Breastfeeding Basics: What You Need to Know to Get Started

If you've never nursed a baby, you probably don't know what it's like to find yourself in a crowded restaurant, breasts ready to explode, frantically searching for a discreet corner to feed your hungry little one. You probably do not have a freezer full of frozen breast milk. You probably have never broken out in a sweat while standing in line at the bank, suddenly realizing you forgot to wear nursing pads and will begin leaking through your shirt at any moment.

You probably never worried about any of these things. But for many women these and other worries are a pretty routine aftereffect of the choice to give their babies breast milk. In fact, in 1998, 64 percent of women opted to breastfeed their babies in the early postpartum period, according to the U.S. Department of Health and Human Services (HHS). Some 29 percent were still breastfeeding six months later, and 16 percent continued to breastfeed until baby's first birthday. With a slew of recent research to support the benefits to child, mother and society overall, experts seem to agree: breast milk is best, a message HHS plans to reinforce to the public with a new ad campaign slated for fall 2003.

Why Breastfeed? "I usually explain it to moms this way: Breast milk is human milk for human babies," says Carol Ryan, an international board-certified lactation consultant and director of the Georgetown University Hospital Lactation Center in Washington, D.C. "The most basic benefits are that it is species-specific, readily available, always warm and always sterile." In addition, breast milk contains antibodies that may help baby avoid certain illnesses and allergies. There is also evidence that breastfed babies have higher IQs than their formula-fed counterparts, according to the American Academy of Pediatrics (AAP).

For the breastfeeding mother, nursing may be linked to a reduction in certain cancers and in hip fractures, according to AAP. And, because mom is the manufacturer, breastfeeding is essentially free and eco-friendly, requiring no special packaging or preparation. Plus, many moms revel in the unique closeness with baby that breastfeeding offers.

How to Breastfeed

Of course, such goodness doesn't come without a price. Initially, at least, breastfeeding takes some patience and perseverance. Although it's a natural process, breastfeeding requires time and effort from both baby and mother in order to get the hang of it. And if not done properly, breastfeeding can be painful and frustrating. It also requires a heavy time commitment from mom, because breastfed babies feed often and because mom is the only one with the equipment needed to provide the food (although a breast pump can help once breastfeeding is well established).

It's worth pointing out that for those women who can't or who choose not to breastfeed, formula is the next-best choice. And although there is often a lot of pressure on women to breastfeed, the decision is an extremely personal one and shouldn't be second-guessed. However, because it's hard to restart milk production once it starts, most doctors recommend at least trying to breastfeed if at all possible. You can always switch to formula, but it's far harder to switch from formula to breast milk.

Breastfeeding Crash Course

If you're not familiar with the ins and outs of breastfeeding, don't feel bad. Most people have no idea what goes into such a seemingly simple act, which makes a quick explanation a good idea at this point. Ideally your baby will begin to breastfeed shortly after birth (the AAP recommends starting within an hour — this is when baby is most alert). During the first few days, the breasts produce colostrum, a pre-milk substance, which is easy for baby to digest. It's low in volume, and in fat, but high in nutritional value, providing baby with plenty of carbohydrates, protein and antibodies. Colostrum also has a laxative effect on baby, which helps him pass his first stools. Frequent feeding at this stage — eight to 12 times in a 24-hour period — is important not only for baby but also for you, because it stimulates your milk production.

To breastfeed, you'll hold baby in one of four basic positions (a lactation consultant or nurse can show you these positions) so that he is squarely facing your breast, which you'll hold in one hand, with your thumb above the areola and fingers and palm below it. Then you'll bring baby's mouth toward the nipple, stoking his lip or cheek with the nipple to simulate his rooting reflex. This should get him to open his mouth wide and take in the entire areola, rather than just the nipple. The nipple will then be pressed up against the roof of the baby's mouth and he'll begin sucking. At this point, the baby is said to be "latched on" and if you're the one he's attached to and you try to pull him away, you'll understand why!

Feeding Schedule

Three to four days after baby is born your milk "comes in," at which point you may feel your breasts getting very full, often to the point of engorgement, which can be painful. The best way to relieve engorgement is to nurse, but breasts that are too full for baby to handle — imagine trying to get your lips around an overinflated balloon and you'll see baby's problem — can be made more manageable by pumping off a bit of milk.

Keep in mind that after your milk comes in it still may take a few minutes of sucking before your milk begins to flow. It is the baby's sucking (or, alternatively, the sucking action of a breast pump) that stimulates your "let down" reflex and allows the milk to flow. Most women alternate breasts so that baby nurses on both breasts during one feeding.

For the first six weeks, babies usually feed every two to three hours. After that their feedings will still be frequent but may begin to be spaced further apart, with exceptions during periodic growth spurts, says Margot Mann, a board-certified lactation consultant, vice president of external affairs for the International Lactation Consultant Association (ILCA) and director of Riverdale Lactation Center in Riverdale, N.Y. Eventually, as babies get more efficient at sucking, they cut their nursing time. By 6 months old, they may finish nursing in as little as five to 10 minutes.

How do you know if baby is latched on and getting milk? "If the mother is not in pain and the baby seems to be feeding well, he's probably latched on," says Ryan. Here are some signs to look for:

Baby has the entire areola in his mouth.
His cheeks are round, rather than dimpled, while nursing.
There is no clicking and popping sound.
There appears to be good rhythmic sucking.
You can hear baby swallowing.
He is gaining weight.
He is producing six or more wet diapers per day and has at least two bowel movements (although bowel movements will become less frequent after the first few weeks of life).
He is mostly content between feedings.
Your breasts are full before feeding and feel less full after a feeding.

Also, while some babies will want to nurse for long periods just to satisfy their sucking needs, if a baby wants to nurse for long periods every time he is fed, it may be an indication that he is not getting enough milk. The AAP recommends that all babies released from the hospital within 48 hours of birth get a checkup by a pediatrician when the baby is two to three days old. This is a good time for the doctor to evaluate the baby's feeding progress.

Breastfeeding FAQ

Now that you've heard the basics, you probably have questions. Below are answers to some commonly asked questions:

Is breastfeeding painful? "No, pain means that something is wrong," says Ryan. Some tenderness in the first few days of breastfeeding is common, but cracked, bleeding or extremely sore nipples may be a sign that baby is not latched on properly. If so, now is the time to get help from a lactation consultant on how to properly position baby and ensure he's latched on. In addition to positioning, it's possible, although less likely, that baby is having trouble nursing because of an anatomical problem, which your pediatrician can diagnose.

Are there some people who just can't breastfeed? While there are some women who cannot breastfeed — those who genetically do not have enough mammary tissue, who have had a double mastectomy, who are HIV positive, who have certain serious illnesses or who are going through chemotherapy — "it is very, very rare that a woman cannot produce milk," says Ryan. Having flat or inverted nipples usually doesn't preclude a woman from breastfeeding, nor does having only one breast. Babies can also have problems that make breastfeeding impossible, including metabolic disorders or a deformity such as cleft lip that interferes with sucking.

Can I store my breast milk? For all the effort it takes to pump breast milk, the end product is a little like liquid gold. You will probably find yourself hoarding it, reluctant to let any go to waste. Fortunately, breast milk can be stored, which is great if you're planning on going back to work or plan to be away from baby for any other reason (even if it's just to give yourself a much needed baby break). If you have a healthy full-term infant, you can store breast milk in the refrigerator for five to six days, and in the freezer for several weeks to several months, depending on how good your freezer is. Keep in mind that your body automatically adjusts the makeup of your milk to meet the needs of your baby at that time. Therefore, the milk that you pump and store when baby is 1 month old is not the same as the milk you produce when he is 3 months old. That's not to say that you shouldn't give it to him, just that you should use the oldest milk first even if you're nowhere near its "expiration" date.

Breastfeeding Diet

Generally speaking, because only a small amount of what you consume is passed along in your breast milk, you don't have to avoid quite as many things as you did while pregnant. However, "use common sense," says Ryan. "If you're not eating it while you're pregnant — like fish with high levels of mercury — then you should be cautious while lactating," she adds. In addition, certain spicy or strongly flavored foods might cause baby to reject your breast milk (temporarily). If they do, you may have to give them up until you wean your baby. Babies also sometimes show intolerance to the proteins found in cow's milk, to nuts, wheat products or citrus fruits. If baby appears to be in distress, his pediatrician might recommend that you remove such foods from your diet (one at a time in order to determine which is the culprit). Medications can also be passed along through breast milk, although many are safe to take while breastfeeding. Read the label to determine if it is safe, or ask your doctor.

Do I have to avoid alcohol while breastfeeding? Unfortunately (or fortunately, depending on how you look at it), just because you finally had your baby doesn't mean alcohol is no longer taboo. Generally speaking, it's OK to have an occasional small drink while breastfeeding. However, because alcohol can be passed along in breast milk, you want to avoid consuming large quantities, says Ryan. In other words, a glass or two of wine is OK. Guzzling the whole bottle is not. If you do consume alcohol, you can expect your body to metabolize small quantities in a few hours, so it's probably safe to nurse baby just before drinking a glass of wine, say, and then several hours later when baby would normally eat again. If you've had more than a little, you should pump and discard your breast milk when you would normally feed baby. For that feeding, give baby some of your stored breast milk instead.

Do I need to eat more when I'm breastfeeding? Because producing milk requires a little extra fuel, the American Dietetic Association recommends lactating mothers consume 500 calories more per day than they would have pre-pregnancy. Of course, those calories should come from healthful sources.

How Long Should You Breastfeed?

The AAP recommends babies breastfeed for the first year of life and as long thereafter as mutually desirable. Doctors typically recommend that at 6 months of life babies be given solid food in addition to milk. But even before you move to solid food breastfeeding doesn't have to be an all-or-nothing proposition. You can breastfeed and bottle feed using either expressed breast milk or formula. "It's fine to use bottles when needed as long as the baby is well established at breastfeeding," says Mann, who adds that overuse of bottles may put some infants at risk for rejecting breastfeeding altogether. Also, many experts recommend waiting to introduce a bottle until the baby is at least 1 month old to avoid confusing baby. After that, "the container that baby uses to get the milk — breast or bottle — is not as important as the content of the meal," says Mann, who advises sticking with breast milk rather than opting for formula.

Still, while breast milk is considered best, you can supplement your breastfeeding by giving baby occasional bottles of formula if you so choose. Again, this is only advisable once your milk supply is well established. Once that happens your body will adjust milk production, producing less as you breastfeed less. One warning: Cutting back on breastfeeding too quickly can lead to engorgement and could even contribute to mastitis (breast infection). So gradually slow your breastfeeding or pumping, says Mann.

What happens if you have trouble to begin with? "Many mothers are now leaving the hospital without their baby actually latching on, and moms are not being given instructions on how to do it or even how to get help if they have trouble," says Mann, who says her initial consultations with mothers last two hours, far longer than most women get in the hospital. Before you leave the hospital, get the help you need or find out where to call to get additional help. Most hospitals provide on-going lactation consulting, either on the phone or in person. At the very least, they can put you in touch with a lactation consultant.

Mann advises making sure you can get the baby properly latched on yourself (it doesn't count if the lactation consultant gets baby latched on for you) before you head home from the hospital. "Make sure you hear swallowing — not just sucking — and that the baby has produced a dirty diaper," before you go home, Mann advises. If you're unsure about your breastfeeding skills, make an appointment to see a lactation consultant before you leave the hospital. And fear not, with the right help even those who get off to a rocky start can usually succeed in breastfeeding happily for as long as they choose.

Christina Breda Antoniades is a freelance writer and mother of 9-month-old Vasili. She has written extensively for Discovery.com, including the Travel Channel Online and Discovery Health Online. In her nine months as a new mommy, Christina has come to learn the joys and pains of parenthood.