Breastfeeding FAQs: Getting Started

Whether you're a new mom or a seasoned parenting pro, breastfeeding often comes with its fair share of questions. Here are some answers to common queries that mothers — new and veteran — may have.

When will my milk come in?

For the first few days after your baby's birth, your body will produce colostrum, a nutrient-rich "pre-milk" or "practice milk." Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that aren't available in infant formula.

For some women, colostrum is thick and yellowish. For others, it is thin and watery. The flow of colostrum is slow so that a baby can learn to nurse — a process that involves coordination to suck, breathe, and swallow.

After about 3 to 4 days of producing colostrum, your breasts will start to feel firmer. This is a sign that your milk supply is increasing and changing from colostrum to breast milk, which resembles skim (cow's) milk.

Sometimes a mother's milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don't need much more than colostrum for the first few days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed often to stimulate milk production.

When should I begin breastfeeding?

If possible, try to start nursing within an hour of your baby's birth. This timing takes advantage of the natural wakefulness of a newborn immediately after birth. After the initial period of being alert, a newborn will spend much of the next 24 hours sleeping. So it may be more difficult to get your baby to latch on after those first few hours.

A newborn baby placed on the mother's chest after birth will naturally "root" (squirm toward the breast, turn the head toward it, and make sucking motions with the mouth). To breastfeed, the baby will latch onto the breast by forming a tight seal with the mouth around the nipple and areola. Even if your baby doesn't actually latch on at this time and just "practices," it's still good for your baby (and you!) to get used to the idea of breastfeeding.

In the first few days of life, your baby will want to feed on demand, usually about every 1-3 hours day and night. As babies get older and their bellies grow to accommodate more milk, they will go longer between feedings.

Are bottles or pacifiers OK?

If you plan to exclusively breastfeed, it's best to allow your baby time to practice breastfeeding without being confused by a bottle or a pacifier. Sucking on a bottle or a pacifier requires a different set of skills than breastfeeding. So until breastfeeding is well established (sometime within the first month or so), experts suggest not introducing a bottle or pacifier to avoid "nipple confusion." (But while some babies experience this confusion, others have no problem moving between a bottle and the breast.)

There's also a chance that breastfed babies who are given a bottle early on may prefer it. Since drawing milk from a bottle requires less effort and the milk flows much quicker than at the breast, sometimes babies stop breastfeeding altogether and will only take bottles.

Experts also worry that giving a pacifier early on and often will prevent parents from recognizing a baby's hunger cues, causing a baby to miss necessary feedings. Giving a pacifier occasionally (such as during a circumcision, when baby boys may be given pacifiers with sugar water) is OK and usually won't undermine breastfeeding efforts.

In certain situations, doctors may recommend supplementing your breast milk with formula. If this happens, it's still possible to simulate breastfeeding by feeding your baby through a nursing system that lets formula be delivered through a small tube attached to your nipple.

How do I know that my baby is hungry?

Despite what you might think, crying is a late sign of hunger. Try to nurse your baby before he or she is upset from hunger and is difficult to calm down.

Other signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers' breasts
• stretching
• showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

What is "let-down"?

During the first few days to weeks after delivery, you may feel a pins-and-needles or tingling sensation in your breasts just after your baby starts to suckle. Milk may seep from the other breast. This is called the let-down reflex, or milk-ejection reflex.

The let-down reflex happens when your baby's sucking (or a machine pumping) triggers nerves in the nipple. The nerves send a message to your brain telling it to release milk. The brain releases a hormone called oxytocin that causes tiny muscles in the breast to tighten and squeeze the milk out, or "let it down." Oxytocin also can make you feel cramps in your uterus when your milk lets down. This is helpful in returning your uterus back to its original size. 

Let-down also can happen if a feeding is overdue or before you start nursing (some women have let-down from simply seeing their baby or hearing a baby cry). Or it can happen after your baby is latched on and has sucked a few times. Some women have multiple let-downs during a single feeding.

Some women, however, never have a feeling of let-down, which is OK, too. Even if you don't feel it, you should still see milk coming from your nipple and hear and see your baby swallowing.

How do I latch my baby on correctly?

Many new mothers have trouble getting their baby to latch correctly. An incorrect latch can be frustrating for babies and very painful for mothers.

Here's how you can make sure your baby gets a good latch every time:

1. Make sure your baby's mouth is opened wide and his or her tongue is down when latching on.
2. Support your breast with your hand, positioning your thumb on top and your fingers at the bottom, keeping your thumb and fingers back far enough so that your baby has enough of the nipple and areola (the darker circle of skin around the nipple) to latch onto.
3. Gently glide your nipple from the middle of your baby's bottom lip down to his or her chin to help prompt your baby to open his or her mouth.
4. When your baby opens his or her mouth wide and the tongue comes down, quickly bring your baby to your breast (not your breast to your baby). Your baby should take as much of your areola into his or her mouth as possible.
5. Make sure your baby's nose is almost touching your breast (not pressed against it), his or her lips are turned out (or flanged), and you see and hear your baby swallowing. (You should be able to tell by seeing movement along your baby's lower jaw and even in your baby's ear and temple. Some babies may also make small noises when they swallow that sound like little clicks.)
6. Have a nursing session observed by someone knowledgeable about breastfeeding.

When your baby is properly latched on, you may have 30 to 60 seconds of latch-on pain (this is caused by the nipple and areola being pulled into the baby's mouth). Then the pain should ease. It will then feel like a tug when your baby is sucking.

If you continue to feel pain, stop feeding momentarily and reposition your baby on your breast. If you still feel pain during feeds even after repositioning, talk to your doctor or lactation consultant to make sure something else isn't going on, such as an infection.

How can I tell if my baby is latched on wrong?

If your baby tends to suck on the tip of your nipple, without getting much of your areola, he or she is latched on incorrectly. Babies who tend to latch on wrong also fall asleep at the breast more often and may not seem satisfied because they may not be getting enough. If this happens, break the suction and reposition your baby onto your breast to include the nipple and areola.

Call your doctor or a lactation consultant if:

• you're unable to nurse your baby without pain (you may just need help getting your baby to latch on correctly, or it could be a sign of a nipple injury or breast infection)
• your baby consistently sleeps at the breast
• your baby is nursing but doesn't seem satisfied when feedings are over
• your baby does not gain weight as expected or does not produce the usual numbers of wet and soiled diapers (about 6 wet and 4 soiled each day at first)

How can I tell if my baby is getting the milk?

Once a baby is latched onto the breast, he or she usually takes four to five sucks, followed by a 5- to 10-second pause. Your baby's sucks will increase in number as the quantity of your milk increases. As the milk flow slows, your baby's pattern will probably change to three or four sucks and pauses that last longer than 10 seconds.

Most babies will release the breast on their own. If your baby doesn't release your breast but the sucks now seem limited to the front of his or her mouth, slip your finger in the side of your baby's mouth (between the gums) and then turn your finger a quarter turn to break the suction. Then, try to burp your baby and switch him or her to the other breast.

Newborns will often fall asleep while breastfeeding. If this happens, try to wake your baby by tickling the feet, rubbing the back, or taking off some clothing. Sometimes burping your baby or changing the diaper also can be helpful.

Is there more than one way to hold my baby?

Yes. You can try several different nursing positions (or holds) to figure out which one is the most comfortable for you and your baby.

They include the:

• Cradle Hold: This is the traditional hold many mothers will try from the get-go, holding the baby across the chest and using the arm on the same side as the nursing breast to support the baby.
• Clutch (or Football) Hold: This position holds the baby at your side, under your arm, and is good for the mom who's had a C-section (because the baby doesn't put pressure on the mother's belly), as well as for mothers with large breasts or those who had twins.
• Cross-Cradle (or Crossover) Hold: Similar to the cradle hold, this position involves using the arm on the opposite side as the nursing breast to support the baby. Some mothers find that this hold makes it easier to control how their babies latch on.
• Side-Lying Position: This position, in which mom lies on her side facing the baby, allows moms to get some rest during feedings and is also a common choice for mothers who've had C-sections.

How can I make breastfeeding more comfortable?

Again, it's mostly about finding a comfortable nursing position and proper latch-on — once you've gotten those down, it can make for a truly rewarding bonding experience.

Here are some other things that might help you to relax and enjoy the experience:

• Keep a breastfeeding goodie bag or basket near all of your regular nursing areas at home (next to the bed, on the couch, etc.). Fill it with bottled water, some healthy snacks, a few magazines, your portable home phone or cellphone (so you don't have to get up to answer or make calls), plenty of burp cloths or cotton diapers for dribbles and spit-up, and the remote controls if you want to use a TV, DVD player, or stereo nearby.
• Find the most comfortable seating arrangement and stick to it so that your baby gets comfortable with — and looks forward to — the routine. Many mothers like to sit in a glider or in a cozy chair with armrests.
• Give your feet and back a break. Footstools and pillows can give extra support. Pillows that some women find helpful are the wraparound nursing pillows or the "husband" back pillows with arms on each side for nursing in bed.

How long should I plan to breastfeed my baby?

That's a personal choice. Experts do recommend that babies be breastfed exclusively (without offering formula, water, juice, non-breast-milk, or food) for the first 6 months, and that breastfeeding continue until 12 months (and beyond) if it's working for both mother and baby.

Studies on infants show that breastfeeding can lower the occurrence or severity of diarrhea, ear infections, and bacterial meningitis. Breastfeeding also may protect children against sudden infant death syndrome (SIDS), diabetes, obesity, and asthma.

Breastfeeding also burns calories and helps shrink the uterus, so nursing moms might be able to return to their pre-pregnancy shape and weight quicker. And studies show that breastfeeding helps lower a woman's risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

I'm having a hard time. What can I do?

Nursing comes easily for some moms, but takes time and practice for others. In fact, it can be one of the most challenging and rewarding things you do as a mother.  

While you're in the hospital, seek help from a lactation consultant, who can help you through most of your breastfeeding challenges. If your hospital doesn't provide a lactation consultant, the nursing staff, your baby's pediatrician, or your OB-GYN can be very helpful in guiding you through the dos and don'ts of breastfeeding.

Doctors usually want to weigh infants and evaluate breastfeeding within 24 to 48 hours after a mother and newborn leave the hospital. But if you have any concerns or difficulties before then, make sure to talk to your doctor.

Whatever you do, try not to become too discouraged. With a little patience and some practice, it will likely become easier for both you and your baby in the coming weeks. Like the old saying goes, practice makes perfect.