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Guide to Breastfeeding: Getting Started

Marianne is a mother from Scotland who is passionate about providing accurate information about breastfeeding and parenting.

How to Start Breastfeeding: A Guide for New Mothers

How to Start Breastfeeding: A Guide for New Mothers

Breastfeeding was not what I expected. The first few weeks of my baby's life were so intense and exhausting, but also amazing. I had assumed that breastfeeding was only about feeding my baby, but it became much more important than that. Breastfeeding is not just about food. It is a journey involving two people together: the mother and child.

I also noticed that there is a lot of misinformation out there about breastfeeding. Many medical professionals know surprisingly little about it. Many mothers who run into problems are not provided with useful support. I set out to read and learn all I could about breastfeeding.

This article explains how to get started with breastfeeding, and answers some common questions.

The Benefits of Breastfeeding

Here are the main reasons to breastfeed your baby:

  • Breastfeeding is about more than feeding your baby, it is a parenting tool that allows you to bond with, soothe and comfort your baby.
  • Breastfeeding is convenient, at least once you have the hang of it and are in a rhythm. You always have your breasts with you. You don’t need to remember to buy anything in the shops to feed your baby, or have the expense of paying for them. You can’t accidentally leave your breasts behind somewhere.
  • You don’t need to buy any equipment for breastfeeding. There are lots of companies ready to sell you breastfeeding accessories, but for most women, none of these are essential for successful breastfeeding. Some of them are useful, but none vital.
  • There are health benefits for your baby, breastfed babies have a lower risk of sudden infant death syndrome (SIDs), infections, diarrhoea, obesity and heart disease when older.
  • Breastfeeding also brings health benefits to the mother. Evidence shows the longer you breastfeed the lower the risk of developing breast cancer, ovarian cancer, osteoporosis, heart disease and becoming obese.

(Source for the health benefits: Benefits of breastfeeding - NHS (www.nhs.uk))

Why I Chose to Breastfed My Baby

Health bodies around the world recommend you breastfeed for 6 months exclusively. This means your baby is solely fed breastmilk and has no solids, formula or water. As breastfeeding is recommended, I planned to do it before I had my baby. Breastfeeding was also recommended to me by my mum as you don’t need to worry about the faff of bottles or sterilising.

Once my baby was born, breastfeeding felt right. It was hard at first, but once I got the hang of it, it became an important part of how I parented.

Getting Started With Breastfeeding

Ideally, you should have skin to skin with your baby immediately after they are born, and breastfeed them in the first hour of birth. If this doesn’t happen don’t worry, it won’t necessarily mean you have problems with breastfeeding, but you might need a little extra help if birth doesn't go smoothly.

Babies are born with tiny stomachs, so they need to feed frequently at first. In the first few days expect to feed at least 8-12 times in 24 hours.

Learn your baby’s cues for being fed. You want to feed your baby when they are calm, so before they start crying.

Examples of early cues your baby is hungry:

  • Licking lips
  • Opening and shutting mouth
  • Sucking on something

How to Get a Good Latch

There are different ways you can latch your baby in. What’s important is you work out what works for you and your baby.

How to tell if your baby is latched well

  • Baby has a mouthful of your areola, not just your nipple
  • The latch feels comfortable and it does not hurt
  • You can see or hear your baby drinking
  • Baby's body should be in a straight line and they shouldn't need to turn their head

Laidback approach

The ‘laidback' approach is one of the methods that works best with a newborn for many mothers. It's simple:

  1. Lie back, supporting yourself with pillows or cushions as needed
  2. Place your baby on your chest with their head near your breasts
  3. Your baby’s natural instincts will cause them to root, find your breast and latch on

This is usually the method that will be recommended during skin to skin when your baby is just born, but you can keep using it after that. It’s a great position because it allows you to rest a little while feeding. There is evidence that using this method decreases nipple pain and damage, and leads to better positioning.

Here is a helpful video where a mother shows you how she latches her baby in a laid back position.

Lying down breastfeeding

The side lying breastfeeding position is a game-changer because it means you can rest and breastfeed at the same time. It's a good method to try if you are healing from a caesarean section because you can avoid the scar. Not all mothers master this position straightaway, if it doesn't work for you first time, it's worth waiting a few days until your baby grows and trying again.

Many breastfeeding mothers feed their baby in this position and sleep. If you think you are in danger of falling asleep breastfeeding read about how to safely bedshare and try this position.

Below is a video where a lactation consultant shows you how to do this.

Other breastfeeding positions

The other main breastfeeding positions you will hear about are

  • Cross cradle position: this is probably the most useful to try with a newborn, see the video below for guidance
  • Cradle position: this is where you cradle the baby in your arms, it's best when your baby is a little older
  • Football hold: the main difference with this is that your baby is to your side rather than cradled

Remember what works for you will depend on your body shape and your baby. Don't feel you have to master the rules of set positions. The main thing is that your baby is latched well and that you are comfortable. How exactly you achieve this doesn't matter so much.

Why Is a Good Latch So Important?

Issues with latch are a common cause of breastfeeding problems. If your baby does not latch properly:

  • baby may struggle to get enough milk.
  • pain and damage may be caused to your nipples.
  • you may become engorged if breasts not drained effectively, and at risk of develop mastitis.

If you are concerned about your baby’s latch, try different positions to see if it helps. If you keep having issues, seek advice.

How to Tell If Your Baby Is Getting Enough Breastmilk

One of the best ways to tell if your baby is getting enough milk is by what comes out the other end.

As a rough guide here is what you should expect in your newborn baby’s nappies:

DayWet NappiesDirty Nappies

1

Only 1 or 2 in the first couple of days

Black meconium stained nappies

3

Number should gradually increase

Lighter more green coloured poo

5

At least 6 wet nappies a day

Yellow coloured nappies at least twice a day

Your baby should also come off the breast by themselves and seem content.

Lastly your baby should start to gain weight by 2 weeks after they were born.

(Source: Unicef getting breastfeeding off to the best start leaflet)

What Doesn't Tell You Whether Your Baby is Getting Enough Milk

  • How much milk you can express or pump. Some mothers successfully breastfeed, but never manage to express. Other mothers manage to pump lots of milk, but their baby may struggle to get it at the breast
  • Your baby wants to feed frequently all the time, cluster feeding is a way of building milk supply up and normal. Babies also feed for comfort and security, not only milk. However do trust your instinct, if your baby never ever seems content, it may be a sign of an issue.
  • Exactly how long they feed on each side, or exactly how often they feed. As a rough guide a newborn baby will spend 20 - 45 minutes for each feed, and should feed more than 8 times in 24 hours, but that's only a guide.

Bottlefeeding and Breastfeeding

You do not need to use a bottle if you are breastfeeding. If you do decide to use a bottle alongside breastfeeding, wait until you have got the hang of breastfeeding, normally after 5 or 6 weeks.

There are a couple of exceptions, sometimes if you are having problems breastfeeding you may be advised to top up your baby with expressed milk, or formula if you are not able to express milk.

Another reason you might need to introduce a bottle sooner is if you need to leave your baby in the care of someone else, for example, to return to work.

If you bottle-feed, practise paced bottle feeding.This is also known as responsive bottle feeding. This means that you let the baby take the lead in how much milk to take and when. You need to watch for the baby’s feeding cues, hold your baby close semi-upright, and keep the bottle almost horizontal.

Source: Kellymom guidance on bottle feeding

What is nipple confusion? Is it real?

Sometimes babies who are breastfed and also bottlefed can end up rejecting the breast. The way a baby sucks at an artificial teat, for example a bottle or a pacifier/dummy, is different from how they suck at the nipple. This is sometimes termed “nipple confusion”.

There’s debate about whether ‘nipple confusion’ is real. It's possible that the association with stopping breastfeeding could be linked to the fact that the bottlefed babies in studies have other issues with breastfeeding.

However, there is clear evidence that supplementing and bottle feeding your baby can lead to problems breastfeeding. This is because feeding your baby from your breast sends signals to your body about how much milk it needs make. This means that not feeding your baby directly may cause issues for supply. All women and babies are different, so this might not happen to you, but it will happen to some women.

Therefore unless medically advised because your baby is not getting enough milk from your breast, avoid supplementing if you want to succeed in breastfeeding. Here are a couple of tips if you need to supplement:

  • You don’t need to use a bottle. A teaspoon or syringe may be suitable for a newborn. For an older child a cup might work.
  • If you are using formula try to express milk when you would otherwise be feeding
  • Practice ‘paced bottle feeding’ so you more closely mimic the flow of milk from the breast. Otherwise, the flow of milk from a bottle can be a lot faster than the flow of milk from the breast. This means that some babies may become used to the fast flow from the bottle and reject the breast.

(Source and more advice: La Leche League guidance on formula supplements/)

FAQs

Does breastfeeding hurt?

Breastfeeding should not hurt. If breastfeeding hurts, it’s often a sign that there is an issue. One of the most common reasons is an issue with your baby’s latch and attachment to your breast.

When breastfeeding is going well it releases the happy hormone oxytocin which makes you and the baby feel good.

Is breastfeeding hard?

Breastfeeding is not easy, especially as you get started in the beginning. How hard breastfeeding is will vary for different mothers, and depend on their circumstances and support network. Think of breastfeeding as a skill you and your baby need to learn together, as you get more practice it will become easier.

Once (and if) you and your baby get the hang of breastfeeding, it is the most convenient way to feed a baby for most women.

Is it worth it?

Yes, breastfeeding is worth it for many reasons. What could be more satisfying than watching your baby grow from your own milk?

See the section on benefits of breastfeeding above for reasons to breastfeed.

How can I relieve sore nipples?

If you have painful nipples, it’s a sign of an issue with breastfeeding. Your priority needs to be to identify the cause of the problem to make sure your nipples don’t get more damaged. If your nipples are always sore, cracked, or bleeding, check your latch and seek advice to avoid the problem becoming worse.

In the meantime some options to try and relieve pain are:

  • Breastmilk - hand express some breastmilk and rub it over the nipple
  • Nipple cream - lanolin-based is the most popular type, but there are many others on the market like calendula (marigold) based ones. There’s not a lot of actual evidence as to what sort works best.
  • Silver cups - silver has a natural anti-inflammatory property. You can buy little silver cups to place over your nipples between feeds to help heal them.

If your nipples have become damaged, then nipple shields that you put over your nipples while you feed may be helpful. Nipple shields help babies attach to the breast when they are struggling to feed. Some of my friends used them. They should normally be a temporary solution. If you think you need nipple shields, speak to a lactation consultant for advice.

Can you breastfeed after bottlefeeding?

It is possible to get back to breastfeeding after bottle feeding. Look up ‘relactation’ for advice on how to return to breastfeeding. When I was a baby I was formula fed for a few weeks. I initially chewed my mum’s nipples instead of latching and my mum didn’t know any better until they were bleeding and cracked. She fed me with bottles while they healed. She eventually managed to breastfeed me again, and I was breastfed for about a year.

Resources

Websites

Recommended websites for breastfeeding advice:

La Leche League International

La Leche League are an international organisation whose mission is to support mothers to breastfeed. Their website has some excellent advice. La Leche Leaders are trained breastfeeding counsellors who volunteer to offer advice around the world, if you are struggling with breastfeeding, it's worth looking up if there is a leader or group near you.

Kellymom

Kellymom is a website started by an International Board Certified Lactation Consultant (IBCLC) to provide evidence-based information about breastfeeding. There are articles on the site that answer nearly any breastfeeding question you can think of. My only criticism is that undoubtedly as a result of the site being around since 1996, you sometimes find deadlinks.

These are the books I downloaded to my kindle and read while breastfeeding my baby in bed that I found most useful for practical breastfeeding information.

The Positive Breastfeeding Book by Professor Amy Brown

This book has great pragmatic non-judgemental factually sound advice about all aspects of breastfeeding.

The Womanly Art of Breastfeeding, by La Leche League

The Womanly Art of Breastfeeding was first published in 1956, but has been substantially updated since then. It is now in its 8th edition and full of information. What is especially useful is that you can look up the answer to just about any breastfeeding problem in the index.

Further Support

This article only contains general advice. If you are struggling with breastfeeding it's best to seek guidance on an individual basis. International Board Certified Lactation Consultant (IBCLC) is the international gold standard qualification for a lactation consultant so it's a good idea to look for someone with that qualification.

Your local La Leche League group may also be able to help, and additionally, in many countries, there are other breastfeeding support organisations. Attending a breastfeeding support group can be great way to meet other mothers and find some emotional support and company.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2021 Marianne Sherret

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