Begin breastfeeding immediately after birth, usually within the first half-hour. Newborns have a quiet, alert period after birth when they are especially receptive to breastfeeding. If your baby doesn’t want to nurse immediately, try again in half-an-hour. A good rule to keep in mind is that you can’t overfeed a breastfed baby. (Refer to “How Often and How Long to Breastfeed” below.)

Latching On

Tickle baby’s lips with your nipple until baby’s mouth opens really wide, like a yawn. When baby’s mouth is wide open, pull her close to take as much of your areola in her mouth as possible so her jaws don’t close on your nipple. By positioning baby’s mouth back from the nipple, her suckling will stimulate the milk ducts to bring the milk forward into the nipple area. This will ensure your baby gets as much milk as possible and will help prevent nipple soreness.

When well-positioned at the breast, baby’s lips will be flanged out and tongue cupped at the bottom of your nipple with chin touching the lower part of your breast. This is called “latching on.” Baby should breathe easily with nostrils flared out specifically for this purpose. If baby seems to have trouble breathing, lift your breast a little or pull baby’s legs a little closer to you so her nose pulls away slightly from the breast. Don’t push on your breast to move it away from baby’s nose because this action may pull your nipple out of the back of baby’s mouth, which could cause soreness to your nipple.

At first you may feel a stretching sensation as baby starts to pull your nipple into her mouth. For some women the feeling may be slightly painful, but it goes away quickly during feeding and fades after a few days. If your baby tends to arch backward and pull away, tucking her legs in on the other side of your body will help keep baby attached and breastfeeding effectively.

Let baby breastfeed until she lets go of the breast. You might try burping your baby, although some breastfed babies don’t burp much; then offer the other breast.

Continue to offer both breasts at each nursing session during the early weeks because it will help establish your milk supply. Start the next nursing on the last breast offered or the breast that baby didn’t take at the last feeding. It’s easy to remember which breast to offer first because that side will feel fuller. Remember that it is normal for one breast to make more milk than the other and for baby to prefer one breast to the other.

Be careful when removing baby from your breast. If baby’s gums rub across your nipples, it will hurt and your nipples may become sore. We suggest gently putting your finger between baby’s gums to break the suction and holding your finger there to protect your nipple while removing your nipple/breast from baby’s mouth.

Breast Milk Composition/Color/Timing

During the last few weeks of pregnancy, some women notice a little colostrum leaking from their nipples. This nutrition-packed “early milk” ranges in color from a clear liquid to a yellow or an orange color. It’s normal to have this leakage, but it may not occur in all women.

During the first week after delivery, oftentimes on the third or fourth day, your milk supply will increase. That’s when women say their milk has “come in,” which is not exactly accurate as your body has produced milk from the time baby was born. Gradually your milk will change from colostrum to transitional to mature milk during the next few weeks. Colostrum is early milk produced during pregnancy and readily available the first 36-72 hours after birth. Transitional Milk is a mix of colostrum and mature milk produced between days 3 and 14. Mature Milk develops about two weeks after giving birth and appears thinner than cow’s milk. It may look slightly blue, although the color varies from woman to woman, and may be affected by diet. As long as you breastfeed, your milk will change to meet your baby’s needs. For instance, at the beginning of a nursing session your milk is plentiful and high in carbohydrates. Toward the end of the nursing session you produce Hindmilk, a creamy milk that is high in fat and calories and is very filling to your baby.

“Let-Down”

The “let-down” or milk ejection reflex (MER) is a hormonal release that is critical to successful breastfeeding. During MER, your body pushes milk out of the alveoli and the milk ducts into the nipple area and may do so with such force that you may hear your baby gulping or swallowing to keep pace with the stream of milk. Some women have no physical sensation at let-down but others say they experience a tingling or burning. This is a subjective experience that varies from woman to woman.

Supply and Demand

Breastfeeding works on the principle of supply and demand.
The amount of milk you make depends on how often your baby nurses and how effectively milk is removed from your breasts. The more milk baby removes from the breast, and the more often baby nurses, the more milk you will produce. Research shows that women who nurse more frequently make more milk. It’s truly a matter of supply and demand.

Positioning

Proper positioning is key to comfortable breastfeeding—along with patience, persistence, and personal confidence.

Don’t worry if you or your baby prefers one breastfeeding position more than the others. If you are comfortable, and baby is breastfeeding effectively and gaining enough weight, that’s all that matters. Following is a description of the most common breastfeeding positions.

If you’re sitting in a straight-backed or upholstered chair or bed, don’t lean backward away from your baby or forward over your baby. Pillows behind your back and shoulders, or under your arms or knees, may provide extra comfort and support. It also may increase your comfort level to put your feet on a stool or low table so your legs are slightly raised to help support your baby.

Cradle Hold is the most common way to hold a breastfeeding baby. Baby’s head should rest on your forearm, near your elbow, on the same side as the breast you will offer. Baby’s body should lay along your forearm, with your hand holding his bottom. Use pillows to help support his weight because even a small baby may seem heavy after a while. Use your opposite hand to hold and support your breast as needed, with your thumb on top of your breast and fingers underneath. Keep your fingers positioned far behind your areola.

Baby’s mouth should be level with your nipple and, depending on the size of your breasts, you may either need to lift your breast or put another pillow under your baby to raise him to the right level. Your baby should be lying sideways so that you are chest to chest, with baby’s head and body in a straight line. If baby has to turn to reach your breast, it will be more difficult for baby to grasp the breast properly and swallow. When baby is older and has learned to breastfeed well, it won’t be as important to keep head and body in line.

Football or Clutch Hold is another common position. Hold your baby along one side of your body as if carrying a football. You should hold his head in your hand so his mouth is level with your nipple. Put pillows under his body for support with his bottom resting on the pillows. His legs should point upward so his feet won’t touch the back of the chair and he won’t be tempted to push with his legs. Hold your breast with your opposite hand and tickle his lips with your nipple so he opens his mouth wide.

The clutch hold lets you see how your baby is nursing. This is especially helpful with premature babies or babies who have trouble learning to suckle. If you have had a cesarean birth, the clutch hold avoids putting pressure on your incision. Large-breasted women sometimes prefer this position.

Transitional or Cross Cradle Hold is helpful when you need to watch your baby because she’s having trouble breastfeeding. As your baby lies horizontally in your lap, hold her head with the hand opposite your breast, baby’s feet positioned toward your elbow. Support your breast with the hand on the same side. This position makes it easier to guide her mouth to your breast.

Lying Down Hold helps after a cesarean birth or when you need to rest while baby nurses. Use lots of pillows for support. A pillow between your knees helps take stress off your back. Lay your baby on her side next to you on the bed with her mouth at nipple level. When baby opens her mouth wide, pull her close so she takes enough of your breast in her mouth.

Ways to Increase Your Comfort Level

Breast Discomfort

When your milk supply increases, your breasts may feel very full. If you are uncomfortable, apply a warm compress just before nursing to help initiate the milk flow and let baby nurse more frequently to help bring down the swelling. If your baby has trouble breastfeeding when your breasts are very full, pump or express a little milk to soften the nipple and areola to make it easier for baby to latch on. You may also use cold compresses on the breasts between nursing sessions to reduce swelling. If baby is nursing well, this fullness will subside in 12-48 hours.

Approximately a month after you begin to breastfeed, your breasts will start to feel softer. This is a sign that your body has adjusted to making milk.

How Often and How Long to Breastfeed

At first, nursing will take about 20-45 minutes, but the time will decrease as both you and your baby become more experienced at breastfeeding.

During the first week or two, nurse frequently, about 8-12 times every 24 hours.

Once your milk supply is established, and your baby has grown so his stomach holds more milk, your baby will probably fall into a fairly regular feeding schedule. Try to remain flexible because a variety of factors can change the schedule. For instance, growth spurts, typically at two to three weeks, six weeks, and again at three to four months, may cause baby to nurse more frequently. Continue to nurse on cue and your milk supply will catch up to the increased demand.

Shorter, more frequent nursing will increase your milk supply more effectively than longer, less frequent nursing. Offer both breasts at each nursing while baby is going through a growth spurt. Be aware that sometimes babies nurse more frequently because they need the comfort and companionship that nursing provides.

Your Baby’s Feeding Cues

Look for signs that your baby wants to nurse. These include:

•	Open lips
•	Sucking a fist or fingers
•	Rooting (turning head to the side with lips open to suck when side of mouth or cheek is touched)
•	Fretful sounds

Eventually, crying will become a “late” sign for hunger. Avoid reaching the stage when baby is upset and crying hard because it’s more difficult for a distraught baby to settle at the breast. Calm your upset baby before trying to nurse.

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