Breastfeeding: Everything You Need to Know

Breastfeeding is when you feed your baby breast milk, usually directly from your breast. It’s also called nursing or chestfeeding. Making the decision to breastfeed is a personal matter. It’s also one that’s likely to draw opinions from your friends and family.

Many medical experts, including the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists, strongly recommend breastfeeding exclusively (no formula, juice, or water) for 6 months. After the introduction of other foods, it recommends continuing to breastfeed through the baby’s first year of life.

How often you should breastfeed your baby depends on whether your baby prefers small, frequent meals or longer feedings. This will change as your baby grows. Newborns often want to feed every 2-3 hours. By 2 months, feeding every 3-4 hours is common, and by 6 months, most babies feed every 4-5 hours.

You and your baby are unique, and the decision to breastfeed is up to you.

Benefits of Breastfeeding

Benefits of breastfeeding for the baby

Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat — everything your baby needs to grow. And it’s all provided in a form that’s more easily digested than infant formula. Breast milk contains antibodies that help your baby fight off viruses and bacteria. Breastfeeding lowers your baby’s risk of having asthma or allergies. Plus, babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and trips to the doctor.

Breastfeeding has been linked to higher IQ scores in later childhood in some studies. Breastfed infants are more likely to gain the right amount of weight as they grow, rather than becoming overweight in childhood. The AAP says breastfeeding also plays a role in the prevention of sudden infant death syndrome(SIDS). Breastfeeding has been thought to lower the risk of diabetes, obesity, and certain cancers as well, but more research is needed. 

Breastfeeding benefits for you

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.

Is your baby getting enough milk?

Many breastfeeding moms wonder whether their babies get enough milk for good nutrition. If your baby is getting enough breastmilk, they should:

• Not lose more than 7% of their birth weight in the first few days after delivery
• Seem content for about 1-3 hours between feedings
• Have at least 6 diapers a day wet with very pale or clear pee by the time they are 7-10 days old

How to increase milk supply

As your baby needs more milk and nurses more, your breasts usually respond by making more milk. Experts recommend trying to breastfeed exclusively (no formula, juice, or water) for 6 months. If you supplement with formula, your breasts might make less milk.

But some new parents struggle to make enough milk early on. This could happen if your baby was born prematurely or if you were separated from your baby soon after their birth.

One way to increase your milk supply may be to pump more often, not longer. Try pumping for 10 minutes, then take a 10-minute break for about an hour, in addition to your normal pumping schedule. This could help increase your milk supply within 3-4 days.

Be sure to stay hydrated when nursing, especially if you’re also drinking any caffeinated beverages.

If you’re not seeing an increase in your milk supply despite pumping often, talk with your health care provider or a lactation consultant. It may be the case that your breast pump doesn’t fit your breast, and they can help you find the right size.

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.

What does hand expression of breast milk mean?

Hand expression is a type of massage to the breasts that releases milk. Parents choose to hand express for many reasons, including:

• It’s a way to express milk when the baby cannot nurse. This allows you to collect milk for later.
• It may allow you to avoid engorgement. Engorgement can be painful and cause leaking or clogged ducts.
• It requires less equipment than pumping. Breast pumps often require a whole bag of equipment, with the machine, the tubes, the flanges, and the bottles. This can be difficult or annoying to carry around.
• You can hand express milk in more places than you can pump. Most pumps require electricity. If you’re in a situation where you don’t have electricity available to you, you won’t be able to pump. Additionally, if you’re out and about and didn’t bring the pump with you, you still have the option of hand expressing.
• The skin-to-skin contact offered by hand expression encourages the milk letdown reflex. The milk letdown reflex is what causes your milk to start flowing and may be easier to trigger with hand expression than with a pump.
• You may get more milk with hand expression than with a pump.
• It’s free. In many cases, insurance will cover your breast pump. But if you don’t have insurance, or for some reason your pump is unusable, hand expression will save you from having to spend money on a pump.

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.

Continue around your breast until all areas of the breast are drained and soft. Hand expression of milk can take 20 or 30 minutes at a time.

When does pumping help?

Breast pumps can be cumbersome. They require a lot of parts and a supply of electricity. It’s not always possible to carry those parts around with you, and you may not be in a situation where you have consistent access to electricity. In that case, hand expression likely wins out over pumping. Pumps can also be noisy and uncomfortable to use.

But there are reasons some parents may prefer a pump to hand expression. Some pumps are hands-free, allowing you to do other things while pumping, such as working, tending to other children, or entertaining yourself with a book or your phone. 

Additionally, pumping can allow you to store milk if you’re going to be away from your baby. This can offer you more independence and allow other caregivers to help feed your baby.