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Learning to breastfeed 

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Learning to breastfeed 


Breastfeeding may be natural, but it's also a skill that takes practice. Learn what makes a good latch, see different breastfeeding holds, and find out how to tell if your baby is getting enough breastmilk. 

Preparing to breastfeed 
Learn steps you can take before and after birth to help breastfeeding go smoothly for you and your baby. 

Prepare for breastfeeding before birth 
•    Get good prenatal care, which can help you avoid premature birth and a baby in the hospital after you go home. Premature babies (born before 39 weeks of pregnancy) have more problems with breastfeeding than full-term babies.1 
•    Tell your doctor about your plans to breastfeed and ask if the place where you plan to deliver your baby has the staff and setup to support breastfeeding after childbirth. Some hospitals and birth centers have taken special steps to create the best possible environment for supporting breastfeeding. These places are called Baby-Friendly Hospitals and Birth Centers. 
•    Take a breastfeeding class. Pregnant women who learn about how to breastfeed are more likely to breastfeed than those who do not. Breastfeeding classes offer pregnant women and their partners the chance to prepare and ask questions before the baby's arrival. 
•    Ask your doctor to recommend a lactation consultant. You can establish a relationship with a lactation consultant before your baby comes so that you will have support ready after your baby is born. 
•    Talk to your doctor about your health. Discuss any breast surgery or injury you may have had. If you have depression, or are taking supplements or medicines, talk with your doctor about treatments that can work with breastfeeding. 
•    Tell your doctor that you would like to breastfeed as soon as possible after delivery. The sucking instinct is very strong within the baby's first hour of life. 
•    Talk to your doctor about your birth control options after delivery. Some types of birth control interfere with breastfeeding, but many do not. 
•    Talk to friends who have breastfed, or consider joining a breastfeeding support group. 
•    Get the items you may need for breastfeeding, such as nursing bras, covers, and nursing pillows. 

Steps you can take right after birth to get you off to a great start breastfeeding 
•    Cuddle with your baby skin-to-skin right away after giving birth if you are both healthy. 
•    Breastfeed as soon as possible after giving birth. 
•    Ask for a lactation consultant to help you. 
•    Ask the hospital staff not to give your baby pacifiers, sugar water, or formula, unless it is medically necessary. 
•    Let your baby stay in your hospital room all day and night so that you can breastfeed often. 
•    Try not to give your baby any pacifiers or artificial nipples until he or she is good at latching on to your breast (usually around 3 to 4 weeks old). 

Steps your partner can take to help support your breastfeeding 
Talk to fathers, partners, and other family members about how they can help support your breastfeeding. Partners and family members can: 
•    Support your breastfeeding by being kind and encouraging 
•    Show their love and appreciation for all of the work that goes into breastfeeding 
•    Be good listeners if you need to talk about any breastfeeding concerns you might have 
•    Help make sure you have enough to eat and drink and get enough rest 
•    Help around the house 
•    Take care of any other children who are at home 
•    Give the baby love through playing, talking, and cuddling 

Tips for breastfeeding success 
•    Learn your baby's hunger signs. Signs your baby may be hungry include: 
o    Becoming more alert and active 
o    Putting hands or fists to the mouth 
o    Making sucking motions with the mouth 
o    Turning the head to look for the breast 
Crying can be a late sign of hunger, and it may be harder for the baby to latch if he or she is upset. Over time, you will be able to learn your baby's cues for when to start feeding. 
•    Follow your baby's lead. Some babies will feed from (or "take") both breasts, one after the other, at each feeding. Other babies take only one breast at each feeding. Help your baby finish the first breast as long as he or she is still sucking and swallowing. Your baby will let go of your breast when he or she is finished. Offer your baby the other breast if he or she seems to want more. If your baby falls asleep while nursing and you are worried, he or she did not get enough milk, try switching to the other breast or squeeze your breast to encourage more milk to flow and wake up your baby. Learn how to tell if your baby is getting enough milk. 
•    Keep your baby close to you. Skin-to-skin contact between you and baby will soothe his or her crying and also will help keep your baby's heart and breathing rates stable. A soft carrier, such as a wrap, can help you "wear" your baby. 
•    Avoid nipple confusion. Do not use pacifiers and bottles in the first few weeks after birth unless there is a medical reason. If you need to use supplements, work with a lactation consultant. She can show you ways to give supplements that help you and your baby continue breastfeeding. These include feeding your baby with a syringe, a tiny tube taped beside your nipple, or a small, flexible cup. Try to give your baby expressed or pumped milk first. 
•    Make sure your baby sleeps safely and close by. Have your baby sleep in a crib or bassinet in your bedroom so that you can breastfeed more easily at night. Research has found that when a baby shares a bedroom with his or her parents, the baby has a lower risk of sudden infant death syndrome (called SIDS)  
 
Making breastmilk 
Your breasts make milk in response to your baby's suckling. The more your baby nurses, the more milk your breasts will make. Knowing how your breasts make milk can help you understand the breastfeeding process. 

How is breastmilk made? 
Breasts often become fuller and more tender during pregnancy. This is a sign that the alveoli, cells that make breastmilk, are getting ready to work. Some women do not feel these changes in their breasts. Other women may feel these changes after their baby is born. 
The alveoli make milk in response to the hormone prolactin (proh-LAK-tin). Prolactin levels go up when the baby suckles. Levels of another hormone, oxytocin (oks-ee-TOH-suhn), also go up when the baby suckles. This causes small muscles in the breast to contract and move the milk through the milk ducts. This moving of the milk is called the "let-down reflex." Learn more about the let-down reflex. 
The release of prolactin and oxytocin may make you feel a strong sense of needing to be with your baby. 
 
How do I know if I will make enough breastmilk? 
Many mothers worry about making enough milk to feed their babies. Some women worry that their small breast size will make it harder to feed their babies enough milk. But women of all sizes can make plenty of milk for their baby. The more often your baby breastfeeds, the more milk your breasts will make. 
Your baby's weight should double in the first few months. Because babies' tummies are small, they need many feedings to grow and be healthy. You can tell if your baby is getting enough milk by the number of wet diapers he has in a day and if he is gaining weight. 
If you think you have or will have a low milk supply, talk to a lactation consultant. Visit the Finding support and information section for other types of health professionals who can help you. 

Will my breastmilk change as my baby grows? 
Yes. Your breastmilk changes in the days after birth and continues to change as your baby grows. Learn what will happen with your milk, your baby, and you in the first few weeks. 

Birth 
Milk: Your body makes colostrum (a rich, thick, yellowish milk) in small amounts. It gives your baby early protection against diseases. 
Baby: Your baby will probably be awake in the first hour after birth. This is a good time to breastfeed your baby. 
You (Mom): Let your baby begin the process of searching for your nipple. This baby-led way of breastfeeding can help your baby get a good latch. 

First 12 to 24 hours 
Milk: Your baby will drink about 1 teaspoon of colostrum at each feeding. You may not see the colostrum, but it has what your baby needs and in the right amount. 
Baby: It is normal for the baby to sleep heavily. Labor and delivery are hard work! Some babies like to nuzzle and may be too sleepy to latch at first. Feedings may be short and disorganized. 
You (Mom): Your body is still making colostrum. Take advantage of your baby's strong instinct to suck and feed upon waking every couple of hours to help your milk come in faster. 

Next 3 to 5 days 
Milk: Your mature (white) milk takes the place of colostrum. It is normal for mature milk to have a yellow or golden tint at first. 
Baby: Your baby will feed a lot, at least 8 to 12 times or more in 24 hours. Very young breastfed babies do not eat on a schedule. It is okay if your baby eats every 2 to 3 hours for several hours, then sleeps for 3 to 4 hours. Feedings may take about 15 to 20 minutes on each breast. The baby's sucking rhythm will be slow and long. The baby might make gulping sounds. 
You (Mom): Your breasts may feel full and leak. (You can use disposable or cloth pads in your bra to help with leaking.) 

First 4 to 6 weeks 
Milk: White breastmilk continues. 
Baby: Your baby will now likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and may be farther apart. 
You (Mom): Your body gets used to breastfeeding. Your breasts may become softer and the leaking may slow down. 

What if my breastmilk supply goes down? 
If you don't feel as "full" as you did in the first few weeks of breastfeeding, you may worry that you are not making enough milk for your baby. But know that the milk is still there and flowing to your baby. Usually, after a few months of breastfeeding, your body learns to make the right amount of milk for your baby. 
Also, your baby may only nurse for short periods, such as five minutes at each feeding. These are not signs of lower milk supply. Your body adjusts to meet the needs of your baby, and your baby gets very good at getting milk from the breast. It's also normal for your baby to continue to nurse longer on each breast at each feeding. 

What can affect how much breastmilk I make? 
You may make more or less milk, depending on: 
•    How completely milk is removed each time you breastfeed. An empty breast means better milk production. 
•    How often you nurse or pump to remove milk. The more often you empty your breasts, the more milk your breasts will make. 
•    The amount of milk your breasts store between feedings. If your breast stores too much milk between feedings (because your baby doesn't empty the breast), your breast will make less milk. If your breast is emptied, it will make more milk. It is common for one breast to make more milk than the other, and it is normal for babies to prefer one breast over the other. This can affect how much milk you make in that breast. 
How can I make more breastmilk? 
The best way to make more breastmilk is to breastfeed often and to empty your breasts completely at each feeding. 
After emptying your breasts at each feeding, less milk builds up in your breasts between feedings. 
To better empty your breasts, follow these tips: 
•    Use breast massage and compression. 
•    Offer your baby both breasts at each nursing. 
•    Pump after nursing if your baby does not remove all the milk from your breasts. Your breasts will soften when the milk is removed. If the baby empties your breasts, then you can pump to remove milk and increase milk production between nursing sessions. 

What is the let-down reflex during breastfeeding? 
The let-down reflex (also called just "let-down" or the milk ejection reflex) happens when your baby begins to nurse. The nerves in your breast send signals that release the milk into your milk ducts. Let-down happens a few seconds to several minutes after you start breastfeeding your baby. It also can happen a few times during a feeding. You may feel a tingle in your breast or you may feel a little uncomfortable. You also may not feel anything. 
Let-down can happen at other times, too, such as when you hear your baby cry or when you're just thinking about your baby. If your milk lets down as more of a gush and it bothers your baby, try expressing some milk by hand before you start breastfeeding. 
Many factors affect let-down, including anxiety, pain, embarrassment, stress, cold, too much caffeine, smoking, alcohol, and some medicines. Mothers who have had breast surgery may have nerve damage that interferes with let-down. 

How often should I breastfeed? 
You should breastfeed as soon as possible after giving birth. Then, breastfeed your baby every 2 to 3 hours each day so that you will make plenty of milk. This means that in the first few days after birth, your baby will probably need to breastfeed about everyone to two hours during the day and a few times at night. 
Healthy babies develop their own feeding patterns. Follow your baby's cues for when he or she is ready to eat. 


How long should feedings be? 
There is no set time for feedings. They may be 15 to 20 minutes per breast, or they may be shorter or longer. Your baby will let you know when he or she is finished feeding. If you worry that your baby is not getting enough milk, talk to your baby's doctor. 

How do I know if my baby is getting enough breastmilk? 
There are many signs you can watch for to see if your baby is getting enough milk: 
•    Your baby passes enough clear or pale-yellow urine (see the chart below). The urine is not deep yellow or orange. 
•    Your baby has enough bowel movements (see the chart below). 
•    Your baby switches between short sleeping periods and wakeful, alert periods. 
•    Your baby is satisfied and content after feedings. 
•    Your breasts may feel softer after feeding. 
From birth to 3 months old, a baby usually will gain up to 1 ounce of weight each day. Keep in mind that many babies lose a small amount of weight in the first days after birth. Your baby's doctor will check your baby's weight at your first doctor visit after you leave the hospital. Make sure to visit your baby's doctor for a checkup within three to five days after birth and then again when the baby is 2 to 3 weeks old. 
To learn more, watch the video Is my baby getting enough milk? Also, talk to your doctor if you are worried that your baby is not getting enough breastmilk. 

How much do babies typically eat when breastfeeding? 
A newborn's tummy is very small, especially in the early days. Once breastfeeding is established, exclusively breastfed babies who are 1 to 6 months old take in between 19 and 30 ounces of breastmilk each day.2 If you breastfeed your baby eight times a day, your baby will get around 3 ounces per feeding. But every baby is a little different. 

The Newborn Tummy 
At birth, the baby's stomach can comfortably digest what would fit in a hazelnut (about 1 to 2 teaspoons). By around 10 days, the baby's stomach grows to hold about 2 ounces, or what would fit in a walnut. 
 
Typical number of wet diapers and bowel movements in a baby's first week (it is fine if your baby has more): 1 day = 24 hours* 
 

Baby's age Number of wet diapers Number of bowel movements Texture and color of bowel movements
Day 1 (first 24 hours after birth)  1-2 The first bowel movement usually occurs within 8 hours after birth  Thick, tarry, and black 
Day 2 2 3 Thick, tarry, and black 
Day 3 5-6 disposable, 
6-8 cloth 
3 Looser and greenish to yellow (color may vary) 
Day 4 6 3 Soft, watery, and yellow 
Day 5 6 3 Loose, seedy, and yellow 
Day 6 6 3 Loose, seedy, and yellow 
Day 7 6 3 Larger amounts of loose, seedy, and yellow 

If you are using disposable diapers, the absorbency may make it harder to tell if the diaper is wet. Use this chart as a guide but talk to your child's doctor if you are concerned about your child not getting enough milk. 
*Source: American Academy of Pediatrics 

How long should I breastfeed my baby? 
The American Academy of Pediatrics (AAP) recommends breastfeeding as the only source of food for the first 6 months of your baby's life. The AAP also recommends continuing breastfeeding (after starting solid food) beyond your baby's first birthday and for as long as both you and your baby would like.3 The easiest and most natural time to wean is when your child leads the process. But how you feel is also very important in deciding when to wean. 
Your decision may depend on several factors, such as returning to work, your or your baby's health, or a feeling that the time is right. 

When should I not breastfeed? 
While rare, your doctor may advise you not to breastfeed if you: 
•    Take certain medicines, like anxiety medicine or certain migraine medicines, that are dangerous for babies and can be passed to your baby in your breastmilk 
•    Have a specific illness (like HIV or active tuberculosis) 
•    Get radiation therapy, though some therapies may mean only a brief pause in breastfeeding 
If you take medicine or are sick, talk to your doctor before you begin breastfeeding. Medicines that are safe for you to take during pregnancy may also be safe while you are breastfeeding. But you should always check with your doctor before you start breastfeeding. Talk to your baby's doctor if your baby shows any signs of a reaction to your breastmilk, such as diarrhea, excessive crying, or sleepiness. 

Should I stop breastfeeding when I am sick? 
You can usually continue to breastfeed your baby when you are sick, and if your baby is sick. If you need to rest, you can pump or hand express breastmilk for someone else to feed the baby. But if you are sick with the flu, including the H1N1 flu (also called the swine flu), do not touch or be near your baby, so that you do not infect him or her. Have someone who is not sick feed your baby your pumped or expressed breastmilk. 

Getting a good latch 
Getting your baby to "latch on" properly can take some practice. You can try different breastfeeding holds to help your baby get a good latch. Learn signs of a good latch. 

How can I help my baby get a good latch while learning to breastfeed? 
The steps below can help your newborn latch on to the breast to start sucking when he or she is ready. Letting your baby begin the process of searching for the breast may take some of the pressure off you and keeps the baby calm and relaxed. This approach to learning to breastfeed is a more relaxed, baby-led latch. Sometimes called biological nurturing, laid-back breastfeeding, or baby-led breastfeeding, this style of breastfeeding allows your baby to lead and follow his or her instincts to suck. 
Keep in mind that there is no one way to start breastfeeding. As long as the baby is latched on well, how you get there is up to you. 
•    Create a calm environment first. Recline on pillows or another comfortable area. Be in a place where you can be relaxed and calm. 
•    Hold your baby skin-to-skin. Hold your baby, wearing only a diaper, against your bare chest. Hold the baby upright between your breasts and just enjoy your baby for a while with no thoughts of breastfeeding yet. 
•    Let your baby lead. If your baby is not hungry, she will stay curled up against your chest. If your baby is hungry, she will bob her head against you, try to make eye contact, and squirm around. Learn how to read your baby's hunger signs. 
•    Support your baby, but don't force the latch. Support her head and shoulders as she searches for your breast. Avoid the temptation to help her latch on. 
•    Allow your breast to hang naturally. When your baby's chin hits your breast, the firm pressure makes her open her mouth wide and reach up and over the nipple. As she presses her chin into the breast and opens her mouth, she should get a deep latch. Keep in mind that your baby can breathe at the breast. The nostrils flare to allow air in. 
If you have tried the "baby-led" approach and your baby is still having problems latching on, try these tips: 
•    Tickle the baby's lips with your nipple to encourage him or her to open wide. 
•    Pull your baby close so that the baby's chin and lower jaw moves into your breast. 
•    Watch the baby's lower lip and aim it as far from the base of the nipple as possible so that the baby takes a large mouthful of breast. 
 
What are signs of a good latch? 
Signs of a good latch include the following: 
•    The latch feels comfortable to you and does not hurt or pinch. 
•    Your baby's chest rests against your body. Your baby does not have to turn his or her head while drinking. 
•    You see little or no areola (the darker skin around the nipple), depending on the size of your areola and the size of your baby's mouth. 
•    When your baby is positioned well, his or her mouth will be filled with breast. 
•    The baby's tongue is cupped under the breast, so you might not see the baby's tongue. 
•    You hear or see your baby swallow. Some babies swallow so quietly that a pause in their breathing may be the only sign of swallowing. 
•    You see the baby's ears "wiggle" slightly. 
•    Your baby's lips turn outward like fish lips, not inward. You may not even be able to see the baby's bottom lip. 
•    Your baby's chin touches your breast. 

What are some common breastfeeding latch problems? 
Below are some common latch problems and how to deal with them. 
•    You're in pain. Many moms say their breasts feel tender when they first start breastfeeding. A mother and her baby need time to find comfortable breastfeeding positions and a good latch. If breastfeeding hurts, your baby may be sucking on only the nipple, and not also on the areola (the darker skin around the nipple). 
Gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth. Then try again to get your baby to latch on. To find out if your baby is sucking only on your nipple, check what your nipple looks like when it comes out of your baby's mouth. Your nipple should not look flat or compressed. It should look round and long or the same shape as it was before the feeding. 
Get answers to common questions about breastfeeding and pain. 
•    You or your baby feels frustrated. Take a short break and hold your baby in an upright position. Try holding your baby between your breasts with your skin touching his or her skin (called skin-to-skin). Talk or sing to your baby or give your baby one of your fingers to suck on for comfort. Try to breastfeed again in a little while. 
•    Your baby has a weak suck or makes tiny sucking movements. Your baby may not have a deep enough latch to suck the milk from your breast. Gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth. Then try to get your baby to latch on again. Talk with a lactation consultant or pediatrician if you are not sure if your baby is getting enough milk. But don't worry. A weak suck is rarely caused by a health problem. 
•    Your baby may be tongue-tied. Babies with a tight or short lingual frenulum (the piece of tissue attaching the tongue to the floor of the mouth) are described as "tongue-tied." The medical term is ankyloglossia (An-ke-low-GLAH-SIA). These babies often find it hard to nurse. They may be unable to extend their tongue past their lower gum line or properly cup the breast during a feed. This can cause slow weight gain in the baby and nipple pain in the mother. If you think your baby may be tongue-tied, talk to your doctor. 

What are some typical breastfeeding holds? 
Some moms find that the following positions are helpful ways to get comfortable and support their babies while breastfeeding. You can also use pillows under your arms, elbows, neck, or back to give you added comfort and support. Keep trying different positions until you are comfortable. What works for one feeding may not work for the next feeding. 
Clutch or "football" hold: useful if you had a C-section, or if you have large breasts, flat or inverted nipples, or a strong let-down reflex. This hold is also helpful for babies who like to be in a more upright position when they feed. Hold your baby at your side with the baby lying on his or her back and with his or her head at the level of your nipple. Support your baby's head by placing the palm of your hand at the base of his or her head. 
Cross-cradle or transitional hold: useful for premature babies or babies with a weak suck because this hold gives extra head support and may help the baby stay latched. Hold your baby along the area opposite from the breast you are using. Support your baby's head at the base of his or her neck with the palm of your hand. 
Cradle hold an easy, commonhold that is comfortable for most mothers and babies. Hold your baby with his or her head on your forearm and his or her body facing yours. 
Laid-back hold (straddle hold): a more relaxed, baby-led approach. Lie back on a pillow. Lay your baby against your body with your baby's head just above and between your breasts. Gravity and an instinct to nurse will guide your baby to your breast. As your baby searches for your breast, support your baby's head and shoulders but don't force the latch. 
Side-lying position: useful if you had a C-section, but also allows you to rest while the baby breastfeeds. Lie on your side with your baby facing you. Pull your baby close so your baby faces your body. 
 


Finding breastfeeding support and information 
New moms need support and information when learning to breastfeed. Breastfeeding moms can get help from different types of health professionals, organizations, and members of their own families. 

What did health professionals help with breastfeeding? 
These professionals can help with breastfeeding: 
•    International Board-Certified Lactation Consultants (IBCLCs). IBCLCs are certified breastfeeding professionals with the highest level of knowledge and skill in breastfeeding support. IBCLCs help with a wide range of breastfeeding concerns. To earn the IBCLC certification, candidates must have a medical or health-related education and breastfeeding-specific education and experience. They must also pass a challenging exam. Ask your obstetrician, pediatrician, or midwife for the name of a lactation consultant who can help you. Or find an IBCLC in your area 
•    CLCs (Certified Lactation Counselors) or CBEs (Certified Breastfeeding Educators). A breastfeeding counselor or educator teaches about breastfeeding and helps women with basic breastfeeding challenges and questions. These counselors and educators have special breastfeeding training, usually a one-week-long course. 
•    Doulas (DOO-las). A doula is professionally trained to give birthing families social and emotional support during pregnancy, labor, and birth, as well as at home during the first few days or weeks after the baby is born. Doulas who are trained in breastfeeding can help you learn to breastfeed. 

What types of mother-to-mother breastfeeding support are available? 
Other breastfeeding mothers can be a great source of support. Mothers can share tips and offer encouragement. You can connect with other breastfeeding mothers in many ways: 
•    Ask your doctor or the staff at the hospital where you delivered your baby to suggest a support group. Some pediatric practices have an IBCLC on staff who leads regular support group meetings. 
•    Ask your doctor or nurse for help finding a breastfeeding peer counselor. "Peer" means that the counselor has breastfed her own baby and can help other mothers breastfeed. Many state Women, Infants, and Children (WIC) programs offer peer counselors. 
•    Search the Internet for a breastfeeding center near you. These centers may offer support groups. Some resources include: 
o    Nursing Mothers Advisory Council 
o    Breastfeeding USA 
•    Visit La Leche League International website to find a local La Leche League International support group. 
•    Search the Internet for breastfeeding blogs, message boards, and chats. Social media sites are very popular "gathering places" for new mothers, but do not rely on these resources for medical advice. Talk to your doctor about any medical questions you have. 

What federal programs are available to help with breastfeeding? 
•    WIC program. The U.S. Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (commonly called WIC) offers food, nutrition counseling, and access to health services for low-income women, infants, and children. 
Breastfeeding mothers supported by WIC may receive peer counselor support, an enhanced food package, breast pumps, and other supplies. Breastfeeding mothers can also participate in WIC longer than non-breastfeeding mothers. Many WIC offices have an IBCLC as well.  
 


Breastfeeding may be natural, but it's also a skill that takes practice. Learn what makes a good latch, see different breastfeeding holds, and find out how to tell if your baby is getting enough breastmilk. 

Preparing to breastfeed 
Learn steps you can take before and after birth to help breastfeeding go smoothly for you and your baby. 

Prepare for breastfeeding before birth 
•    Get good prenatal care, which can help you avoid premature birth and a baby in the hospital after you go home. Premature babies (born before 39 weeks of pregnancy) have more problems with breastfeeding than full-term babies.1 
•    Tell your doctor about your plans to breastfeed and ask if the place where you plan to deliver your baby has the staff and setup to support breastfeeding after childbirth. Some hospitals and birth centers have taken special steps to create the best possible environment for supporting breastfeeding. These places are called Baby-Friendly Hospitals and Birth Centers. 
•    Take a breastfeeding class. Pregnant women who learn about how to breastfeed are more likely to breastfeed than those who do not. Breastfeeding classes offer pregnant women and their partners the chance to prepare and ask questions before the baby's arrival. 
•    Ask your doctor to recommend a lactation consultant. You can establish a relationship with a lactation consultant before your baby comes so that you will have support ready after your baby is born. 
•    Talk to your doctor about your health. Discuss any breast surgery or injury you may have had. If you have depression, or are taking supplements or medicines, talk with your doctor about treatments that can work with breastfeeding. 
•    Tell your doctor that you would like to breastfeed as soon as possible after delivery. The sucking instinct is very strong within the baby's first hour of life. 
•    Talk to your doctor about your birth control options after delivery. Some types of birth control interfere with breastfeeding, but many do not. 
•    Talk to friends who have breastfed, or consider joining a breastfeeding support group. 
•    Get the items you may need for breastfeeding, such as nursing bras, covers, and nursing pillows. 

Steps you can take right after birth to get you off to a great start breastfeeding 
•    Cuddle with your baby skin-to-skin right away after giving birth if you are both healthy. 
•    Breastfeed as soon as possible after giving birth. 
•    Ask for a lactation consultant to help you. 
•    Ask the hospital staff not to give your baby pacifiers, sugar water, or formula, unless it is medically necessary. 
•    Let your baby stay in your hospital room all day and night so that you can breastfeed often. 
•    Try not to give your baby any pacifiers or artificial nipples until he or she is good at latching on to your breast (usually around 3 to 4 weeks old). 

Steps your partner can take to help support your breastfeeding 
Talk to fathers, partners, and other family members about how they can help support your breastfeeding. Partners and family members can: 
•    Support your breastfeeding by being kind and encouraging 
•    Show their love and appreciation for all of the work that goes into breastfeeding 
•    Be good listeners if you need to talk about any breastfeeding concerns you might have 
•    Help make sure you have enough to eat and drink and get enough rest 
•    Help around the house 
•    Take care of any other children who are at home 
•    Give the baby love through playing, talking, and cuddling 

Tips for breastfeeding success 
•    Learn your baby's hunger signs. Signs your baby may be hungry include: 
o    Becoming more alert and active 
o    Putting hands or fists to the mouth 
o    Making sucking motions with the mouth 
o    Turning the head to look for the breast 
Crying can be a late sign of hunger, and it may be harder for the baby to latch if he or she is upset. Over time, you will be able to learn your baby's cues for when to start feeding. 
•    Follow your baby's lead. Some babies will feed from (or "take") both breasts, one after the other, at each feeding. Other babies take only one breast at each feeding. Help your baby finish the first breast as long as he or she is still sucking and swallowing. Your baby will let go of your breast when he or she is finished. Offer your baby the other breast if he or she seems to want more. If your baby falls asleep while nursing and you are worried, he or she did not get enough milk, try switching to the other breast or squeeze your breast to encourage more milk to flow and wake up your baby. Learn how to tell if your baby is getting enough milk. 
•    Keep your baby close to you. Skin-to-skin contact between you and baby will soothe his or her crying and also will help keep your baby's heart and breathing rates stable. A soft carrier, such as a wrap, can help you "wear" your baby. 
•    Avoid nipple confusion. Do not use pacifiers and bottles in the first few weeks after birth unless there is a medical reason. If you need to use supplements, work with a lactation consultant. She can show you ways to give supplements that help you and your baby continue breastfeeding. These include feeding your baby with a syringe, a tiny tube taped beside your nipple, or a small, flexible cup. Try to give your baby expressed or pumped milk first. 
•    Make sure your baby sleeps safely and close by. Have your baby sleep in a crib or bassinet in your bedroom so that you can breastfeed more easily at night. Research has found that when a baby shares a bedroom with his or her parents, the baby has a lower risk of sudden infant death syndrome (called SIDS)  
 
Making breastmilk 
Your breasts make milk in response to your baby's suckling. The more your baby nurses, the more milk your breasts will make. Knowing how your breasts make milk can help you understand the breastfeeding process. 

How is breastmilk made? 
Breasts often become fuller and more tender during pregnancy. This is a sign that the alveoli, cells that make breastmilk, are getting ready to work. Some women do not feel these changes in their breasts. Other women may feel these changes after their baby is born. 
The alveoli make milk in response to the hormone prolactin (proh-LAK-tin). Prolactin levels go up when the baby suckles. Levels of another hormone, oxytocin (oks-ee-TOH-suhn), also go up when the baby suckles. This causes small muscles in the breast to contract and move the milk through the milk ducts. This moving of the milk is called the "let-down reflex." Learn more about the let-down reflex. 
The release of prolactin and oxytocin may make you feel a strong sense of needing to be with your baby. 
 
How do I know if I will make enough breastmilk? 
Many mothers worry about making enough milk to feed their babies. Some women worry that their small breast size will make it harder to feed their babies enough milk. But women of all sizes can make plenty of milk for their baby. The more often your baby breastfeeds, the more milk your breasts will make. 
Your baby's weight should double in the first few months. Because babies' tummies are small, they need many feedings to grow and be healthy. You can tell if your baby is getting enough milk by the number of wet diapers he has in a day and if he is gaining weight. 
If you think you have or will have a low milk supply, talk to a lactation consultant. Visit the Finding support and information section for other types of health professionals who can help you. 

Will my breastmilk change as my baby grows? 
Yes. Your breastmilk changes in the days after birth and continues to change as your baby grows. Learn what will happen with your milk, your baby, and you in the first few weeks. 

Birth 
Milk: Your body makes colostrum (a rich, thick, yellowish milk) in small amounts. It gives your baby early protection against diseases. 
Baby: Your baby will probably be awake in the first hour after birth. This is a good time to breastfeed your baby. 
You (Mom): Let your baby begin the process of searching for your nipple. This baby-led way of breastfeeding can help your baby get a good latch. 

First 12 to 24 hours 
Milk: Your baby will drink about 1 teaspoon of colostrum at each feeding. You may not see the colostrum, but it has what your baby needs and in the right amount. 
Baby: It is normal for the baby to sleep heavily. Labor and delivery are hard work! Some babies like to nuzzle and may be too sleepy to latch at first. Feedings may be short and disorganized. 
You (Mom): Your body is still making colostrum. Take advantage of your baby's strong instinct to suck and feed upon waking every couple of hours to help your milk come in faster. 

Next 3 to 5 days 
Milk: Your mature (white) milk takes the place of colostrum. It is normal for mature milk to have a yellow or golden tint at first. 
Baby: Your baby will feed a lot, at least 8 to 12 times or more in 24 hours. Very young breastfed babies do not eat on a schedule. It is okay if your baby eats every 2 to 3 hours for several hours, then sleeps for 3 to 4 hours. Feedings may take about 15 to 20 minutes on each breast. The baby's sucking rhythm will be slow and long. The baby might make gulping sounds. 
You (Mom): Your breasts may feel full and leak. (You can use disposable or cloth pads in your bra to help with leaking.) 

First 4 to 6 weeks 
Milk: White breastmilk continues. 
Baby: Your baby will now likely be better at breastfeeding and have a larger stomach to hold more milk. Feedings may take less time and may be farther apart. 
You (Mom): Your body gets used to breastfeeding. Your breasts may become softer and the leaking may slow down. 

What if my breastmilk supply goes down? 
If you don't feel as "full" as you did in the first few weeks of breastfeeding, you may worry that you are not making enough milk for your baby. But know that the milk is still there and flowing to your baby. Usually, after a few months of breastfeeding, your body learns to make the right amount of milk for your baby. 
Also, your baby may only nurse for short periods, such as five minutes at each feeding. These are not signs of lower milk supply. Your body adjusts to meet the needs of your baby, and your baby gets very good at getting milk from the breast. It's also normal for your baby to continue to nurse longer on each breast at each feeding. 

What can affect how much breastmilk I make? 
You may make more or less milk, depending on: 
•    How completely milk is removed each time you breastfeed. An empty breast means better milk production. 
•    How often you nurse or pump to remove milk. The more often you empty your breasts, the more milk your breasts will make. 
•    The amount of milk your breasts store between feedings. If your breast stores too much milk between feedings (because your baby doesn't empty the breast), your breast will make less milk. If your breast is emptied, it will make more milk. It is common for one breast to make more milk than the other, and it is normal for babies to prefer one breast over the other. This can affect how much milk you make in that breast. 
How can I make more breastmilk? 
The best way to make more breastmilk is to breastfeed often and to empty your breasts completely at each feeding. 
After emptying your breasts at each feeding, less milk builds up in your breasts between feedings. 
To better empty your breasts, follow these tips: 
•    Use breast massage and compression. 
•    Offer your baby both breasts at each nursing. 
•    Pump after nursing if your baby does not remove all the milk from your breasts. Your breasts will soften when the milk is removed. If the baby empties your breasts, then you can pump to remove milk and increase milk production between nursing sessions. 

What is the let-down reflex during breastfeeding? 
The let-down reflex (also called just "let-down" or the milk ejection reflex) happens when your baby begins to nurse. The nerves in your breast send signals that release the milk into your milk ducts. Let-down happens a few seconds to several minutes after you start breastfeeding your baby. It also can happen a few times during a feeding. You may feel a tingle in your breast or you may feel a little uncomfortable. You also may not feel anything. 
Let-down can happen at other times, too, such as when you hear your baby cry or when you're just thinking about your baby. If your milk lets down as more of a gush and it bothers your baby, try expressing some milk by hand before you start breastfeeding. 
Many factors affect let-down, including anxiety, pain, embarrassment, stress, cold, too much caffeine, smoking, alcohol, and some medicines. Mothers who have had breast surgery may have nerve damage that interferes with let-down. 

How often should I breastfeed? 
You should breastfeed as soon as possible after giving birth. Then, breastfeed your baby every 2 to 3 hours each day so that you will make plenty of milk. This means that in the first few days after birth, your baby will probably need to breastfeed about everyone to two hours during the day and a few times at night. 
Healthy babies develop their own feeding patterns. Follow your baby's cues for when he or she is ready to eat. 


How long should feedings be? 
There is no set time for feedings. They may be 15 to 20 minutes per breast, or they may be shorter or longer. Your baby will let you know when he or she is finished feeding. If you worry that your baby is not getting enough milk, talk to your baby's doctor. 

How do I know if my baby is getting enough breastmilk? 
There are many signs you can watch for to see if your baby is getting enough milk: 
•    Your baby passes enough clear or pale-yellow urine (see the chart below). The urine is not deep yellow or orange. 
•    Your baby has enough bowel movements (see the chart below). 
•    Your baby switches between short sleeping periods and wakeful, alert periods. 
•    Your baby is satisfied and content after feedings. 
•    Your breasts may feel softer after feeding. 
From birth to 3 months old, a baby usually will gain up to 1 ounce of weight each day. Keep in mind that many babies lose a small amount of weight in the first days after birth. Your baby's doctor will check your baby's weight at your first doctor visit after you leave the hospital. Make sure to visit your baby's doctor for a checkup within three to five days after birth and then again when the baby is 2 to 3 weeks old. 
To learn more, watch the video Is my baby getting enough milk? Also, talk to your doctor if you are worried that your baby is not getting enough breastmilk. 

How much do babies typically eat when breastfeeding? 
A newborn's tummy is very small, especially in the early days. Once breastfeeding is established, exclusively breastfed babies who are 1 to 6 months old take in between 19 and 30 ounces of breastmilk each day.2 If you breastfeed your baby eight times a day, your baby will get around 3 ounces per feeding. But every baby is a little different. 

The Newborn Tummy 
At birth, the baby's stomach can comfortably digest what would fit in a hazelnut (about 1 to 2 teaspoons). By around 10 days, the baby's stomach grows to hold about 2 ounces, or what would fit in a walnut. 
 
Typical number of wet diapers and bowel movements in a baby's first week (it is fine if your baby has more): 1 day = 24 hours* 
 

Baby's age Number of wet diapers Number of bowel movements Texture and color of bowel movements
Day 1 (first 24 hours after birth)  1-2 The first bowel movement usually occurs within 8 hours after birth  Thick, tarry, and black 
Day 2 2 3 Thick, tarry, and black 
Day 3 5-6 disposable, 
6-8 cloth 
3 Looser and greenish to yellow (color may vary) 
Day 4 6 3 Soft, watery, and yellow 
Day 5 6 3 Loose, seedy, and yellow 
Day 6 6 3 Loose, seedy, and yellow 
Day 7 6 3 Larger amounts of loose, seedy, and yellow 

If you are using disposable diapers, the absorbency may make it harder to tell if the diaper is wet. Use this chart as a guide but talk to your child's doctor if you are concerned about your child not getting enough milk. 
*Source: American Academy of Pediatrics 

How long should I breastfeed my baby? 
The American Academy of Pediatrics (AAP) recommends breastfeeding as the only source of food for the first 6 months of your baby's life. The AAP also recommends continuing breastfeeding (after starting solid food) beyond your baby's first birthday and for as long as both you and your baby would like.3 The easiest and most natural time to wean is when your child leads the process. But how you feel is also very important in deciding when to wean. 
Your decision may depend on several factors, such as returning to work, your or your baby's health, or a feeling that the time is right. 

When should I not breastfeed? 
While rare, your doctor may advise you not to breastfeed if you: 
•    Take certain medicines, like anxiety medicine or certain migraine medicines, that are dangerous for babies and can be passed to your baby in your breastmilk 
•    Have a specific illness (like HIV or active tuberculosis) 
•    Get radiation therapy, though some therapies may mean only a brief pause in breastfeeding 
If you take medicine or are sick, talk to your doctor before you begin breastfeeding. Medicines that are safe for you to take during pregnancy may also be safe while you are breastfeeding. But you should always check with your doctor before you start breastfeeding. Talk to your baby's doctor if your baby shows any signs of a reaction to your breastmilk, such as diarrhea, excessive crying, or sleepiness. 

Should I stop breastfeeding when I am sick? 
You can usually continue to breastfeed your baby when you are sick, and if your baby is sick. If you need to rest, you can pump or hand express breastmilk for someone else to feed the baby. But if you are sick with the flu, including the H1N1 flu (also called the swine flu), do not touch or be near your baby, so that you do not infect him or her. Have someone who is not sick feed your baby your pumped or expressed breastmilk. 

Getting a good latch 
Getting your baby to "latch on" properly can take some practice. You can try different breastfeeding holds to help your baby get a good latch. Learn signs of a good latch. 

How can I help my baby get a good latch while learning to breastfeed? 
The steps below can help your newborn latch on to the breast to start sucking when he or she is ready. Letting your baby begin the process of searching for the breast may take some of the pressure off you and keeps the baby calm and relaxed. This approach to learning to breastfeed is a more relaxed, baby-led latch. Sometimes called biological nurturing, laid-back breastfeeding, or baby-led breastfeeding, this style of breastfeeding allows your baby to lead and follow his or her instincts to suck. 
Keep in mind that there is no one way to start breastfeeding. As long as the baby is latched on well, how you get there is up to you. 
•    Create a calm environment first. Recline on pillows or another comfortable area. Be in a place where you can be relaxed and calm. 
•    Hold your baby skin-to-skin. Hold your baby, wearing only a diaper, against your bare chest. Hold the baby upright between your breasts and just enjoy your baby for a while with no thoughts of breastfeeding yet. 
•    Let your baby lead. If your baby is not hungry, she will stay curled up against your chest. If your baby is hungry, she will bob her head against you, try to make eye contact, and squirm around. Learn how to read your baby's hunger signs. 
•    Support your baby, but don't force the latch. Support her head and shoulders as she searches for your breast. Avoid the temptation to help her latch on. 
•    Allow your breast to hang naturally. When your baby's chin hits your breast, the firm pressure makes her open her mouth wide and reach up and over the nipple. As she presses her chin into the breast and opens her mouth, she should get a deep latch. Keep in mind that your baby can breathe at the breast. The nostrils flare to allow air in. 
If you have tried the "baby-led" approach and your baby is still having problems latching on, try these tips: 
•    Tickle the baby's lips with your nipple to encourage him or her to open wide. 
•    Pull your baby close so that the baby's chin and lower jaw moves into your breast. 
•    Watch the baby's lower lip and aim it as far from the base of the nipple as possible so that the baby takes a large mouthful of breast. 
 
What are signs of a good latch? 
Signs of a good latch include the following: 
•    The latch feels comfortable to you and does not hurt or pinch. 
•    Your baby's chest rests against your body. Your baby does not have to turn his or her head while drinking. 
•    You see little or no areola (the darker skin around the nipple), depending on the size of your areola and the size of your baby's mouth. 
•    When your baby is positioned well, his or her mouth will be filled with breast. 
•    The baby's tongue is cupped under the breast, so you might not see the baby's tongue. 
•    You hear or see your baby swallow. Some babies swallow so quietly that a pause in their breathing may be the only sign of swallowing. 
•    You see the baby's ears "wiggle" slightly. 
•    Your baby's lips turn outward like fish lips, not inward. You may not even be able to see the baby's bottom lip. 
•    Your baby's chin touches your breast. 

What are some common breastfeeding latch problems? 
Below are some common latch problems and how to deal with them. 
•    You're in pain. Many moms say their breasts feel tender when they first start breastfeeding. A mother and her baby need time to find comfortable breastfeeding positions and a good latch. If breastfeeding hurts, your baby may be sucking on only the nipple, and not also on the areola (the darker skin around the nipple). 
Gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth. Then try again to get your baby to latch on. To find out if your baby is sucking only on your nipple, check what your nipple looks like when it comes out of your baby's mouth. Your nipple should not look flat or compressed. It should look round and long or the same shape as it was before the feeding. 
Get answers to common questions about breastfeeding and pain. 
•    You or your baby feels frustrated. Take a short break and hold your baby in an upright position. Try holding your baby between your breasts with your skin touching his or her skin (called skin-to-skin). Talk or sing to your baby or give your baby one of your fingers to suck on for comfort. Try to breastfeed again in a little while. 
•    Your baby has a weak suck or makes tiny sucking movements. Your baby may not have a deep enough latch to suck the milk from your breast. Gently break your baby's suction to your breast by placing a clean finger in the corner of your baby's mouth. Then try to get your baby to latch on again. Talk with a lactation consultant or pediatrician if you are not sure if your baby is getting enough milk. But don't worry. A weak suck is rarely caused by a health problem. 
•    Your baby may be tongue-tied. Babies with a tight or short lingual frenulum (the piece of tissue attaching the tongue to the floor of the mouth) are described as "tongue-tied." The medical term is ankyloglossia (An-ke-low-GLAH-SIA). These babies often find it hard to nurse. They may be unable to extend their tongue past their lower gum line or properly cup the breast during a feed. This can cause slow weight gain in the baby and nipple pain in the mother. If you think your baby may be tongue-tied, talk to your doctor. 

What are some typical breastfeeding holds? 
Some moms find that the following positions are helpful ways to get comfortable and support their babies while breastfeeding. You can also use pillows under your arms, elbows, neck, or back to give you added comfort and support. Keep trying different positions until you are comfortable. What works for one feeding may not work for the next feeding. 
Clutch or "football" hold: useful if you had a C-section, or if you have large breasts, flat or inverted nipples, or a strong let-down reflex. This hold is also helpful for babies who like to be in a more upright position when they feed. Hold your baby at your side with the baby lying on his or her back and with his or her head at the level of your nipple. Support your baby's head by placing the palm of your hand at the base of his or her head. 
Cross-cradle or transitional hold: useful for premature babies or babies with a weak suck because this hold gives extra head support and may help the baby stay latched. Hold your baby along the area opposite from the breast you are using. Support your baby's head at the base of his or her neck with the palm of your hand. 
Cradle hold an easy, commonhold that is comfortable for most mothers and babies. Hold your baby with his or her head on your forearm and his or her body facing yours. 
Laid-back hold (straddle hold): a more relaxed, baby-led approach. Lie back on a pillow. Lay your baby against your body with your baby's head just above and between your breasts. Gravity and an instinct to nurse will guide your baby to your breast. As your baby searches for your breast, support your baby's head and shoulders but don't force the latch. 
Side-lying position: useful if you had a C-section, but also allows you to rest while the baby breastfeeds. Lie on your side with your baby facing you. Pull your baby close so your baby faces your body. 
 


Finding breastfeeding support and information 
New moms need support and information when learning to breastfeed. Breastfeeding moms can get help from different types of health professionals, organizations, and members of their own families. 

What did health professionals help with breastfeeding? 
These professionals can help with breastfeeding: 
•    International Board-Certified Lactation Consultants (IBCLCs). IBCLCs are certified breastfeeding professionals with the highest level of knowledge and skill in breastfeeding support. IBCLCs help with a wide range of breastfeeding concerns. To earn the IBCLC certification, candidates must have a medical or health-related education and breastfeeding-specific education and experience. They must also pass a challenging exam. Ask your obstetrician, pediatrician, or midwife for the name of a lactation consultant who can help you. Or find an IBCLC in your area 
•    CLCs (Certified Lactation Counselors) or CBEs (Certified Breastfeeding Educators). A breastfeeding counselor or educator teaches about breastfeeding and helps women with basic breastfeeding challenges and questions. These counselors and educators have special breastfeeding training, usually a one-week-long course. 
•    Doulas (DOO-las). A doula is professionally trained to give birthing families social and emotional support during pregnancy, labor, and birth, as well as at home during the first few days or weeks after the baby is born. Doulas who are trained in breastfeeding can help you learn to breastfeed. 

What types of mother-to-mother breastfeeding support are available? 
Other breastfeeding mothers can be a great source of support. Mothers can share tips and offer encouragement. You can connect with other breastfeeding mothers in many ways: 
•    Ask your doctor or the staff at the hospital where you delivered your baby to suggest a support group. Some pediatric practices have an IBCLC on staff who leads regular support group meetings. 
•    Ask your doctor or nurse for help finding a breastfeeding peer counselor. "Peer" means that the counselor has breastfed her own baby and can help other mothers breastfeed. Many state Women, Infants, and Children (WIC) programs offer peer counselors. 
•    Search the Internet for a breastfeeding center near you. These centers may offer support groups. Some resources include: 
o    Nursing Mothers Advisory Council 
o    Breastfeeding USA 
•    Visit La Leche League International website to find a local La Leche League International support group. 
•    Search the Internet for breastfeeding blogs, message boards, and chats. Social media sites are very popular "gathering places" for new mothers, but do not rely on these resources for medical advice. Talk to your doctor about any medical questions you have. 

What federal programs are available to help with breastfeeding? 
•    WIC program. The U.S. Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants, and Children (commonly called WIC) offers food, nutrition counseling, and access to health services for low-income women, infants, and children. 
Breastfeeding mothers supported by WIC may receive peer counselor support, an enhanced food package, breast pumps, and other supplies. Breastfeeding mothers can also participate in WIC longer than non-breastfeeding mothers. Many WIC offices have an IBCLC as well.  
 

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