfeeding is the process of feeding your baby milk that your body has made. Your baby attaches their mouth onto your breast and, through a suckling motion, drinks milk. Your baby will likely start breastfeeding soon after birth, often within the first few hours.

At first, your body will make an early form of milk called colostrum. This is a protein-rich, thick liquid. It’s full of antibodies that help guard your newborn against infections. Your colostrum will change into mature milk after about three to five days of breastfeeding. During this time, your baby will lose a bit of weight. This is normal. They’ll regain it once your milk “comes in.”

Breastfeeding has many benefits both for you and your baby. These include lowering your risk for postpartum depression and building your baby’s immune system.

If possible, exclusively breastfeed your baby for their first six months of life. Continue breastfeeding as you introduce solid foods. Because breastmilk has so many benefits, you can keep providing it until your baby’s second birthday or longer.

Keep in mind that there are many ways to feed your baby. You might nurse directly. You might pump milk to feed your baby with a bottle. You may breastfeed and supplement with formula. You may use only formula or donor breast milk. Your needs and your baby’s needs might change over time. What matters most is that your baby has the nutrients they need to grow and develop. Your healthcare provider can guide you on what’s best in your situation.

How does breastfeeding work?

Milk makes its way from your body to your baby through a series of steps:

• Your baby latches on to your breast.
• Your baby’s suckling stimulates nerves that tell your body to release certain hormones (prolactin and oxytocin).
• Prolactin tells your alveoli (tiny sacs in your breasts) to make milk.
• Oxytocin triggers the release of milk (let-down) into your milk ducts and out through your nipple.

You might hear your provider say that lactation works on a supply and demand basis. This means your body takes cues from your baby’s “demands” to know how much milk to produce. If your baby empties your breast, your body will replenish the supply. If your baby removes less milk because they’re starting solids, your body will adjust and make less.

This is why pumping while you’re away from your baby can help you keep up your supply. When milk is removed, your body knows to make more. This is also why you shouldn’t pump to “empty your breasts” to get rid of engorgement if you have an issue with overproduction. Draining your breasts only tells your body to make more milk.

How do I start breastfeeding?

A healthcare provider will help you get started soon after delivery. If you and your baby are healthy, you’ll hold your baby against your skin for at least two hours. This is called skin-to-skin contact. This close contact encourages your baby to bond and breastfeed.

Your baby will eventually start moving toward your breast. This is an instinct, and it’s a special one for you to witness! Your provider can help make sure your baby latches on and begins taking in milk.

For every breastfeeding session after, you’ll:

1. Find a breastfeeding position that’s comfortable for you and your baby, bringing your baby close to you.
2. Guide your baby’s mouth to your nipple. The nipple should be pointing toward their nose. Your baby’s chin should be resting against the bottom part of your breast.
3. Help your baby latch on. Their mouth should be wide open and cover most of the bottom part of your areola. Some of your areola should be visible above their upper lip.
4. Let your baby suckle to remove milk from your breast. They’ll settle into a rhythm of suckling and short pauses. You should be able to hear your baby swallow as they take in milk. Let your baby feed from this breast until they stop suckling and swallowing or until they let go.
5. Burp your baby for several minutes.
6. Offer your other breast to your baby. If your baby’s had enough to fill their tummy, they may turn away, and that’s OK.

The next time you feed your baby, start with the breast that wasn’t emptied as much. It’ll likely feel fuller because it contains more milk.

Your baby might be hungry if they:

• Act alert
• Turn their head to look at your breast or move toward it
• Suck on their hands, smack their lips or stick out their tongue
• Move their hands toward their mouth in fists or suck on their fingers (but past the newborn stage, this might just be a sign of curiosity and not hunger)

Your baby is likely full if they:

• Break their latch
• Seem relaxed
• Open up their fists
• Turn away from your breast (but past the newborn stage, this might just mean they’re distracted)

What foods, drinks or substances should I avoid while breastfeeding?

Just like during pregnancy, you should pay attention to what you eat and drink when you’re breastfeeding. There aren’t as many restrictions when you’re breastfeeding compared to pregnancy. But there are some things to limit or avoid:

• Limit caffeine. It’s OK to still have some caffeine, but no more than 300 milligrams (mg) per day. That’s about two 12-ounce mugs of coffee. Don’t forget to count tea (about 37 mg of caffeine per 12-ounce mug), sodas (23 to 83 mg per can) and chocolates.
• Limit alcohol. There aren’t any known risks to drinking up to one standard drink per day when you’re breastfeeding. But you should drink it at least two hours before nursing. This lets the alcohol clear from your system.
• Avoid fish with high mercury levels. Mercury from the fish you eat passes into your breastmilk. It can harm your baby’s brain and nervous system. Don’t eat any fish that’s high in mercury, including king mackerel, marlin, orange roughy, shark and swordfish.
• Avoid nicotine. Smoking or vaping reduces the nutritional value of your breastmilk and lowers your supply. Secondhand smoke raises your baby’s risk for allergies, upper respiratory infections and sudden infant death syndrome.
• Avoid marijuana. Experts don’t know how marijuana exposure might affect your baby. It may cause harm. So, it’s a good idea to avoid using any marijuana or being exposed to secondhand smoke.
• Avoid nonprescribed substances. Substances like opioids, benzodiazepines, stimulants, cocaine and phencyclidine (PCP or “angel dust”) can harm your baby. If you’re living with a substance use disorder, your provider can offer treatment to help.
• Avoid certain medicines. Most common medicines are safe to take while breastfeeding. But some may harm your baby or reduce your milk supply. It’s always a good idea to ask your provider or pharmacist before taking any medicine or supplements.

Can I use birth control while I’m breastfeeding?

Yes, but you should talk with your healthcare provider about the best type for you and when to start it. In general, it’s safe to use:

• Barrier methods (like a condom or vaginal diaphragm)
• IUDs (these can often be implanted right after you deliver your baby)
• Progestin-only hormonal methods (like the “mini-pill”)

Hormonal birth control methods that contain estrogen (like certain pills, patches and vaginal rings) may lower your milk supply. So, your provider may suggest you avoid them or wait at least one month after giving birth (and take the lowest possible dose).

Remember that you can still get pregnant while breastfeeding — even if you haven’t gotten a period yet.

Are there any reasons I shouldn’t breastfeed?

Healthcare providers recommend breastfeeding in most situations. But you shouldn’t breastfeed if:

• Your baby is diagnosed with galactosemia (a condition that makes it hard for their body to process a sugar found in breastmilk)
• You have certain infections that could spread through your breastmilk, like HIV (with certain criteria like a detectable viral load), HTLV-1, HTLV-2, brucellosis or Ebola virus disease
• You have herpes sores on your breast
• You have hepatitis C along with cracked or bleeding nipples

Some of these situations are temporary. Your provider will tell you if and when it’s safe to nurse. They’ll also explain other options for feeding your baby, like formula and donor breast milk.

What challenges might I face when breastfeeding?

If you run into challenges while breastfeeding — or have trouble getting started — you’re not alone. It’s common to face issues like:

• Breast engorgement
• Oversupply of milk (hyperlactation)
• Low supply of milk
• Clogged milk ducts
• Breast inflammation (mastitis)
• Nipple blebs
• Sore, cracked or painful nipples
• Pain or bleeding from your baby’s teeth/biting
• Latching difficulties, which may be more likely if your baby has tongue-tie or cleft lip/cleft palate
• Challenges due to your nipple anatomy (flat or inverted nipples)
• Challenges with expressing milk by hand or with a breast pump
• Difficulty weaning

The most important thing to know is that help is available. Often, these issues are solvable. Healthcare providers can help you manage any challenges so you can continue breastfeeding for as long as you’d like.

Who can help with breastfeeding?

When you’re trying to learn how to breastfeed or solve a problem, you might wonder where to turn for help. You can always contact your primary care provider or obstetrician to get started. Or you may choose to see a provider with special training in breastfeeding. Examples include:

• Breastfeeding medicine specialist. This is a board-certified physician with advanced training in breastfeeding support. They can diagnose and treat all possible lactation disorders, from nipple blebs to mastitis. They also offer education and support.
• International Board Certified Lactation Consultant (IBCLC®). A lactation consultant can offer clinical care. This includes taking your medical history, learning your child’s feeding history and creating a plan to help.
• Breastfeeding and Lactation Educator or Counselor. This provider offers basic education and counseling. This means they can teach you about breastfeeding and lactation and answer your questions. There are about 20 different roles within this group. These include Certified Breastfeeding Counselor (CBC) and Certified Lactation Educator (CLE).
• Breastfeeding Peer Supporter. This is someone who has experience breastfeeding and wants to use their experience to help you. They offer education and support from a peer’s perspective. Titles you may see include Breastfeeding Peer Counselor (BPC) and La Leche League Leader (LLLL).

Sometimes you don’t need an expert but instead just an extra set of hands. This is where your support network can step in and help. Don’t hesitate to ask your partner or a loved one to be there with you while you breastfeed. They can grab supplies, burp your baby or just keep you company (and awake) when you need a boost.

What are some common concerns about breastfeeding?

For many, there are concerns and worries about specific aspects of breastfeeding. It’s important to remember that all questions are worth asking when it comes to caring for your child. Don’t be afraid to share whatever’s on your mind with your healthcare provider. It’s best that you get the correct information before you make important decisions about breastfeeding.

Some common questions and answers include:

Are my breasts too small to breastfeed?

No. Breast size doesn’t affect your ability to breastfeed. The amount of milk your breasts make will depend on your overall health and how much your baby eats.

Will breastfeeding hurt?

Breastfeeding shouldn’t hurt. If it does, it might be because your baby isn’t latched onto your breast well. Your healthcare provider can help you learn how to hold your baby and get a good latch. If you still have pain, tell your provider so they can look for other causes.

Is breastfeeding hard to do?

Each person’s experience is unique. In general, breastfeeding is a learned skill and takes practice.

You might feel like you need four arms or hands to do it for the first couple of weeks. But learning to breastfeed is a bit like learning how to ride a bike. Reading the instructions can help you understand the basics, but you don’t truly learn how to do it until you’re “hands-on” and start practicing.

Many hospitals offer breastfeeding classes that you can attend during pregnancy. In most cases, nurses and lactation consultants are also available to give you information and support.

What if I need to be apart from my baby?

If you need to be away from your baby, you can pump or hand express your milk. Store the milk in the fridge or freezer. The person who’s staying with your baby can feed them from a bottle.

If you’re returning to work, talk to your employer about their policies for pumping breaks. In the U.S., the Fair Labor Standards Act provides you with the right to take breaks for pumping.

Pumping while you’re away from your baby serves two purposes. It allows you to store your milk to give to your baby later. It also helps you keep up your milk supply.