Getting Breastfeeding Off to a Good Start

By OBOS Pregnancy & Birth Contributors |

Breastfeeding is about building a relationship with your infant, and, like any long-term relationship, establishing it requires patience, give-and-take, and sometimes hard work.

Most healthy newborns will be ready to nurse within the first hour after birth. Right after your baby is born, hold her or his belly skin to skin with yours. Most babies held in this position can locate the nipple and begin feeding on their own.

Babies who have the opportunity to initiate the feeding process themselves are more likely to feed well as they grow. Your colostrum (sometimes called the “first milk”) is the best fuel for your baby during this learning phase. Frequent skin-to-skin contact in the early days and keeping your baby in your room at night can make breastfeeding easier and help you get more rest.

Latching On

I was lucky. My kids latched on right away after they were born. It’s like they were showing me how to do it.

Establishing a good “latch” or seal for breastfeeding is the single most important thing you can do to prevent sore nipples and other breastfeeding problems. A healthy latch is not painful and allows the baby to draw an adequate amount of milk from the breast. For most mother-baby teams, patience and practice are the keys to establishing a pain-free latch.

Images courtesy of the National Women’s Health Information Service

Here is how to establish a good latch:

  1. Tickle the baby’s lips to encourage her or him to open wide.
  2. Point your nipple to the roof of the baby’s mouth and when she or he opens wide, pull her or him onto the breast, chin and lower jaw first.
  3. Watch the lower lip and aim it as far from base of nipple as possible, so the baby’s tongue draws lots of breast into the mouth.

Another important part of establishing a healthy latch is getting comfortable with a few basic ways to cradle your baby while breastfeeding. Nurses and lactation consultants often encourage mothers to start newborns out with the “crossover” and “football” holds; both of these nursing positions are relatively easy to master and provide a mother with good control of her baby’s delicate head and neck. Large-breasted women may be presented with specific challenges or need to experiment with different holds. In any position, it is important to keep the baby’s head in alignment with her or his body and keep the baby horizontal, with her or his head, chest, navel, and knees all facing you.

To begin, it is important for you to know what a good latch looks like. Ask someone knowledgeable about breastfeeding, such as a nurse, midwife, or lactation specialist, to look at your baby’s latch and give you feedback. You can also consult books and online resources that show images of correct latch.

Watch your baby and follow her or his signals. Learn to respond to the more subtle signs of hunger before your baby becomes agitated and starts to cry. Among the newborn’s first signs of interest in food are little movements of the body, especially the hands moving near the head, smacking the lips, mouthing movements, seeking with the lips, rooting (turning the head in response to anything that touches the cheek), and bobbing the head. Babies who are awake and somewhat hungry will respond to the smell of their mother’s milk and the closeness of her nipple by opening their mouths widely and sealing onto the breast and nipple. During the early days, breastfeeding frequently helps increase your chance of breastfeeding success. Put your baby to the breast at any sign of hunger. Rooming in with your baby at the hospital will help you learn to recognize and respond to these hunger signs.

Babies draw both nipple and breast tissue into their mouths when breastfeeding. To help your baby do this, line the baby up so that you are belly to belly and her or his neck is not turned to the side. When your baby’s mouth is open wide, gently bring your baby to your breast, and insert your entire nipple and as much of the areola (the darker skin around the nipple) as possible into her or his mouth (flattening your breast with your thumb and index finger makes this easier). It is important to bring the baby to the nipple rather than leaning forward and pushing your breast toward the baby. The baby’s lower jaw should be on the breast as far as possible from the nipple, so that the lower jaw and the tongue can draw milk from the breast.

Once the baby has established a seal, pause to look and listen. Your baby’s cheeks should touch your breast, hiding her or his mouth. Your baby’s lips, if you can see them, should be rolled slightly outward, away from your breast. If your baby’s lips are curled in or under, gently break the suction by putting your pinkie between the nipple and the baby’s mouth, and then try again (if just the bottom lip is turned in, you can pull down slightly on the jaw rather than re-latching). Your baby’s chin should be firmly planted on the breast. A good latch position will allow you to have good eye-to-eye contact with your baby. Listen for the sounds of swallowing and a shift in breathing between sucks. Watch to see if the baby’s ears move, a sign that she or he is swallowing. If your baby is correctly positioned, you should not feel any pain. If feeding is painful, ask a nurse or lactation specialist for help.

If detailed instructions about latch and positioning make your head spin, it’s important to remember that breastfeeding is, at heart, a human instinct. While it may take time and effort to get a healthy nursing relationship started, within a matter of days or weeks, you and your baby will learn about each other and establish a relationship. Rather than worrying about picture-perfect holds, listen to and look to your baby for cues. Trust yourself and your baby. Filter out unhelpful, unsolicited opinions. Respond to your baby’s—and your body’s—needs. And don’t hesitate to seek help if you need it, as many women do.
Some babies, especially those born prematurely, may not have a strong enough sucking action to draw the nipple fully into the back of the mouth. This is necessary in order to draw milk from the breast and initiate the suck-breathe-swallow cycle. They may also tire more easily than full-term infants. Sleepy or jaundiced babies may prefer napping to nursing during the first few days of life and may need to be woken frequently to nurse. In rare cases, babies have anatomical conditions that can interfere with the establishment of a healthy latch. An experienced lactation specialist should be available for all women and babies experiencing such problems, as they can usually be overcome with individualized care and support.

He had trouble nursing right off the bat and was grunting for air a bit. He would latch on, but he had a weak suck. I had him latched on wrong for the first day or two and wound up with sore nipples and spoon-feeding him the colostrum because it hurt so badly. The nurse/lactation consultant came out on the second day to check up on us .​ . . It​ took me a couple weeks to fully adjust to nursing him; it was still uncomfortable but not painful. After that, I was able to nurse him for nearly two years without problems. I am so glad I did.

If you are having difficulties, see Challenges to Breastfeeding.

Early Breastfeeding Patterns

Breastfed newborns need to nurse at least eight to twelve times within a twenty-four-hour period. All that suckling, while providing nourishment for your baby, is also stimulating your breasts to ramp up their milk production, so as your baby grows, your supply will grow, too.

Frequent nursing is important for your baby’s health and development as well as for building your milk supply, but this does not mean that you need to stick to a strict schedule. Breastfeed whenever your infant shows hunger cues. Sometimes babies cluster-feed (nursing every thirty to forty-five minutes right after or before sleeping) and then take long naps in between.

You may wonder if your baby is getting enough milk. Usually, you do not have to worry about this. Your baby will drink what she or he needs, and your body will make whatever your baby needs. Breastfeeding works on the principle that the more your baby sucks, the more milk you will make. If your baby is nursing and growing, she or he is doing fine. Still, in the first few days it makes sense to watch for other signs that the baby is getting enough.

The common guide for many years was “at least six wet diapers a day” once mature milk comes in. However, some babies urinate and pass stool at the same time, and it can be difficult to tell how many times your baby has urinated. Diapers holding only urine should be well saturated every couple of hours.

Breastfed babies generally have fairly watery bowel movements. The color will progress from greenish black in the first day or two to mustard yellow when they are getting milk. During the first two weeks after birth, your baby should have four or more stools every day; if not, contact your pediatric care provider.