Breastfeeding Basics
[Check out Options for Feeding Baby for the pros and cons of breastfeeding, pumping and formula, and Breastfeeding Problems & Solutions for how to handle common challenges]
While it’s wise to learn about what to expect with breastfeeding, the mechanics might not make a ton of sense until you’re actually experiencing it. Hopefully you’ll return here down the road if you encounter challenges (bookmark it!).
Third Trimester & Gear Prep
Colostrum:
Towards end of pregnancy, you may begin producing colostrum - the thicker yellow substance (sometimes referred to as “liquid gold”) that is super nutrient, antibody dense, and nourishes your baby for the first days of life
Consider collecting early colostrum using a kit like this - bring some to the hospital in case you’re unable to breastfeed after birth for any reason, or keep some frozen to give baby an extra does of antibodies if he gets sick
Set up a “nursing station”:
Really comfy glider chair (and ottoman if chair doesn’t have a footrest) - you’ll spend a lot of time here, so worth getting a good one!
$$$: Crate & Barrel Milo Glider and Ottoman
$$: NurtureAnd Glider (reclines and has charging port)
$: Babyletto Kiwi Glider & Recliner
Note: for recliners, make sure there’s a good space in the nursery for it to actually recline
Nipple Cream: very helpful for the first few weeks, but then your nipples should adjust
Vitamin D drops: only nutrient that breastmilk doesn’t contain in sufficient quantities; put a drop on your nipple once a day right before nursing (e.g. always first feed in the morning, so easy to remember) or add it to a bottle if doing a bottlefeed. Alternatively, if it’s easier to just supplement your own prenatal vitamins with an additional extra-strength Vitamin D (5,000 IU), that increases the amount getting to baby through breastmilk too.
Water bottle and/or tea mug: hydration is always a good thing, and warmth of tea can be calming, which may promote release of milk. While there is no scientific evidence that special fenugreek/fennel tea actually helps production, there is anecdotal evidence and it’s been proven safe so no harm in trying if you like the taste. Use a covered mug (e.g. Yeti) so you don’t spill hot tea on baby!
Nursing pillow (optional): some moms find these make nursing more comfortable and reduce neck/back strain. Others find it’s more awkward or prefer the flexibility of not using extra gear. I’d recommend the Boppy rather than My Brest Friend, because if you decide you don’t like it for nursing, it can also be used as a lounger for baby for tummy time and sitting practice. You may also already have throw pillows at home that work.
Other gear to have ready:
Breast pads (disposable and/or washable): use these nonstop in the beginning to catch leaky milk and keep shirts dry; the leaking should subside after a month or two
Hot/Cold Packs: used cold to relieve engorgement, or hot to relieve clogged ducts
Milk storage bags: pump and store extra milk in the freezer
Device for catching other breast’s let-down (optional): Haaka is the most popular, but it can get harder to use as baby is older and more mobile. I personally prefer Milkies Milk Saver or Elvie Catch as a way to collect the extra milk. But it’s also totally fine to just use a burp cloth to cover other boob and absorb the letdown without saving it.
Nursing bras: soft ones you can just pull up or down, or more supportive bras that unlatch; Kindred Bravely makes lots of good options but expensive. Don’t really need nursing-specific clothes, just shirts/dresses that easily pull down.
Backup formula: even if you’re hoping to breastfeed exclusively, have formula on hand just in case. A reliable, basic brand is Enfamil; Kendamil and Bobbie are recommended brands that follow the more organic, European style of having fewer artificial ingredients, but are available here in the US (including at Target).
Immediately after Birth
Skin-to-skin:
Try to do this for at least one hour (even if you’ve had a C-section), as this is proven to be the best thing you can do to promote breastfeeding, among other benefits (paper)
Continue doing skin-to-skin when possible for the next few months (partner can do it too!)
First feed:
During the first skin-to-skin, baby may instinctively “root” around, trying to find your nipple - you can also help bring her to it
Baby will also instinctively suck, though may need help adjusting the latch
Latch Basics:
Begin by touching your baby’s lower lip to your nipple to encourage him to open his mouth up super wide, and bring them chin-first towards the breast.
Then make sure baby puts the full areola in mouth, not just nipple - like a whole mouthful of boob with lips turned out like a fish
It can help to hold your boob with one hand like you’re holding a big sandwich - this helps bring the areola closer to them and can also allow you to squeeze some milk to entice baby with a taste
If it really hurts or you hear a clicking sound, latch is probably wrong; put your finger in baby’s mouth to break the latch and try again
If you have flat or inverted nipples, consider trying nipple shields to help your baby latch
Pushing down on the top of your boob can help make the nipple protrude more (called “breast compression”); squeezing or massaging downwards promotes the flow of milk
Utilize lactation support in hospital
Now common practice for a lactation expert to come by your postpartum room, possibly multiple times, to educate and support you with breastfeeding
If for some reason they don’t, make sure to request it - and involve your partner!
Don’t worry about “rooming in”:
During your stay at the hospital, you may have the option to have your newborn spend a few hours being cared for in the nursery, so you can get some much-needed rest
Some breastfeeding advocates claim this is detrimental to breastfeeding, and advise “rooming in” with baby the whole time, but there isn’t good evidence to support this; plus you can ask them to bring baby to you when it’s time for them to nurse again
First Days Home
Milk “coming in”:
Within 72 hours of birth, breasts should switch from colostrum to normal milk - you’ll notice your boobs feeling fuller
For about a third of first-time moms it takes longer, which may be related to mother’s health or circumstances of the birth. Continue breastfeeding frequently and consider pumping to further stimulate production. May need to temporarily supplement with formula
Engorgement can occur at any time but is especially common during these early days
Follow Baby’s Lead:
In the first few weeks, baby may nurse every 1-3 hours, for about 8-12 times per 24 hours
Don’t follow a schedule but instead watch baby for hunger cues (“nursing on demand”):
Smacking/licking lips, sticking out tongue, opening/closing mouth, sucking hands
Searching side to side, moving towards your chest (or whoever they are with)
Squirming, crying, fussiness
Let your baby nurse for as long as they want on one breast, then offer the other breast (will likely take much less on second side ). Next feed, start with the other breast to balance - you’ll probably be able to feel which one is fuller and due to go first
Don’t switch sides too soon as it’s important for babies to get a mix of foremilk - the first milk that is mostly water and needed for hydration, and hindmilk - the milk that comes towards the end and is rich in fat
Supply & Demand:
Breastfeeding is a feedback system - the more your baby nurses, the more milk you’ll produce. Pretty amazing actually. Your baby’s sucking sends a signal to your brain to make more oxytocin, which in turn stimulates the hormone prolactin, which produces milk.
Though exhausting, frequent nursing in early weeks helps increase your supply
Read more about oversupply and undersupply (note that boob size has no correlation to milk production)
Tracking Feeds/Diapers:
Initially, track feed timing and number of pee and poop diapers (called “wet” and “dirty”). Many apps for this or just use notepad/whiteboard to minimize phone usage
You don’t need to be concerned about baby having too much (you can’t overfeed a breastfed baby), only too little
If baby is gaining weight well and you have a general sense of diaper output, you can stop tracking - it’s personal preference when this is (might be days, weeks or months!)
First 3 Months (“4th Trimester”)
Immunity Boost:
Period when babies’ immune systems are least developed and they haven’t yet received all their vaccines, so they benefit greatly from antibodies in breastmilk
If you can keep up some amount of breastfeeding during these months- even if also doing formula - you are giving your baby great additional protection
Let Down:
A few weeks in, you may start to feel the “let down” sensation - a tingling or warmth when your breasts release milk, which happens a minute or so after baby has been sucking
There may be 1-2 additional letdowns during a session, but most only feel the initial one
Some women don’t feel it at all, but still notice baby’s sounds change from sucking to gulping
Other breast also releases milk during let-down - consider using pad or collecting it
Read more about fast let down and slow let-down
Experiment with Different Positions:
You and your baby will figure out what works best, but two underrated, comfy positions are sidelying (especially post- C-section) and laid back/biological
“Stud & Dud”:
Most women have a dud (or “slacker”) breast that produces less milk than the other
This isn’t a problem but if it bothers you aesthetically, you can try to increase your dud by always starting nursing on that side, or doing an extra pump session
Cluster Feeding:
During a growth spurt, baby might have a few days where seems to be nursing non-stop
This can be exhausting, but know that it will pass. Lean on your support people.
Build a Frozen Stash:
Consider occasionally pumping after a certain feeding (the morning is typically the most bountiful) to build up a small stash of frozen milk; but beware that this can sometimes cause oversupply issues since your body thinks baby is needing more. You are effectively committing yourself to continuing that pump session
Even if hoping to exclusively breastfeed, good to have backup in case you are sick or away from baby longer than expected
Store in small batches (2-4 oz) to avoid wasting milk since it must be used within 24 hours once thawed
It is better to thaw frozen breastmilk slowly by transferring it to the fridge (takes ~12 hours, so I recommend doing it overnight) rather than thawing it quickly under hot water (preserves the concentration of antibodies) (paper)
In addition to labeling your frozen bags with the date and amount, you can also add “AM” or “PM” so that later on you can match the milk, so baby gets the extra cortisol in the morning milk (which promotes alertness) and the melatonin in the evening milk
Pacifiers are Fine:
Fears about “nipple confusion” are overblown!
Pacifiers can be a great substitute for “non-nutritive sucking” where baby is no longer hungry, but just nursing for comfort
Try the Babylist Sampler pack to find one baby likes best, or try my personal fave Avent Ultra Light
Once breastfeeding is going well, try introducing a bottle while baby still has involuntary sucking reflex (between 4-6 weeks). Doing at least one bottle a day can help prevent bottle refusal later on.
I recommend Lansinoh nipples as they most closely resemble real nipples, enabling baby to better go back and forth between nursing and bottles.
Serve the pumped milk as soon as possible and refrigerate rather than freeze, to better preserve the protein content (paper)
Have someone else give the first bottle, since your baby may be confused as to why he’s not getting your boob
For the first bottle, pick a feed when your baby is generally happy/easy - you want him hungry but not crazily so, so don’t wait too long
Mimic the conditions of breastfeeding as much as possible:
Warm the milk up (if you don't have a bottle warmer, you can just use a bowl of warm water)
Use a "slow flow" nipple - size 0 - which resembles flow from breast
Put some milk on the outside of the nipple to entice him
Let baby open mouth rather than forcing nipple in, and then ensure there's a good deep latch
Allow baby to take breaks every 20-30 secs by tipping bottle down (called "paced feeding")
A few things that are different than breastfeeding
Hold him more upright, almost like he's sitting up
Burp him for longer than normal because babies are more likely to swallow air from bottles vs. boobs
Pumping Hacks:
If you’re pumping multiple times a day, store the used pump parts in the fridge in a ziplock bag until the next use, without having to wash them. Refrigeration keeps it clean and prevents growth of any bacteria on the residual milk.
Buy two sets of pump parts, so that you always have one available if one is in the dishwasher
If you don’t want to lug the full electric pump on a short outing, a manual pump is much more portable and will do the job (just takes a bit longer because it’s only one side at a time)
Hands-free pumping bra can help hold the pump parts in place so you can type, text, etc. This one is my favorite for pumping in bed at night or early morning as it’s really easy to take on/off and holds it securely, whereas this one can also be used as a normal bra throughout the day.
Milk Usage Rules:
4 hours at room temperature (this is conservative - I think up to 6 hours is fine)
4 days in the fridge (similarly, up to 6 days is probably fine -these reusable labels can help you track of dates)
6 months in the freezer
2 hours after baby has already drank from bottle (saliva introduces bacteria). Again, very conservative and not based on great data; I’m personally comfortable reusing up to 4 hours - otherwise so much gets wasted
24 hours after milk has been thawed
Use this calculator to determine when your milk will be free of alcohol, based on your weight and number of drinks
Schedules:
Around 3-4 months, baby sleeping and feeding patterns might become more consistent
Some moms/babies appreciate the predictability of sticking to a “schedule”, others prefer to “go-with-the-flow”, so do what works best for you
Just like adults, babies have different feeding habits - some might have nice long meals, while others are snackers. Snacking is only a problem if it’s frustrating for you.
Stretches & Massages:
You may develop neck/back issues from nursing in strange positions/places
Best practice is “bring baby to boob, not boob to baby” but sometimes with a fussy baby, you’ll do whatever works!
This video contains a nice 10 minute stretching sequence for BFing moms
Ask your partner to massage you or treat yourself to a professional one - occupational therapy!
Months 5-8
Returning to Work:
At this point, many women decide whether to keep breastfeeding and therefore start pumping at work, or transition off of breastfeeding by gradually weaning
You only need a small stash of frozen milk before returning to work, since you will be adding newly pumped milk every day
Some women who dislike pumping are able to achieve “partial weaning” through combination feeding - they nurse when they’re with baby, but baby is given formula during working hours and they don’t pump. For some women who attempt this, however, it leads to decrease in supply that makes it hard to keep up the nursing.
Things Get Easier:
Your milk has regulated so you’re leaking less and probably don’t need to wear pads
Baby is more efficient so nursing sessions go from 20-30 minutes to 5-15 minutes
Baby goes longer stretches between nursing, especially at night - your body will adjust milk production, so you don’t need to pump at night once baby is going longer, but consider keeping a manual pump beside your bed if you need to relieve some fullness during the adjustment period
Things Get Harder:
Baby is more engaged with the world, which means they are more easily distracted
As first teeth come in, you may get bitten! Try to minimize your reaction as much as possible, otherwise it might encourage baby to bite again to get reaction again
Babies start to “twiddle” or play with your other nipple while nursing, which some find unpleasant: easy solution is to hold their hand or give them something else to play with
Baby might develop a preference for the bottle over the boob - can be hard not to take this personally but can also be liberating!
Months 9-12+
Enjoy Quiet Time: as your baby becomes more mobile crawling and starting to walk, nursing can become a rare moment to spend quiet time together, so savor it!
Intake may Decrease: as intake of solids is increasing with 3 meals a day, normal to see milk intake go down. May only have 3-4 milk feeds a day, spaced out from solid meals so baby has appetite
Weaning
Weaning from nursing or pumping must be done gradually to allow your body to adapt; it is normal for this to be emotionally challenging for both you and your baby
If before 12 months, replace a feed at a time with formula, giving your body several days to adjust before replacing the next one. If baby balks at formula, you can begin by mixing milk and formula to get them used to the taste.
At 12 months, can switch to another milk (cow, oat, soy, etc.) or just get enough dairy through other sources (cheese, yogurt)
Many moms continue nursing well beyond 12 months, so keep going if it’s working and mutually enjoyed! Keep in mind that it may become harder to wean as toddler gets older and more demanding, but plenty of kids do self-wean.
Note on Drinking, Drugs & Diet:
Alcohol:
As with pregnancy, fears here are overblown. If you’re sober enough to drive, you’re sober enough to nurse (being drunk while handling baby isn’t a good idea, nursing aside!)
Alcohol levels peak in milk 30-60 minutes after consumption, so if you want to be extra careful, nurse baby after at least 90 minutes (it takes ~2 hours for 1 drink to fully clear your system).
Use this calculator to determine when your milk will be fully free of alcohol, based on your weight and number of drinks
The best time to drink is right after you’ve fed your baby, as it allows the longest time before the next feed/pump
If you’ve had more than 2 drinks, you may want to “pump and dump” - which means just pouring the milk down the drain
Please note - pumping & dumping doesn’t get the alcoholic milk out of your system any faster, only time will do that. But it’s a way to keep your normal production schedule going, while not actually serving your baby that milk.
FYI - claims that beer is actually good for milk supply are unfounded
Marijuana:
THC and CBD both pass into breastmilk and take a long time (weeks!) to leave the body
Given there isn’t great data on the long-term outcomes for babies, consider an alternative
Psychedelics
Unfortunately there isn’t any research in this area yet, so we don’t really know how long it might remain present in breastmilk
I would just hold off until you’re fully done nursing (your trip will be more carefree that way, too!)
Medications:
Use LactMed database or Mother to Baby and discuss with your doctor; there is almost always a breastfeeding safe alternative
If you end up having postpartum depression, multiple antidepressants are compatible with breastfeeding
Calories:
You’ll need an extra 400-500 calories/day to maintain your milk supply - many people find they are more hungry while breastfeeding than they were during pregnancy (your boobs are producing about a quart of milk every 24 hours!)
You can still lose your pregnancy weight while breastfeeding (especially since it burns more calories), just do so gradually at 1-2 pounds per week max
Galactogogues:
“Lactogenic” foods that are believed to support milk production include oats, barley, brewer’s yeast, fennel, garlic, ginger, flaxseed, leafy greens
Limited scientific evidence, but plenty of anecdotal and little downside if it’s tasty/healthy
No-bake lactation balls are easy to make (add Rice Krispie cereal for extra crunch!)
Off-Limit Foods:
Mercury fish is only banned food: these include marlin, shark, swordfish, & tuna
A small percentage of babies have a sensitivity to a certain food mom eats, the most common being dairy. But don’t jump to this conclusion too quickly, as there are many other possible causes of gassiness/fussiness to explore first.
Caffeine:
Generally safe to have up to 3 cups of coffee (300mg caffeine) a day while nursing - may be necessary if you’re exhausted!
Monitor your baby’s reaction as some are more sensitive, especially as newborns
