The evidence in support of breastfeeding is overwhelming. There are decades of documentation on the positive effects of breastfeeding on immunity, health, and the connection between mother and baby. Despite all of the evidence supporting breastfeeding, most parents supplement or switch to infant formula within the first year. Many factors contribute to a lack of encouragement for exclusive breastfeeding. Educating yourself and finding support are the two key things you can do to get breastfeeding off to a great start. This article covers the basics you should know about breastfeeding and the foundational principles to make breastfeeding easier.
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Article and Resources
I support the decisions you make for you and your baby regarding feeding, and I want to make sure that you have accurate information on breastfeeding and support to be successful. This article covers the basics you should know about breastfeeding and the foundational principles to make breastfeeding easier.
For all of the breastfeeding resources, episodes, and articles in one place, see this page.
The Importance of Breastfeeding
Breastfeeding is arguably the best thing you can do for a new baby. Your milk contains every vitamin, mineral, and nutritional element your baby needs. While infant formulas have improved over the years, none come close to mimicking all of breastmilk’s beneficial properties.
Your baby is born without natural immunity, and breastmilk helps build their immune system. Breastmilk contains living cells to inhibit the growth of bacteria and viruses. It has antimicrobial proteins and peptides, anti-inflammatory and antioxidative factors. Your milk will produce antibodies in response to germs your baby transfers to your breasts.
Breastfeeding has benefits to your baby’s health in both the short and long term. The microbiome in your milk shapes your baby’s intestinal microbiome. Babies who are breastfed are at a lower risk for ear infections, intestinal upsets, respiratory problems, and dental problems. There is also evidence that breastfed infants are less likely to be overweight and have a lower risk of type II diabetes. If that isn’t enough, breastfeeding is also associated with increased intelligence and higher IQ.
There are even benefits to you breastfeeding. If you are exclusively breastfeeding (including at least once at night), you most likely will not get your period for at least six months after your baby is born, although that can and will vary from one woman to the next. Exclusively breastfeeding can act as a form of birth control, but please talk to your care provider about this and the specifics before relying on it.
Breastfeeding even reduces your risk of breast and ovarian cancer. Breastfeeding produces prolactin and oxytocin, which are hormones that foster a connection to your baby and help you recover from birth better. Studies show that breastfeeding is associated with maternal responsiveness.
Rates of Exclusive Breastfeeding
Although there is a massive amount of evidence in support of breastfeeding, rates are still low. For 2018, the most recent year data is available from the US. 83.9% of babies were breastfed at least once. At six months, 56.7% of babies were still receiving breastmilk, and by 12 months, that dropped to 35%. Even so, many of these babies were supplemented with formula. The rates of exclusive breastfeeding are even lower. At three months, 46.3% of babies were exclusively breastfed. By six months, that number dropped to 25.8%.
With all of the evidence supporting breastfeeding, why are the majority of parents not doing it? Many factors contribute to a lack of support for exclusive breastfeeding. This is partly due to a lack of community resources and social support. For an interesting interview on breastfeeding issues in the real world, see this episode. While breastfeeding may come naturally to some mothers, for many, it is challenging. Hopefully, the information in this article will add some tools to your toolbox to make breastfeeding easier.
How Breastfeeding Changes Your Breasts
Your breasts go through a lot of changes during pregnancy and postpartum. Everyone is different, and you may not gain several cup sizes, but that seems to be most common across the whole population. One study showed that the average breast size increase didn’t change based on the initial size.
Your areolas will get larger and darker. Your nipples will also change by getting bigger, sticking out more, and may even change shape slightly. Like the changes to your areolas, your nipples will get smaller and go more back to what they were pre-pregnancy after pregnancy and cessation of breastfeeding. For more in-depth information on breast changes during pregnancy and postpartum, see this article.
If you are concerned about how your breasts will look after breastfeeding, this study on breastfeeding and breast aesthetics showed breastfeeding did not have a negative effect on aesthetics. Your breasts are designed to produce milk for your baby. While physical changes to your breasts may be unwelcome, have some compassion for the hard work your body is doing to support your baby.
How Long Should You Breastfeed?
There are common misconceptions about the length of time babies should be breastfed. These surround some milestones your baby will hit, like getting teeth at six months or talking and walking after about age one. Any length of time your baby receives breastmilk is beneficial. If you do stop breastfeeding before the first year, you will need to supplement with formula. Some mothers only breastfeed for a short time, and others continue it well into the toddler years.
Recommendations from the World Health Organization and Pediatric Associations
The World Health Organization recommends exclusive breastfeeding (with no other drinks or solid foods) for the first six months. Then adding in solid foods gradually after that point with continued breastfeeding for two years and beyond. The American Academy of Pediatrics recommends exclusive breastfeeding for about six months, with the continuation of breastfeeding for one year or longer as mutually desired by mother and infant. One or two years may sound like a long time. Any amount of time your baby is getting breastmilk will benefit them greatly.
Two Keys to Breastfeeding Success
You can do two key things to make sure you are successful with breastfeeding. Number one, educate yourself. Learn what the benefits of breastfeeding are, along with techniques and troubleshooting. The Womanly Art of Breastfeeding is a complete guide on everything you need to know from the moment your baby is born until the end of your breastfeeding relationship. I have personally read numerous times and a reference I went back to time and time again. As a disclaimer, this book is intense and thick, and it is highly biased to exclusive breastfeeding and not supplementing with formula.
The second thing you can do to ensure you get breastfeeding off to a good start and continues to go smoothly is to find support. Please get help as soon as there is any issue or even proactively check out a breastfeeding support group before encountering any issues. La Leche League is an excellent group for some free help and support. Hopefully, everyone in your life is supportive of your breastfeeding. While people have a lot of opinions on breastfeeding, few have education about it. By creating supportive people in your life, you can get the support and encouragement you need, even if it is not coming from everyone.
How Your Partner Can Help with Breastfeeding
If you are supplementing with formula, your partner can help feed your baby. If your baby is exclusively on breastmilk, you may feel like your partner can do nothing. That could not be further from the truth. There are many ways in which your partner can support breastfeeding.
Encouragement and support from you go a long way. Your partner can check in with you on how breastfeeding is going and encourage you to go to a support group, reach out to your doctor or midwife, or seek a lactation consultant. Your partner acknowledging the hard work you put in can give you a mental boost, especially when things get challenging.
When you are stuck sitting or lying down with one arm holding your baby, your partner can get you something to drink or something you can easily eat with one hand. Nursing a baby can be lonely, especially in the early days and weeks when it feels like you have a baby constantly attached to your breast. It can make a big difference to have your partner sit with you or watch a show. If you are out and about, your partner should support you in nursing your baby anywhere you are comfortable. That could be hanging out with you on a park bench or helping you find a secluded spot.
While you are taking care of all the breastfeeding, your partner can take care of diaper changes, do the dishes, make dinner, clean the house, or go grocery shopping. There are many chores required to keep a house running. If your partner is generally not the person in your relationship who tackles these tasks, ask them to step up and help out.
Breastfeeding and Skin to Skin Contact
The best way to get breastfeeding off to a great start is to be skin to skin with your baby. This means your little one is either naked or in a diaper, and you do not have a bra or shirt on. You can place a blanket over the baby if the temperature is cool or wear a buttoned shirt that you can open up. There are many benefits of skin-to-skin contact. The biggest is that it stabilizes your baby’s heart rate, breathing, and temperature and reduces stress in both you and your baby. Your baby instinctively wants to breastfeed, and being skin-to-skin with you will foster that. It also increases your interactions with your baby and increases the likelihood and length of breastfeeding.
During your pregnancy, your body starts producing colostrum. This first milk has immunological properties. Most importantly, colostrum contains high concentrations of secretory immunoglobulin A. This is an anti-infective agent that coats their intestines to protect against the passage of germs and foreign proteins that could create allergic sensitivities. Another ingredient is pancreatic secretory trypsin inhibitor which protects and repairs the infant’s intestine. Colostrum helps seal your baby’s intestines. It may not seem like very much, but at birth, your baby’s stomach is the size of a marble. Colostrum is nature’s perfect food until your milk comes in.
Transitional and Mature Milk
Around day 3 or 4, your milk will come in. You will know this happens when your breasts feel huge. If your breasts feel so full that they are uncomfortable and your baby doesn’t want to nurse at the moment, you can hand express a little milk out, so you aren’t so uncomfortable. Until about two weeks postpartum, your body will produce transitional milk. Maturation of your milk continues from two weeks until around 4-6 weeks. Your milk decreases in protein and antibodies in this transitional period and increases lactose, fat, and water-soluble vitamins. The composition of mature milk remains constant over time.
In the first few days after birth, when you breastfeed, your uterus will contract in response to the oxytocin released by your baby suckling, and you may also get a gush of blood each time. These pains will fade over the first week, and just keep in mind that this is a sign that your uterus and body are getting back to normal. Also, remember that oxytocin has positive effects on bonding with your baby. While these pains can be uncomfortable, they signify your body is doing what it is supposed to do.
How Milk Production Works
Milk production works on a supply and demand system. This principle is the cornerstone of breastfeeding. The amount of milk your body produces depends on how much you remove. The first two to three weeks are crucial for establishing your production. You will want to be on top of nursing for the first few weeks. Each breast calibrates individually, so you want to be sure to use both sides. You do not need to obsess over equally splitting the time between your left and right breasts but make sure you use both throughout the day.
Pro tip: If you are not removing milk, your body will not produce it. This can work to your advantage when you are trying to increase supply. On the flip side, this can create an issue if you ramp up production too much and develop an oversupply issue.
How Often to Breastfeed
In general, you will breastfeed your baby whenever they want to nurse. In the very beginning, if your little one sleeps a ton, you may need to wake them up every 3 hours to nurse. This is until your baby reaches their birth weight. Check in with your pediatrician or a lactation consultant for their recommendation on how often you should be nursing. Once you establish breastfeeding and better understand your baby’s cues, you can relax about how often you are breastfeeding.
Pro tip: There are many apps to help you track when you breastfeed, on which side, and for how long. These may be helpful initially, but it can be a big chore to log every feeding over time. As you and your baby get better at breastfeeding, you don’t need an app to know that your baby is eating well.
Measuring Your Baby’s Weight Gain
Babies will naturally lose weight after birth before they start gaining. Typically, your care provider doesn’t want to see your baby begin to lose more than 10% of their birth weight, and your baby should be back at their birth weight within two weeks.
There is evidence to support using your baby’s weight at 24 hours following birth as the baseline. The reasoning behind this is to account for additional fluids in your baby due to IV fluids you receive during birth. In the first 24 hours, your baby will get rid of extra fluids, which your doctor, midwife, or pediatrician may view as weight loss. In actuality, they may be shedding excess weight from IV fluids. IV fluids are likely in a hospital setting, especially if you have Pitocin or an epidural. Weight is important, but there are other signs that your baby is eating well.
Pro tip: Your pediatrician will weigh your baby at each appointment. Be sure you pay attention to other signs that your baby is getting enough milk.
Measuring Your Baby’s Consumption
One good way to know how much milk your baby is consuming is by their diapers. For the first 24 hours, you will probably only see meconium, the thick, tartar-like, black poop. In the second 24 hours, you should see two or more brown sticky poops. On days 3, 4, and 5, you should see three poopy diapers a day, starting green on day three and getting to yellow by day five. Around three yellowish poopy diapers per day will be the norm moving forward.
Pro tip: At each appointment, your pediatrician will ask you how many wet and poopy diapers your baby has on a typical day. Keep a sheet of paper and pen next to your diaper changing station to keep track for the first week or so.
Breastfeeding Pain and the Proper Latch
You may hear it over and over again. Breastfeeding is not supposed to hurt. I have yet to meet a mom who entirely agrees with that statement. Your nipples will be super sensitive in the beginning. However, they should not be cracked or bleeding. The best thing you can do is make sure your baby latches properly. Making a slight adjustment to your position, your baby, or their latch can make all of the difference.
The latch is everything, and you will be so much more comfortable if your baby latches properly. This means that they have their mouth open pretty wide and have your breast in their mouth. If they only have your nipple in their mouth, you won’t be comfortable, and they won’t be getting much milk. When your baby latches on, they start with quick short sucking motions. This triggers your milk release, sometimes referred to as a letdown, and once milk is flowing, their sucking will slow down.
If you need your baby to stop sucking so you can readjust, you need to break their latch. You do not want to pull your nipple out of their mouth without breaking the suction because it will be uncomfortable. To break their latch, put a finger in the corner of their mouth between their gums and turn your finger. That motion will break the suction, and you can easily pull your nipple out of their mouth.
Pro tip: If it hurts, break the suction and get a better latch. Your nipples will thank you.
Taking Care of Yourself
Your body is working extra hard to produce milk for your baby, and you need to take care of your body. That means making sure you have all of the vitamins and nutrients you need. Continue taking a high-quality prenatal vitamin when you are breastfeeding. It is critical to stay hydrated, and you need additional fluids when you are breastfeeding. You can even mix in electrolytes, like Basis, into your water to increase your hydration.
Breastfeeding burns 300-500 calories per day. Make sure you eat a healthy diet of whole foods. You may find yourself eating many meals with one hand as you nurse or hold your baby with the other. Find some meals and snacks that are easy to prepare and eat.
Pro tip: An easy hack for making sure you are covering these bases is to keep a stash of a couple of water bottles and snacks near the places in your home where you are breastfeeding.
Alcohol and Breastfeeding
If you enjoyed wine or alcohol before you got pregnant, you might be looking forward to enjoying a glass after pregnancy. Many moms are disappointed to learn that you can transfer alcohol to your baby in breastmilk. While this is true, there is more nuance, and it is not 100% off-limits. Alcohol in your breastmilk follows your blood alcohol level. When breastfeeding, you can enjoy a drink, and you do not have to pump and dump. You only need to be mindful about when you are consuming alcohol and when you feed your baby. You may want to pump and dump that milk if your breasts are uncomfortably full. For more details on alcohol, see this Pregnancy Podcast article. Kelly Mom also has an informative article on alcohol and breastfeeding.
Pro-tip: If you are comfortable enjoying an alcoholic beverage, pay attention to the alcohol percentage and the quantity in your drink. A standard drink contains around 14 grams (0.6 ounces) of pure alcohol. This is the equivalent of:
- 12 ounces of beer at 5% ABV
- 8 ounces of malt liquor at 7% ABV
- 5 ounces of wine at 12% ABV
- 1.5 ounces of hard liquor, or one shot, at 40% ABV
- 8-9 ounces of malt liquor at 7% ABV
Caffeine and Breastfeeding
If you are looking forward to enjoying more caffeinated beverages after you have your baby, you should know this is another substance you will still need to be mindful about. You can also pass caffeine through your breastmilk to your baby. Generally, it is recommended that pregnant or breastfeeding mothers keep their caffeine consumption at 200 mg or less per day. An 8 ounce (237 milliliters) cup of coffee has somewhere between 95-200 milligrams of caffeine. The caffeine content depends on the type of the bean, the strength of coffee, and the brewing method.
While alcohol in breastmilk follows your blood alcohol level, caffeine remains in your system much longer. The time it takes your body to eliminate caffeine from your system will be different for everyone. The half-life of caffeine for adults ranges anywhere from 3-7 hours. If you are on the short end of that spectrum, after 9 hours, roughly 12% of the caffeine you consumed is still in your system. This time is even longer for someone who does not metabolize caffeine quickly.
Your baby processes caffeine at an even slower rate. The half-life of caffeine in a newborn is estimated as high as 80 hours. As your baby grows, they have a much shorter caffeine half-life. Infants who drink breastmilk with caffeine can show signs of jitteriness, fussiness, and poor sleep patterns. See this episode, the LactMed database, or this Kelly Mom article for more information on caffeine.
Burping and Spitting Up
It is common for babies to spit up some milk after feedings or even in the middle of a feeding. While this can be inconvenient, especially when it ends up all over you, usually, this doesn’t bother your baby much. Plus, while it may seem like your baby spits up everything they just drank, it looks like more than it is.
Thankfully, you can do some things to reduce how often and how much your baby spits up. Burping is one way to get the air out of your baby’s tummy, so it isn’t coming back up along with some of the milk they just had. To burp your baby, you can hold them against your shoulder and gently rub or pat their back or hold them in a sitting up position in your lap and lean them slightly forward while you gently pat their back. This is where burp cloths come in handy, and you will probably go through a lot. It may also be helpful to keep them upright for a bit after they eat, rather than immediately laying them down.
Pro tip: keep a tee shirt for you, and maybe your partner too, in your diaper bag. If your baby does spit up all over your shirt when you are away from home, you have a clean one to change into.
There are some supplies you may want for breastfeeding. There are many products on the market, and you don’t need all of them, but a few may make breastfeeding more convenient. If you are unsure if you want these items, hold off on buying them or adding them to your registry. You can find all of these products at a local store like Target or Walmart, and you can always order them with quick delivery on Amazon.
Nursing Bras and Clothes
Every list I have seen of must-haves includes nursing bras and nursing tanks. You can breastfeed without these, but they are convenient. Historically, nursing bras have not been the most comfortable. Thankfully, that has changed. My favorites are the nursing bras from Bodily. One perk of nursing bras and tanks is they make breastfeeding in public places more discreet if that is important for you. Whether you go with a nursing bra or just a regular bra, make sure it is not too tight and that you are comfortable.
Pro tip: Before shopping for any nursing bras or clothes, take stock of what you already have. Bras that clasp in the front or a loose sports bra or a bralette may work just as well. Shirts that button down the front are convenient for nursing. You can also layer a tank under a t-shirt so that you can pull the shirt up and the tank down to allow your baby to nurse without feeling naked in public.
If you are concerned about leaking, which happens, you will want to use nursing pads. There are disposable and washable pads. You are more likely to leak early on in breastfeeding as you and your baby calibrate your supply. Disposable pads are convenient to use and throw away, especially if you leak and need to swap them out when you are away from home. They also have a sticker on one side to stick to your bra and keep them in place.
You may consider washable nursing pads, which are more environmentally friendly. You can simply throw them in the washer and dryer. One downside is that they will feel wet against your skin if you leak, where disposable pads tend to absorb more moisture and wick it away from your skin. If you are thinking about trying reusable pads, Bamboobies were my go-to when I was breastfeeding. Bodily also has reusable pads with a non-slip backing.
Pro tip: Pack a few pads in your diaper bag. If you use reusable ones, include a Ziploc to store a wet one until you get home.
One item you will want to get in preparation for breastfeeding is a breast pump. In the United States, health insurance companies cover breast pumps. Even if you are not sure you will use one, get one if it is at no cost to you. It’s free and can come in handy when you need it or plan to build up a stash of milk. Aeroflow is a company that makes this process super easy by working with your insurance company. I have used them in the past and had a great experience. If Aeroflow does not work with your insurance, you can contact your insurance directly to find out how to get a breast pump.
Pro tip: if you want a breast pump not covered by your health insurance, add it to your baby registry, and hopefully, a generous friend or family will help cover it.
Storage bags are a very convenient way to store and freeze breast milk. My favorite storage bags are from Lansinoh. I have used hundreds of these bags and have maybe had one that leaked. They are of excellent quality.
Pro tip: when freezing milk in bags, place the bag flat until it is frozen. That way, it is easier to stack them and fit more in your freezer.
Many moms-to-be stock up on nipple cream in preparation for breastfeeding. This may be helpful, but you may not need it. The best way to prevent sore nipples is to ensure your baby latches properly. If you choose to use a nipple cream, most use lanolin, which comes from sheep’s wool. There are also lanolin-free alternatives. You could even use olive oil or your breastmilk to soothe nipples.
Pro tip: Your breastmilk has antimicrobial proteins, anti-inflammatory, and antioxidative factors. Some moms swear by using breastmilk to help heal everything from cracked nipples to cradle cap.
Don’t Wait to Get help
Get help as soon as everything isn’t going splendidly. Do not wait and try to struggle through issues on your own. Take advantage of the birth center and hospital staff to assist you with breastfeeding before you go home. You can use a lactation consultant or attend a breastfeeding support group. Often you will be able to find these resources at no cost. Even if breastfeeding is going well, it can be nice to go to a support group to meet other women going through the same thing as you.
Thinking Long Term
Breastfeeding can be very challenging in the first few days and weeks. This is new for you and your baby, and it may take some time to find your rhythm. The good news is that breastfeeding will keep getting easier, and you and your baby will get increasingly more comfortable with it. Early on, it may seem like your baby is constantly eating. As they grow, feedings will be further apart, and you will get to a point where it does not feel like they are permanently attached to your breast. Although breastfeeding is work, the benefits to your baby and their long-term health are well worth the effort.
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