The Ultimate Guide to Breastfeeding

Why I wrote this ultimate breastfeeding guide

HELLO!!! Pediatrician mama here! You want to breastfeed your baby? YAY!!! To help all mamas, I created this “ultimate guide” to help you mamas familiarize yourselves with all things breastfeeding. Each section will include links for you to to take an even deeper dive into topics that interest you.

Did you know that breastmilk is the perfect food for your baby? So perfect in fact that the American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of a baby’s life. AAP also suggests that breastmilk remain a major component of baby’s nutrition for at least the first 12 months of your baby’s life. The World Health Organization, UNICEF, La Leche League, and numerous other organizations also encourage breastfeeding. Why you ask? Well it’s not just for funzies. It has numerous benefits for baby (and you, mama!). 

But while breastfeeding can seem like the most natural thing in the world, there’s actually A TON to know. And I’m here to help. It takes A LOT of hard work, tears (believe me, I know!) and dedication. But the bond your form and reward of knowing you’ve nourished your baby from your own body is totally worth it (in my experience!).

*Important: breastfeeding may not be for you and that’s okay*

Before we get started, I think it is really critical to let you know that as you embark upon the journey of learning and dreaming about breastfeeding, the hard reality is that not all mamas are able to successfully breastfeed. And if that’s you, YOUR BABY WILL BE TOTALLY OK! While there are a lot of benefits to breastfeeding, at the end of the day it is only one component to raising a happy, healthy child. While successful breastfeeding may seem like everything when your baby is first born, this is ultimately but one guideline you will either follow or not in the long journey of raising your little human.

Always remember: We’re all perfectly imperfect and exactly the parent our baby needs.

What is Breastmilk?

Breastmilk is perfect food for your baby! It is chock full of nutrients and other components that help feed and protect your baby. Your breastmilk also changes in the first several weeks of your baby’s life to accommodate the needs of your growing baby. I describe the different types of breastmilk below.

First type of breastmilk: colostrum

This is the first milk your body produces. You may have noticed your breasts becoming fuller while you were pregnant. This is because even before your baby is born your body is already working to produce this “liquid gold.” Isn’t your body amazing?! When your baby is born (and sometimes even before!) your body will begin to release the colostrum. The first colostrum is only present in very small amounts. It steadily increases over the first several days of your baby’s life.

Colostrum contains extra high levels of antibodies and white blood cells. This is mama’s way of helping to boost her baby’s immune system. Colostrum includes components that help to coat your baby’s immature gut lining and components that have a laxative effect. This is important to help your baby pass her first sticky meconium poop. The colostrum also gives your baby a nutritional boost! That is because it contains higher levels of certain vitamins and proteins than later milk.  

Second type of breastmilk: transitional milk

About 2-4 days after delivery, you should notice your breasts becoming fuller and the volume of milk increasing. This is often described as your milk “coming in.” For the next few weeks, you will be producing what is known as “transitional milk.” As its name suggests, transitional milk is making the transition from colostrum to more mature milk. During this time, your volume of milk will steadily increase. Your milk will become higher in fat and sugar component and decrease in the amount of vitamins, protein and immune components. But don’t worry! Your milk still contains plenty of those components. Just not quite the “boost” amount your baby needed in her first few days.  

Third type of breastmilk: mature milk

Somewhere between weeks 2-4, your milk will reach its steady state. Amazingly, your body will keep producing this high quality milk for the rest of the time your baby is breastfeeding. While the average composition stays relatively steady, the exact components can still vary from day to day, and even hour to hour. The composition actually adjusts to many different factors in you and your baby’s lives!

The American Academy of Pediatrics has some excellent resources on colostrum and transitional and mature milk.

What is breastmilk made of?

The current understanding of what exactly is in breastmilk is constantly changing and expanding. Here are some of the most important components:

How does your body produce breastmilk

Did you know that your body is already starting to produce colostrum as early as 16 weeks in your pregnancy? But all of the components to produce milk are present long before you even became pregnant, in fact, it’s your breast’s primary function! Most of a woman’s breasts are made up of fatty tissue. But within that fatty tissue are milk producing glands known as lobules. The lobules remove water, nutrients and other components from your blood stream to create the milk. The milk is then stored in the lobules until it is ready to be released. Special hormones and your baby’s sucking tell your lobules it is time to release the milk into the milk ducts and also tell special muscles in your breasts to contract. The milk moves through the milk ducts, which connect to tiny holes in your nipple where the milk leaves your body.

If you’re interested in learning more, check out this really cool video that takes you through the whole process!

Health benefits of breastfeeding to Mother and Baby

Nutritionally, breastmilk is the perfect food for your baby. So perfect in fact, that your baby does not need anything else in his first 6 months of life. Breastmilk is easier to digest than formula and promotes gut health. It confers immune benefits through immunoglobulins and immune cells passed from mother to baby. Baby’s who are breastfed have a lower risk of sudden infant death syndrome and lower rates of certain health conditions later in life.

For mom, breastfeeding provides many benefits. These include helping to foster a strong bond with your baby, convenience (no bottles!), and lower costs (it’s free!). It also can help speed up your post partum recovery and decreases your risk of certain health conditions too!

How early can I start breastfeeding?

Well, not to be flippant, but really the answer is as soon as possible. Ideally within the first hour of baby’s life. This is known as the “magic hour.”

The magic hour for breastfeeding

The reflex to feed is so natural that many babies will find her own way and latch all on her own. This process is known as the “breast crawl.” I must admit that I don’t really remember this, post c-section haze and all. But I had explained my wishes to my husband and delivery room nurse. As soon as it was safe (and while still in the operating room!), they helped place my daughter skin to skin on my chest. By the time we made it to the recovery room, that little champ dove down, nuzzled right into my breast and latched right on with little to no help from her woozy mama! I’ll never cease to be amazed by the tenacity of newborns. Check out this video of a newborn baby in action!

But starting to breastfeed later will work too

And what if your baby doesn’t latch (even with help) in that first hour? Or maybe for some reason you and baby are separated for at birth. Please, DON’T panic! It’s ok. The sucking reflex is strong. Babies maintain the ability to initiate breastfeeding up to 6 or even more weeks after birth. So missing that “golden hour” does not mean an end to your chances for successful breastfeeding. Not by a long shot! However, your milk production works on a supply and demand basis. So if you encounter barriers early on, be sure to talk to your birth team about initiating pumping or other methods to start and maintain your breastmilk production.

Tips to help your baby latch for good breastfeeding

To breastfeed, your baby needs to “latch on.” This is when your baby is properly attached to your breast with his mouth wide open over your nipple, covering most of your areola, and his nose, lips, and chin close to your breast. So how do you get your baby to latch?

Get in a comfortable breastfeeding position

To actively help your baby latch, first make sure you are in a comfortable breastfeeding position. With one hand holding your baby, cup your breast in your other hand and stroke your baby’s cheek and lips with your nipple. This will action stimulates your baby’s rooting reflex and lets him know food’s nearby. He should open his mouth and begin readying to suckle. When your baby’s mouth is open wide, aim your nipple toward the roof of his mouth and bring his whole head and body in close to your breast. Ideally he should then “latch on” and start suckling.

Baby led latching

If you prefer to allow your baby to come to you, you can also try a “baby led latching” approach. In this “laid back” approach to breastfeeding you lie on your back and place your baby on your chest. Make sure your baby is facing your breast so she can easily see and smell your nipple. As you might expect, your baby will begin to explore her surroundings until she finds your nipple and latches on!

Signs of a good latch when breastfeeding

Man, so you’d think that when I first started to breastfeed my baby I would have the latch thing down. Nope…how I wish I had the information I’m giving you below in those early days. My daughter latched on like a champ, but it was crazy painful. I didn’t get very good guidance in the hospital on how to assess the latch. As a result, I suffered needlessly for a week. It turns out she was in effect biting my nipple. But we got things figured out. After I learned how to make sure my daughter had a good latch (plus the confidence to “reset” a too shallow latch), life got Waaaaaaay better!

How do you know if the breastfeeding latch is good?

So your amazing baby has crawled into position, or you’ve successfully gotten him to latch. Now how do you know if you have a good latch? Having a good latch is important for several reasons. It ensures your baby is able to successfully stimulate and empty your breast. This tells your body to produce the proper amount of milk. As a result, your baby receives all the amazing milk he needs to grow and develop properly. But a good latch isn’t only important for baby. It also helps to reduce the chances of painful breastfeeding and injured nipples. So how can you tell if the latch is good?

Fish lips mean good breastfeeding

When your baby has latched properly, you should see his lips flanged out (aka “fish lips”). Your entire nipple and even some breast tissue should be in his mouth.

Don’t be afraid to relatch for proper breastfeeding

If your baby is only sucking on your nipple -ouch!- don’t be afraid to take her off the breast and help him relatch. Just gently press down on your breast near the corner of her mouth with your finger to help break the seal and separate his lips from your breast. Make sure his mouth is open wide. Then try to point your nipple towards the roof of her mouth. This can help to ensure a deeper latch the second time around.

No pain for a good breastfeeding latch

Another clue to a proper latch is pain, or lack thereof. A good latch shouldn’t be painful. If it is, that’s a sign something might need to be adjusted. Some mamas may find breastfeeding a bit uncomfortable, particularly in the early stages. But it definitely shouldn’t be painful. The feeling usually should be akin to a tugging sensation.

Different breastfeeding positions

A lot of breastfeeding is trial and error and the position you feed your baby in is no exception. I personally liked starting with a cross cradle hold. Once my baby was settled in, I’d readjust to the cradle hold. But some days I’d mix it up. And the side lying hold was a lifesaver during those times when I was too exhausted to sit upright. All babies and mamas are different. Feel free to experiment with different positions to find the one that is right for you and your baby. I’ve listed a few of the most common below:

First breastfeeding position: cradle hold

This is the most common, and probably most familiar position to most mamas. In this hold you “cradle” your baby with the arm that is on the same side as the breast you are nursing from. Your baby’s head is held in the corner of your elbow. You can use your free hand to help with positioning and stimulating your baby to suckle.

Second breastfeeding position: cross-cradle hold

This was my personal favorite. It is very similar to the cradle hold, except that you are using the arm opposite the breast you are feeding from to hold the baby. Your hand supports your baby’s head instead of your elbow. I personally found that this setup helped me better position her head for a proper latch.

Third breastfeeding position: football hold

This is a great position for mamas who have just had a c-section, have larger breasts, or who need to feed twins at the same time. In this one, you hold your little baby just like a little football, with your hand cradling her head and the rest of her body nestled along the side of your body supported by the remainder of your arm. Rather than having your baby lying flat, this position is generally easier if you have your baby at a slight incline with the head at the level of your breast and bottom near your waist.

Fourth breastfeeding position: side lying hold

Great for those tired, middle of the night feedings or if you’ve had a c-section. Just like it sounds, you lie on your side and lift your breast to your baby. You baby is lying on his side next to you.

For those of you mamas who are visual learners, here’s a great pictorial of all the different holds I just described.

The supply and demand theory of breastmilk production

How does your body know how much milk to produce? While it seems like magic, it’s actually not. Your body produces milk based on the demands placed on it by your baby (or pump).

Need frequent breastfeedings

That’s why in the early days of nursing it’s so important to put your baby to breastfeed frequently, at a minimum every 2-3 hours (8-10 times per day), but sometimes even more often. At various timepoints, babies will “cluster feed” and want to nurse almost constantly or every hour for a period of several hours, this is like a marathon session for your breasts, telling them to kick into high gear and MAKE MORE MILK!

Unless there are concerns about latching or you’ve been giving instructions otherwise, you should generally encourage your newborn to breastfeed as frequently as she wants. This will ensure that your body is able to respond to your baby’s requests to continue to ramp up milk production. Generally your milk production will increase by about 1 ounce per week until it hits a maximum of about 4 ounces at 4 weeks of your baby’s life.

Triple feeding

Sometimes if there are problems getting a baby to latch successfully a mama will be advised to breastfeed for a set timeframe and then pump, feeding the expressed breastmilk back to her baby. This is a strategy known as triple feeding. This allows the baby to get comfortable feeding at the breast, while also ensuring mama’s breasts are getting the stimulation they need to maintain or increase supply. This is fairly complicated and stressful and typically only short term measure while the latching issues are sorted out.

When my first baby was first born, she wasn’t latching effectively (boy do I wish I knew the tips above). This poor latch lead to my milk being slow to come in. I used the triple feeding technique to get us through those first several days while we worked out the latching issues. Here you can read more about my personal experience with triple feeding as well as learn tips and tricks I’ve used to help myself and mamas of my little patients make it through this tough time. 

What if the breastfeeding latch is painful or my baby can’t latch?

There are lots of different reasons why you may be experiencing pain with breastfeeding. Here is a brief guide to help get you trouble shoot potential issues in the first few days of breastfeeding:

Shallow or improper breastfeeding latch

From personal experience, I can tell you this one is no joke! Thankfully, it’s the most common reason and also often the easiest to fix. Making sure that the latch is deep enough is important to prevent pain. Many new moms don’t realize that the baby doesn’t only latch onto the nipple, but that at least ½ inch up to the entire areola (the flat darker skin around your nipple) and sometimes some regular breast tissue might also be in your baby’s mouth. Otherwise, instead of sucking and drawing milk out, your baby just ends up biting down on your nipple! Follow the tips above to help achieve a deeper latch. If you are having trouble on your own, enlist the help of your nurse, a lactation consultant or other qualified helper to work on achieving a good latch.

Tongue tie/lip tie

Babies have a small amount of tissue under their tongue and between their lip and gums that help to connect the tongue and lips to the floor of the mouth and the gums. This tissue is called a frenulum and sometimes the frenulum has some extra tissue or is a bit too tight. While this is a very hot topic, many babies and mamas have seen a dramatic improvement in latch after having some of this tissue removed in a procedure known as a frenulectomy. Your pediatrician or lactation consultant can help you decide if this warrants further evaluation by a pediatric dentist or Ear nose and throat specialist.

Nipple trauma

Your baby is breastfeeding constantly, and your poor tender nipples just aren’t used to all that attention. Sometimes there’s nothing wrong per se, but your nipples just need a little TLC to get them through those first few days and weeks. There are many strategies that promote healing and help prevent reinjury. Try baby and mama-safe nipple creams, test out a nipple shield while nursing or breast shields when not nursing, spend time topless. These are only some of the many techniques out there to help. I personally found using lanolin to soothe my skin and using wool nursing pads worked for me. 

Other causes of boob and nipple pain when breastfeeding

Ok, so your latch is good, your baby isn’t tongue tied. Or you’ve been nursing for a while without issue but now you’re experiencing pain. These are some other problems common to breastfeeding mamas.

Infection

Yeast thrive in warm, moist environments. Leaking breasts, bras and nursing pads, even baby’s own mouth can put you at risk for developing a nipple infection known at thrush. Keeping your breasts clean and dry (yes! It’s ok to spend lots of time topless in the early days of nursing -or even long after I won’t judge 😉) can help prevent this.(never had this) But once an infection has set in it is best to get evaluated by your baby’s pediatrician or your own doctor to see if you (and baby) require any treatment. I know from my experience as a pediatrician making sure both mama and baby are properly treated, and any bottles, pacifiers etc are sterilized are key to getting this managed quickly. And don’t worry! Your doctor can set up a regimen for treatment that should cause NO interruption in breastfeeding!

Engorgement

Uggh. Just the name sounds painful. And it is (raises hand, I know from personal experience!) uncomfortable. Rock-hard boobs, leaking, difficulty latching; engorgement can cause all of these. Engorgement is when your breasts are in a state of overproducing breastmilk. It is common in the first weeks of breastfeeding when you are just starting to regulate your supply, or if there is an issue with latch where your baby is unable to empty your breast adequately. It can also be caused by a plugged duct, or through overstimulation through pumping. Thankfully for me, a combination of time (just giving my body time to self regulate) as well as a few days of limiting some feeds to one side only cured the issue for me. If you think you’re dealing with engorgement, here is a great resource that can walk you through the different types of engorgement and potential solutions.

Vasospasm and Raynaud’s phenomenon

These are both caused by constriction of blood vessels in the nipple. The nipple can turn white and become very painful. Both vasospasm and Raynaud’s are most likely to be triggered by cold and trauma, although Rynaud’s Phenomenon is more likely to be associated with other symptoms and more severe pain. Healing or avoiding trauma and preventing cold nipples or applying heat are all strategies to help. A doctor’s visit is in order if the pain is severe or persists despite treatment. Here is a good source if you’re looking for more information.

Mastitis

Painful, sore, red or inflamed breast? You might have mastitis, which is an inflammation of the breast. Sometimes an infection can enter through damaged nipple tissue, but it’s usually caused when a milk duct becomes blocked and the milk backs up, causing inflammation and later infection. Treatment focuses on relieving the blockage (rest, heat, massage, and continuing to breastfeed your baby are all part of the treatment). If serious or not resolving your may also need to treat any infection. Let your doctor know right away if symptoms seem serious, you have any fever or chills or do not improve quickly.

Blebs and blisters

Do you have a tiny swollen milk spot on your nipple that won’t go away? It’s probably a bleb or blister. These occur when skin grows over the milk duct in your nipple. The inflammation that leads to the bleb or blister can be caused by a multitude of factors. Oftentimes troubleshooting the source of the irritation coupled with warm soaks and time is enough to relieve the bleb. But if they persist you may require medical evaluation as these can lead to mastitis.

Breastfeeding etiquette

“May I ask how your feeding is going my little love, it seems you’ve lost some interest in my one breast.” “Yes mama, I think I’ve emptied it, may I please have a go at the other side?” “Of course my dear, please be patient and I shall switch you over post haste!”

Ok, so you’re not really going to banter with your baby a la Downton Abby style, but “breastfeeding etiquette” is actually a thing and following good etiquette while breastfeeding can help set you and baby up for success. Good etiquette means allowing your baby to fully empty one breast (to ensure they are receiving a good mix of the early “foremilk” and fat rich “hindmilk” and then being sure to at least offer the second breast.

Don’t forget to use both breasts for proper breastfeeding

Often babies will slow down or lose interest in the breast not because of a lack of hunger but because they can sense they have emptied the breast. If you offer the second breast, it will ensure your baby has the opportunity to eat her fill. If baby doesn’t fully empty your second breast make sure to offer that breast first with the next feeding (some mamas tie a ribbon onto the bra strap to help remember which side to start on at the next feeding). This will help to ensure you’re keeping up your breast milk supply and helps to prevent the dreaded “boob preference.”

Adjust breastfeeding guidelines as needed

It’s important to note that like any etiquette rules there are exceptions. This rule generally applies when you are confidently producing the right amount of milk for your baby. You may need to make adjustments if you are experiencing over or under supply. As you can see above, at varying times, I had to triple feed, then deal with engorgement, so there were definitely times when I had to “break” my own rules! But for the majority of my breastfeeding journey I simply relaxed, followed the guidelines above, and always alternated which side we started on.

Well! There you go! I hope that you found this ultimate guide helpful! Be sure to check out my other posts for deeper dives into some of the more challenging topics. And also take a look at these other ultimate guides: