How to breastfeed: what to expect and what to know
What will the first days of breastfeeding your newborn be like? How will you know you're doing it right? How often should you be feeding, and for how long? And how can you tell if you baby's getting enough milk? We've all the latest advice and research, with expert tips from a La Leche League breastfeeding counsellor
If you've decided to breastfeed your baby – or at least give it a darn good try – you'll need to know practical stuff, like how it all works and how you get your baby to latch onto your breasts correctly. But you'll also need to know what to expect in the week or so – what's normal and what's not, and what might change as the days pass by.
"Breastfeeding is normal and natural but it's something that can take you – and your baby – time to learn," says Justine Fieth of La Leche League GB. "It can take a little while for breastfeeding to feel entirely comfortable. Understanding what to expect from the start, and getting the right support, if you're finding it hard can make all the difference."
So, here's all you need to know about breastfeeding in the first first days...
How soon should I start to breastfeed?
Your breasts have been making colostrum – a special, antibody-rich 'first milk' or 'pre-milk'– during your pregnancy, so they'll be good to go straight after your baby's born.
You – and your baby – may not be good to go quite that soon, however: it does depend a bit on how the birth went and what pain-relieving drugs you've had.
But, if you can, aim to put your baby to your breast within the so-called 'golden hour' after birth. Babies are born with an incredibly strong 'rooting' reflex – in fact, as Unicef has documented1 and, as this YouTube video (amazingly) shows, left alone on your bare-skinned tummy, an alert, vaginally-born newborn will 'breastcrawl' up your body, search for your breast and begin suckling of their own accord.
You shouldn't feel under any pressure to let your baby breastcrawl – it's not for everyone and, in fact, there is a 2016 Iranian study2 that suggests that, if you've had a C-section, it may actually delay the first breastfeed. But responding to this rooting reflex by putting your baby to your breast soon after the birth helps establish the feeding connection and kickstarts your breasts into making more milk3.
What if I can't breastfeed within the 1st hour?
Sometimes, it's just not possible – maybe because you've had a C-section or maybe because your baby's very sleepy.
"Plan to be in close body contact – 'skin-to-skin' – as soon as possible," says Justine, "as this is the best way to establish breastfeeding. If possible, hold or at least touch your baby as soon as you can. Once you are together again, make up for lost time by snuggling together skin-to-skin or lightly dressed."
If your baby was born prematurely and taken to a NICU or neonatal intensive care, the nurses there will show you how to hand express (to allow your baby to get a little colostrum and to get your milk supply going) and they'll also let you have as much skin-to-skin as it medically practical. Later, they will support you to continue breastfeeding when your baby's strong enough to feed from the breast – or maybe even to establish breastfeeding if you weren't able (for whatever reason) to start in the first place.
How do I breastfeed?
Your midwife should help you with at least the 1st breastfeed (do ask if it's not offered!) but here are Justine's basic steps to 'getting a good latch' (getting your baby to attach correctly to your breast for a feed):
- Get comfortable and well supported. Sit back and try to relax.
- Hold your baby close against you, either cradled if you're sitting up or along your body, if you're lying down.
- Keep your breast at its natural level and bring your baby to your breast, rather than the other way round.
- Your baby should now 'latch on', with their chin close to or on your breast, and their head tilted slightly back. As your baby latches on, their lower jaw will be tucked into your breast, well back from the base of your nipple, with their nose free.
Don't worry if your baby doesn't start to suck the moment they latch on. Some newborns do seem to spend a little while licking the nipple before turning the suction on. But then this breastfeeding thing's new to them, too!
Will it hurt?
OK, this is a difficult one. Almost all breastfeeding experts will tell you that, no, it shouldn't hurt, if your baby is latched on correctly (see How do I know if I'm doing it right?, below, for how to tell). And it's true that, if you haven't got the latch spot on, it really can hurt – and you can get some pretty painful damage to your nipples, too.
But we have to say it like it is here and tell you that a good number of women who have a tip-top latch find it hurts, too. Definitely not as much as it would if the latch was wrong, mind (not that they'd know that, of course).
We know that the experts don't want women expecting it to hurt – if we did, then those of us who were getting the latch wrong probably wouldn't seek help to get it right – but, as JoCoffey on our MadeForMums Chat forum says, we don't think it's helpful to pretend it won't ever hurt for anyone with a good latch, either. "It would be good if antenatal care was more honest about breastfeeding," she posts, "and say it can hurt to begin with, even if you're doing it right. Maybe this is because health professionals don't want to put us off?"
So what would this good-latch kind of pain be like? If you've got ultra-sensitive nipples, it could be an ouchy tingle or even a short stab of pain at the moment of latching on. If that's the case for you, take a deep breath in just before your baby latches and breathe out as they latch on (doesn't sound like much but it really helps!)
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For others, it's more of a breaking-your-nipples-in-to-breastfeeding kind of hurt (sort of like it can be for your feet with a new pair of shoes). This tends to reach its peak a few days after the birth and then gradually improve – especially if you use a good nipple cream and, as karen1330170 on our MadeForMums Chat forum recommends, "let your nipples air as much as you can – I used to walk around with them hanging out in the house when they got really sore!"
If you've had a C-section, your surgery may make it difficult to find a good, pain-free position to feed in. You'll probably find it easiest to feed in a side-lying position, as described (and pictured) in our article on best breastfeeding positions for newborns.
You may also notice that you feel some contraction-type tightenings across your tummy as your baby feeds. These 'afterpains', as they're called, are part of the entirely natural process of 'involution', where your uterus (womb) contracts back to its non-pregnant size and expels any remaining blood clots. The reason you feel them when you're breastfeeding is that breastfeeding releases oxytocin, which is the hormone that triggers involution contractions.
A hot-water bottle can help (like it can with period pains) but, if not, your midwife may offer you some ibuprofen (safe, in small doses, when breastfeeding). You should stop feeling afterpains after a couple of days4.
How do I know I'm doing it right?
It can take a few goes for both you and your baby to the hang of breastfeeding. And the really key thing is making sure that you've got the correct latch. If you've not got your baby 'plugged in' right, you may end up getting sore or cracked nipples, your baby may end up not getting enough milk – and, studies show, you're more likely to stop breastfeeding earlier than you'd hoped.5
"Getting your baby latched on comfortably is important for preventing sore nipples," says Justine. "You will know breastfeeding is going well when it is comfortable for you, and your baby is able to easily and efficiently get all the milk they need."
Getting the correct latch is a knack – and, like all knacks, it's easy when you know how and pretty frustrating when you don't. Your midwife should be able to help you get it right (and tell you when it's wrong) but, if you're at all worried or you're feeling pain when you feed, it's definitely worth checking things out with a lactation consultant or a breastfeeding specialist (see Where can I get support?, below)
How often should I breastfeed my baby?
The short answer is very often. At least to begin with. And that's for 3 important reasons:
- Your baby's tummy is (currently) tiny: at birth, it's the size of a small marble and can only hold about 5 to 7ml of milk at a time. So little and often is really the only feeding option at first.
- The more frequently you feed in the early days, the more milk your breasts will be primed to produce – meaning that when your 'regular milk' comes in (sometime between the 2nd and 5th day after the birth) to replace the colostrum your baby's feeding on right now, your supply should easily be able to keep pace with your growing baby's need.
- Your baby digests your milk (both your colostrum and 'regular' mature milk) more easily – and therefore more quickly – than formula milk. So they're likely to want to eat again sooner.
So how much is very often? "In the early weeks, a baby needs to breastfeed every 2 to 3 hours, or at least 8 to 12 times in a 24-hour period, including at night," says Justine. "Frequent nursing is normal, partly because breastmilk is a drink as well as a food."
Rather than watching the clock or trying to stick to a schedule, it's easier (and less stressful) to feed 'on demand'.
This means watching your baby for the signs that they're ready for more milk. Offering your breast before they get really hungry can avoid crying and means you'll both be calmer. And a calm baby will find it easier to latch on than a ravenous one.
Clues that your baby is ready for another feed include 'rooting' movements, such as:
- Turning their head, opening their mouth and moving their tongue in and out for an imagininary nipple
- Nuzzling against your breast when you're holding them
- Crying (though this is generally a late hunger sign – and it's better, if possible, to get feeding before the wailing set in)
And it's also important to know that feeding on demand doesn't mean feeding every time your baby cries: crying isn't always a sign of hunger; your baby may need a clean nappy, a sleep or a cuddle instead.
Will my baby breasfeed less often as they get older?
Probably. Most breastfeeding experts won't give you an exact answer on this one, partly because they know that all babies are different (some will like to feed little and often, and others drink more at one time and go longer between feeds) and partly because they'd rather you carry on feeding your baby responsively, looking for hunger signs, rather than putting your baby on a feeding schedule.
That said, as they get bigger and their tummies can hold more milk, most babies will drink more and go longer between feed. So, as a very rough guide, by the time your baby's 3 months old, they might feed every 3 hours, including at least 1 or 2 night feeds.
How long should I breastfeed for each time?
This will change a lot as your baby grows (older babies get very efficient at filling their tummies with breastmilk super-quickly) but, for now, you should expect each feed to take a good while. Your baby is a beginner at this, just like you.
Opinions differ on what's a normal length for a newborn feed – here at the MadeForMums office, some of us have babies whose first breastfeeds were 15 to 20 minutes; others remember feeds for up to an hour – so, again, it's best not to clock-watch but to accept that you'll be stuck on the sofa (or wherever) for a while.
Make sure you have plenty of cushions for your back, and a within-reach stash of everything you might need for a while (phone, drink, TV remote and so on).
Above all, give yourself permission to prioritise feeding over anything else in the first few weeks. Other stuff can wait till you've got the breastfeeding established. As Mummybunny on our MadeForMums Chat forum says: "Breastfeeding in the first few weeks is literally a full-time job, on top of all the other bits of looking after a baby. I wish I'd known that I shouldn't expect myself to do anything other than look after her."
Breastfeeding baby poo: what does it look like? And how is it different?
After the first sticky black-green newborn meconium poos, a breastfed baby will have soft yellowy-mustardy-coloured poos – sometimes a bit grainy-looking, sometimes a bit creamy-looking, sometimes really quite liquid. They may well poo after nearly every feed, certainly in the first few weeks.
A formula-fed baby, by contrast, will have poos that are firmer and more peanut-butter-coloured – and they may not poo as often.
How do I know my baby's had enough breastmilk?
Once your baby's had their fill, they'll probably fall asleep – or look completely zoned out – and your nipple will (gradually) fall out their mouth.
"Watching your baby (and their nappy!) is a good way to see if they're getting enough milk," says Justine. "Listen for swallowing as your baby feed: the rate will often slow towards the end. And most babies will come off the breast when they are full."
Parents who bottlefeed can, of course, tell exactly how much their baby's had at each feed, and over the course of a day –and night! But that's not possible if you breastfeed – and when you're starting out and want to know that your baby's eating enough to stay healthy and gain weight, it can be a worry.
"In a world where everything is measured, it can be nerve-wracking when you can’t see how much milk your breasts are making," says Justine. "But breastfeeding is so much more than milk, and there will be times that your baby wants to breastfeed for comfort, warmth and just to be close to you. You are the centre of their world, and being at your breast meets so many of their needs.”
A breastfed baby who's feeding well will have 2 or 3 wet nappies in the first 48 hours, rising to about 4 to 6 a day by day 5. For the 1st couple of days, their poos will be greeny-black and sticky (meconium) and then they'll have regular loose yellow bowel movements. They'll also look alert when awake and seem contented after a feed. If your concerned that your baby isn't getting enough milk, do phone your health visitor or make an appointment to see your GP.
Should I offer both breasts at every feed?
You can – but you don't have to.
"In the very early days, it’s good to offer both breasts each time," says Justine, "to make sure your baby is getting all the milk they need, and also to help ‘signal’ to your breasts to make more milk. The more milk that your baby takes from your breast, the more milk you will make. Later on, your baby may be happy with one breast, all the time or sometimes – you’ll know as you get to know your baby what’s right for them and you."
If you do offer both breasts at a feed, always start the next feed with the breast you offered last. If you find it tricky to keep track (and it can be challenge, especially in the middle of the night), try using a bracelet or a hairband: pop it onto the wrist nearest to the breast you didn't feed from (or only fed a little from). When the next feedtime comes round, you only need to glance at your wrists to see which side is 'go'.
Can you overfeed a breastfed baby?
No. The NHS advice is unequivocal about this:6 "You can't overfeed a breastfed baby, and your baby won't become spoilt or demanding if you feed them whenever they're hungry or need comfort."
That's because there's some pretty firm evidence7 that breasted babies are pretty good at deciding how much to eat and when to eat it. It seems that both the breastmilk itself and the way your baby feeds helps them develop healthy eating patterns, meaning that they're better able to regulate their food intake than formula-fed babies, and so are at lower risk for obesity.
What happens when my milk comes in?
Sometime between the 2nd and 5th day after the birth (which, with exquisite timing, is often just when the 'baby blues' are likely to hit), the colostrum in your breasts gives way to bigger doses of mature milk. And all of a sudden your breasts swell and feel rock-hard. They may even throb or leak, too.
This should only last a couple of days until things settle down again. But those couple of days can be a bit of a pain – literally for you and logistically for your baby, who's suddenly having to latch on to something of an altogether different size and shape.
If your baby's having trouble latching on to your new boulder-boob, try putting a warm flannel on your breast before a feed to soften things up. If you're super-careful (and you're not dead tired), you could also try feeding in the bath.
To soothe things for yourself, try wrapping a small bag of frozen peas in a tea towel and stuffing it down your nursing bra. You could also take an ibuprofen-based painkiller (check with your midwife or health visitor first that it's a suitable medication for you).
And, as counter-intuitive as it might seem, don't skip or skimp on the breastfeeds. Or you'll swell up even more. "Keeping the milk moving," says Justine, "by feeling little and often, is the best way to overcome being engorged."
Having said all this, don't panic if your milk comes in nice and politely. It does for the lucky few, like PinkToothbrush on our MadeForMums Chat forum: " Everyone keeps saying that my boobs should be like boulders and really, really tender but that's not been the case. It was never the case for me and I've breastfed 2 babies! I did worry I'm not producing enough of the good stuff as I never see or feel any of it but my baby's weight gain says I am and he's happy, so it's all good."
What is letdown – and what does it feel like?
The letdown reflex or milk ejection reflex (MER) is your body's automatic physical response to your baby suckling at your breast. The action of sucking releases the hormones oxytocin and prolactin and these cause the muscle cells around your milk glands to contract and squeeze out breastmilk.
"Some women experience the letdown reflex as a tingling or warm or even briefly painful sensation in their breast," says Justine, "but not everyone does."
You can sometimes experience letdown when you're not breastfeeding – maybe when you hear your baby cry, during a warm shower or even during sex.
Why is my baby feeding all the time?
One thing breastfeeding isn't – particularly when you're starting out – is predictable. One day, your baby will feed a fairly regular intervals for a fairly consistent length of time; the next, they'll be wanting to feed all the time. The main thing to know is that it will pass!
Feeding all the time, in the early days, is probably either cluster-feeding or the beginnings of a growth spurt. And the response to either is patience and quiet – and belief that it won't last for ever.
"It’s very common for babies to nurse frequently – or ‘cluster-feed’ – in the evening," says Justine. "Your baby is stocking up for the night and putting in his order for tomorrow! Many young babies have a 'fussy period' of a few hours each day, when they especially need lots of calming and soothing. This is most commonly, though not always, in the evening and first part of the night, and tends to build in intensity over the next few weeks."
Turning off the lights and being quiet can help, as can swaddling, rocking, going outside or even handing your baby over to another pair of hands for a while. Hold tight to the thought that, often, cluster-feeding is followed by a longer-than-normal night-time sleep (fingers crossed!).
Growth spurts are nearly always preceded by a milk frenzy, when your previously settled baby is suddenly desperate for loads more milk than usual. This milk frenzy tends to continue for a few days, and then settle again. Growth spurts can happen at any time but are, anecdotally, most common at 3 weeks, 6 weeks and 3 months.
Will I need to wind or burp my breastfed baby?
Maybe but, anecdotally speaking, breastfed babies tend to need burping less than bottlefed ones – probably because they swallow less air when feeding. There are lots of techniques for winding but the simplest is to hold your baby so their chin is resting on your shoulder and one hand is supporting their bottom, then gently rub or pat their back with your other hand.
Why are my breasts leaking?
Leaking can happen if your letdown reflex is strong and also when your milk comes in. If this is you, don't go anywhere without a good supply of breastpads and spread a towel under you at night. Thankfully, leaking tends to stop of its own accord in the first few weeks.
This all sounds quite complicated. Does it get easier?
Yes! As with all new skills, breastfeeding can be tricky at first. You and your baby may take a while to get it right. And you could find some days (and night) really quite tough. But, once the first few weeks are over, and you're both more skilled and efficient at the whole breastfeeding process (and your nipples are less sore), you'll probably begin to feel pleased that you're not having to make up bottles in the night or pack lots of tins and flasks every time you leave the house.
When can I introduce a bottle?
Whether you're thinking of expressing breastmilk or introducing mixed feeding, it's best to wait till your baby has got the hang of breastfeeding first.
"If you can," says Justine, "wait until after the 1st 3 or 4 weeks. Milk supply can adjust to your baby’s needs more easily if they are able to breastfeed directly, and the more practice your baby gets at the breast, the more quickly they will become skilled at breastfeeding.
"Sometimes, parents can worry that if they don’t introduce a bottle early on, the baby won’t take one later. While a younger baby is slightly more likely to accept a bottle than an older one, it’s not a strong effect. Most babies of all ages will accept a bottle – some with a little coaxing!"
Breastfeeding terms: explained
Colostrum: the very first milk your breasts make. It's very concentrated and is full of antibodies, white blood cells and protein.
Cluster-feeding: when your baby feeds many times within a few hours. Some do this, either often or occasionally, and particularly in the evening, before a long nap/sleep or when they are teething, ill or are about to have a growth spurt.
Dream-feeding: when you feed your baby late in the evening without waking them, before you go to bed yourself, in order (hopefully) to encourage them to sleep longer at night. It's a technique both breastfeeding and bottle-feeding parents use but isn't recommended until your baby is at least 3 months old. We're including it here, just in case you hear it mentioned.
Latch: the way your baby attaches their mouth to your breast in order to breastfeed. Getting the correct latch is key to making breastfeeding successful and comfortable.
Letdown: your body's physiological response to your baby sucking at your breast, triggering the release of breastmilk.
Mature milk: the richer, more free-flowing milk that replaces colostrum in your breasts on about the 2nd to 5th day after the birth.
Where can I get help with breastfeeding?
- La Leche League GB (LLLGB). They have local leaders (all breastfeeding counsellors) you can call and support groups in many areas where you can meet with other breastfeeding mothers and get support from LLLGB's accredited counsellors. LLLGB also runs a helpline on 0345 120 2918.
- Association of Breastfeeding Mothers (ABM) helpline. Call 0300 330 5453 (open every day, 9.30am to 10.30pm). ABM also runs local support groups and webchat breastfeeding support.
- NCT National Breastfeeding helpline. Call 0300 330 0700 (open every day, 8am to midnight).
- National Breastfeeding helpline. Call 0300 100 0212 (open every day, 9.30am to 9.30pm)
- The Breastfeeding Network supporter line in Bengali and Sylheti: Call 0300 456 2421
About our expert Justine Fieth
Justine Fieth is a trained breastfeeding counsellor based in Cambridge, who is on the Council of Directors of La Leche League GB. She is co-founder and trustee of the Cambridge Breastfeeding Alliance, and became a recognised post-natal doula in 2016. She is now part of Doula UK and Cambridgeshire Doulas. Justine has extensive experience in helping families with a wide-range of breastfeeding issues, including breastfeeding babies with tongue-tie, twins, premature babies, and slow-weight gain babies.
1 'Breast crawl' phenomeon benefits mothers and newborns. 8 August 2007
2. Comparison of Breast Crawl Between Infants Delivered by Vaginal Delivery and Cesarean Section. Heidarzadeh M et al. Breastfeed Med. 2016 Aug;11(6):305-308
3. Oxytocin effects in mothers and infants during breastfeeding. Moberg K, Prime D. Infant Vol 9 Issue 6 2013
4. Pain relief for after pain (uterine cramping/involution) after the baby's birth. Duessen AR et all, Cochrane 11 May 2011
5. Latching-on and suckling of the healthy term neonate: breastfeeding assessment. Cadwell, K. Midwifery Womens Health 2007 Nov-Dec;52(6):638-42
6. Your breastfeeding questions answered: NHS online
7. Breastfeeding as obesity prevention. Moreno MA et al. Arch Pediatr Adolesc Med. 2011;165(8):772. doi:10.1001/archpediatrics.2011.140
Helen is author of the classic advice book Parenting for Dummies and a mum of 3. Before joining MadeForMums, she was Head of Community at Mumsnet and also the Consumer Editor of Mother & Baby.
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