Breastfeeding - Starting Out Right
is the natural and normal way of feeding infants and young children,
and human milk is the milk made specifically for human infants. Starting
out right helps to ensure breastfeeding is a pleasant experience for
both you and your baby. Breastfeeding should be easy and trouble free
for most mothers.
The vast majority of mothers are perfectly capable of breastfeeding
their babies exclusively for about six months. In fact, most mothers
should be able to produce more than enough milk. Unfortunately, outdated
hospital policies and routines based on bottle feeding still
predominate in too many health care institutions and make breastfeeding
difficult, even impossible, for too many mothers and babies. Too
frequently also, these mothers blame themselves. For breastfeeding to
be well and properly established, getting off to the best start from the
first days can make all the difference in the world. Of course, even
with a terrible start, many mothers and babies manage. And yes, many
mothers just put the baby to the breast and it works just fine.
The basis of breastfeeding is getting the baby to latch on well. A baby
who latches on well gets milk well. A baby who latches on poorly has
more difficulty getting milk, especially if the milk supply is not
abundant. The milk supply is not abundant in the first days after
birth; this is normal, as nature intended, but if the baby’s latch is
not good, the baby has difficulty getting the milk. It is for this
reason that so many mothers “don’t have enough colostrum”. The mothers
almost always do have enough colostrum but the baby is not getting what
is there. Babies don’t need much milk in the first few days, but they
Even if the mother’s milk production is plentiful, trying to breastfeed a
baby with a poor latch is similar to giving a baby a bottle with a
nipple hole that is too small—the bottle is full of milk, but the baby
will not get much or will get it very slowly—so the baby sucking at the
breast may spend long periods on the breast or return to the breast
frequently or not be happy at the breast, all of which may convince the
mother she doesn’t have enough milk, which is most often not true.
When a baby is latching on poorly, he may also cause the mother nipple
pain. And if, at the same time, he does not get milk well, he will
usually stay on the breast for long periods, thus aggravating the pain.
Too often the mothers are told the baby’s latch is perfect, but it’s
easy to say that the baby is latched on well even if he isn’t. Mothers
are also getting confusing and contradictory messages about
breastfeeding from books, magazines, the internet, family and health
professionals. Many health professionals actually have had very little
training on how to prevent breastfeeding problems or how to treat them
should they arise. Here are a few ways breastfeeding can be made
Note: Mothers are often told that if the breastfeeding is
painful, the latch is not good (usually true), so that the mother should
take the baby off and latch him on again and again and again... This
is not a good idea. Instead of delatching and relatching, fix the latch
that you have as best you can by pushing the baby’s bottom into your
body with your forearm. The baby’s head is tipped back so the nose is in
‘sniffing position’. If necessary, you might try gently pulling down
the baby’s chin so he has more of the breast in his mouth. If that
doesn’t help, do not take the baby off the breast and relatch him
several times, because usually, the pain diminishes anyway. The latch
can be fixed on the other side or at the next feeding. Taking the
baby off the breast and latching him on again and again only multiplies
the pain and the damage and the mother’s and baby’s frustration.
The baby should be skin-to-skin with the mother and have access to the breast immediately after birth.
The vast majority of newborns can be skin-to-skin with the mother and
have access to the breast within minutes of birth. Indeed, research has
shown that, given the chance, many babies only minutes old will crawl up
to the breast from the mother’s abdomen, latch on, and start
breastfeeding all by themselves. This process may take only a few
minutes or take up to an hour or longer, but the mother and baby should
be given this time (at least the first hour or two) together to start
learning about each other. Babies who “self-attach” run into far fewer
breastfeeding problems. This process does not take any effort on the
mother’s part, and the excuse that it cannot be done because the mother
is tired after labour is nonsense, pure and simple.
The baby should be kept skin to skin with mother as much as possible
immediately after birth and for as much as possible in the first few
weeks of life. Incidentally, studies have also shown that
skin-to-skin contact between mothers and babies keeps the baby as warm
as an incubator (see paragraph on skin-to-skin contact, below, and the
information sheet The Importance of Skin-to-Skin Contact). It is
true that many babies do not latch on and breastfeed during this time
but generally, this is not a problem, and there is no harm in waiting
for the baby to start breastfeeding. The skin to skin contact is good
and very important for the baby and the mother even if the baby does not
Skin-to-skin contact helps the baby adapt to his new environment: the
baby’s breathing and heart rate are more normal, the oxygen in his blood
is higher, his temperature is more stable and his blood sugar higher.
Furthermore, there is some good evidence that the more babies are kept
skin-to-skin in the first few days and weeks of life (not just during
the feedings) the better their brain development will be. As well, it
is now thought that the baby’s brain develops in certain ways only due
to this skin-to-skin contact, and this important growth happens mostly
in the first 3-8 weeks of life.
A proper latch is crucial to success. This is the key to successful breastfeeding.
Unfortunately, too many mothers are being “helped” by people who don’t
know what a proper latch is. If you are being told your two-day old
baby’s latch is good despite your having very sore nipples, be sceptical
and ask for help from someone else. Before you leave the hospital, you
should be shown that your baby is latched on properly and that he is
actually getting milk from the breast and that you know how to know he
is getting milk from the breast (open mouth wide—pause—close mouth type
of suck). See also the videos on how to latch a baby on. There are also
video clips of babies younger than 48 hours who are breastfeeding not
just sucking. If you and the baby are leaving hospital not knowing
this, get experienced help quickly (see also the information sheet When Latching).
The mother and baby should room in together. There is absolutely no
medical reason for healthy mothers and babies to be separated from each
other, even for short periods, even after caesarean section. Health
facilities that have routine separations of mothers and babies after
birth are not doing right by the mothers and babies. Studies showing
that rooming-in 24 hours a day results in better breastfeeding success,
less frustrated babies and happier mothers date back to the 1930’s. Too
often, irrelevant excuses are given why baby should be separated from
the mother. One example is that the baby passed meconium before birth. A
baby who passes meconium and is fine a few minutes after birth will be
fine and does not need to be in an incubator for several hours’
Separation of mother and baby so the mother can rest. There is no
evidence that mothers who are separated from their babies are better
rested. On the contrary, the mothers are better rested and less stressed
when they are with their babies. Mothers and babies learn how to sleep
in the same rhythm. Thus, when the baby starts waking for a feed, the
mother is also starting to wake up naturally. This is not as tiring for
the mother as being awakened from deep sleep, as she often is if the
baby is elsewhere when he wakes up. If the mother is shown how to feed
the baby while both are lying down side by side, the mother is better
The baby’s feeding cues. The baby shows long before he starts
crying that he is ready to feed. His breathing may change, for example.
Or he may start to stretch. The mother, often being in light sleep in
sync with her baby, will wake up, her milk will start to flow and the
calm baby will usually go to the breast contentedly. A baby who has been
crying for some time before being tried on the breast may refuse to
take the breast even if he is ravenous. Mothers and babies should be
encouraged to sleep side by side in hospital. This is a great way for
mothers to rest while the baby breastfeeds. Breastfeeding should be
relaxing, not tiring.
Bathing. There is no reason the baby needs to be bathed
immediately after birth and bathing can be delayed for several hours.
Immediately after birth, the baby can be dried off but it is not a good
idea to wash or wipe off the creamy layer on the baby’s skin (vernix)
that has been shown to protect his delicate skin. It is best to wait
at least until the mother and baby have had a chance to get
breastfeeding well started, with baby coming to the breast and latching
easily. Furthermore, diapering a baby before a feed is not advised as it
often causes the baby to become upset. Mothers are sometimes told
diapering will help the baby to wake up. It is not necessary to wake the
baby for feedings. If the baby is skin-to-skin with the mother, the
baby will wake when ready and search for the breast. A baby who is
feeding well will let the mother know when he is ready for the next
feed. Feeding by the clock makes no sense.
Artificial nipples should not be given to the baby. There seems
to be some controversy about whether “nipple confusion” exists. Thus, in
the first few days, when the mother is normally producing only a little
milk (as nature intended), and the baby gets a bottle (as nature
intended?) from which he gets rapid flow, the baby will tend to prefer
the rapid flow method. Babies like fast flow. You don’t have to be a
rocket scientist to figure that one out and the baby will very quickly.
By the way, it is not the baby who is confused. Nipple
confusion includes a range of problems, including the baby not taking
the breast as well as he could and thus not getting milk well and/or the
mother getting sore nipples. Just because a baby will “take both” does
not mean that the bottle is not having a negative effect. Since there
are now alternatives available if the baby needs to be supplemented (see
the information sheets Lactation Aid, and Finger and Cup Feeding) why
use an artificial nipple? Using a lactation aid, finger feeding or cup
feeding to supplement when the baby does not need a supplement is only
marginally better than using a bottle to supplement.
No restriction on length or frequency of breastfeedings. A baby
who drinks well will not be on the breast for hours at a time (see the
video clips of very young babies getting milk very well). Thus, if the
baby is on the breast for very long periods of time, it is usually
because he is not latching on well and not getting the milk that is
available. Get help to fix the baby’s latch, and use compression to get
the baby more milk (See the information sheet Breast Compression). Compression works very well in the first few days to get the colostrum flowing well. This, not a pacifier, not a bottle, not
taking the baby to the nursery or nurses’ station, will help. Babies
often feed frequently in the first few days of life—this is normal and
temporary. In fact, babies tend to feed frequently during the first few
days especially in the evening or night-time. This is normal and helps
to establish the milk supply and facilitate mother’s uterus returning to
normal. Latching a baby well, using compressions, and maintaining skin
to skin contact between mother and baby helps this transitional period
to go smoothly.
Supplements of water, sugar water, or formula are rarely needed.
Most supplements could be avoided by getting the baby to take the breast
properly and thus get the milk that is available. If you are being told
you need to supplement without someone having observed you
breastfeeding, ask for someone to help who knows what they are doing.
There are rare indications for supplementation, but often supplements
are suggested for “convenience” or due to outdated hospital policies.
If supplements are required, they should be given by lactation aid at
the breast (see the information sheet Lactation Aid), not cup,
finger feeding, syringe or bottle. The best supplement is your own
colostrum. It can be mixed with 5% sugar water to give more volume if
you are not able to express much at first. It is difficult to express
much at first because even though there is usually enough for the baby,
expressing is not always easy when there is not a lot of milk, as is
expected in the first few days. Formula is hardly ever necessary in the
first few days. (See our GamePlan for Protecting and Supporting
Breastfeeding in the First 24 hours of Life and Beyond, which can be
ordered at nbci.ca
Free formula samples and formula company literature are not gifts.
There is only one purpose for these “gifts” and that is to get you to
use formula. It is very effective and it is unethical marketing. If you
get any from any health professional, you should be wondering about
his/her knowledge of breastfeeding and his/her commitment to
breastfeeding. “But I need formula because the baby is not getting
enough!” Maybe, but, more likely, you weren’t given good help and the
baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.
Under some circumstances, it may be impossible to start breastfeeding
early. However, most “medical reasons” (maternal medication, for
example) are not true reasons for stopping or delaying breastfeeding,
and you are getting misinformation. See the information sheets Medication and Breastfeeding and also Illness and Breastfeeding. Get good help. Premature babies (see the information sheet Premature Baby and Breastfeeding)
can start breastfeeding much, much earlier than 34 weeks of age that
seems to be the rule in many health facilities. Studies are now quite
definite that it is less stressful for a premature baby to breastfeed
than to bottle feed. Unfortunately, too many health professionals
dealing with premature babies do not seem to be aware of this (See the
information sheet Premature Baby and Breastfeeding).
Not latching/Not breastfeeding? If for some reason baby is not
taking the breast, then start expressing your colostrum by hand (often
much more effective than using even a hospital grade pump) should be
started within 6 hours or so after birth, or as soon as it becomes
apparent baby will not be feeding at the breast. See the information
sheet When the Baby Does Not Yet Latch On.
Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding (called The Ultimate Breastfeeding Book of Answers in the USA); and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.
To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.
Written and revised (under other names) by Jack Newman, MD, FRCPC, 1995-2005
Revised Jack Newman MD, FRCPC, IBCLC and Edith Kernerman, IBCLC, 2008, 2009