Non-medicated birth (if possible)

Have a birth with as little medical intervention as possible.  Medication can cause your newborn to be sleepy, and to not be interested in nursing early and often.  But breastfeeding is still possible even after a cesarean.

Nurse your baby as soon as possible

Babies have a period of alertness during the first hour after birth, and display a strong sucking reflex that is not as strong again until approximately 40 hours later.  Nursing soon after birth with help your uterus contract by stimulating the release of oxytocin.  This first time at the breast is a time to introduce your baby to the breast.  Don 't force things or try to practice everything you've read or learned.  Some babies will just nuzzle and lick the breast at first, and others will latch right on.  Sucking in frequent bursts and pauses is the typical pattern for the first few hours and often the first few days.

The vast majority of newborns can be put to breast within minutes of birth. Research has shown that, given the chance, babies only minutes old will often crawl up to the breast from the mother’s abdomen, and start breastfeeding all by themselves.  This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other.  Babies who "self-attach" run into far fewer breastfeeding problems.  Incidentally, studies have also shown that skin to skin contact between mothers and babies keeps the baby as warm as an incubator.

Latch on & Positioning

The trick to 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 difficulty getting milk, especially if the supply is low.  A poor latch is similar to giving a baby a bottle with a nipple hole which is too small-the bottle is full of milk, but the baby will not get much.  When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain.

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’s latch is good despite your having very sore nipples, be skeptical, and ask for help from someone who knows.

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.  If you and the baby are leaving the hospital not knowing this, get help quickly.  For a real look at positioning and latch-on, visit our image collections:

Room in

There is no evidence that mothers who are separated from their babies are better rested.  On the contrary, they are more 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.

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, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse.  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 nurses.  Breastfeeding should be relaxing, not tiring.

No artificial nipples

Artificial nipples (bottle or pacifier) should be avoided, if possible. There seems to be some controversy about whether "nipple confusion" exists.  Babies tend to take whatever method gives them a rapid flow of fluid and may refuse others that do not.  Thus, in the first few days, when the mother is producing only a little milk (as nature intended), and the baby gets a bottle from which he gets rapid flow, he may  prefer the rapid flow method.

Nipple confusion includes not just the baby refusing the breast, but also 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 could not having a negative effect.  Also of note, the use of pacifiers can cut down on milk production.  When using a pacifier, the baby can spend too much time with rubber in his mouth and not enough time with your breast.

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 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.

Remember that milk production is a supply and demand situation.  If your baby is being given a supplement, he is not stimulating your milk supply, and your milk supply will decrease.  The best supplement is your own colostrum.  It can be mixed with sugar water if you are not able to express much at first.  Formula is hardly ever necessary in the first few days.
 

Formula samples and literature are not gifts!

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 very 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 your milk well.  Get good help.  Formula samples are not help.

For more information on formula and formula companies, visit "Formula label, want a scare?" and our Breastfeeding Advocacy Page.

* Some of the information above originally appeared in Dr. Jack Newman's article: "Breastfeeding - Starting Out Right."