Breastfeeding should start as soon as possible after the birth of your baby, preferably within the first hour after birth. You should plan to room in with your baby at the hospital so that you can feed him easily each time he needs to eat. Keep in mind that babies don't usually eat a lot the first day, but will typically want very frequent feedings on the second day. Your milk will likely have a large increase in volume between the third day and fifth days after the arrival of your baby. Breast milk is easily digested so breastfed babies tend to eat a lot, usually ten or more times a day during the early weeks.

Since you won't be able to tell how much milk your baby is actually getting, or colostrum in the early days, you'll need to keep track of your baby's diapers to make sure he's getting enough.  After the fourth day, if he is wetting six or more diapers a day and having three yellow bowel movements or more, he is getting enough to eat.

Painful, sore, or cracked nipples are caused by incorrect positioning and you should get help immediately from qualified staff at the hospital if breastfeeding is at all painful. Breastfeeding should never hurt.

Although you can plan to pump enough milk to allow the baby's father or other caregiver to feed him, you should nurse the baby exclusively during the first few weeks so he will learn to feed correctly, the breastfeeding relationship will get well established, and so you will build a good milk supply.

Preparing For Your Hospital Stay

Being prepared and having a plan for your baby's birth can also help make nursing go more smoothly.  An alert baby will get a better start at breastfeeding so a birth with little or no medication can make a big difference as your baby will be stronger and more alert from the beginning.  If you deliver via cesarean section you can still nurse soon after - how long after depends largely on what type of anesthesia you have.  If you and your baby are alert you can usually nurse in the delivery room, however if you have a general anesthetic you may be too groggy for awhile and will need to wait until you are fully awake.  You will need to use pillows and have some help with positioning for a few days to protect your incision if you do have a cesarean section.

Make sure the hospital staff and your pediatrician know that you don't want your baby to have any bottles, formula or pacifiers during your hospital stay. You can even put a card in the baby's hospital bassinet that expresses your wishes and ask your pediatrician to write it as an order in your baby's records.  Communication is the key.  If you have a choice of hospitals, check them out early on and choose one that has family centered care and encourages rooming in.

Plan to have your baby room in with you and nurse very frequently in the early days because if your baby nurses often, on cue and does not spend time away from you, you will greatly increase your chances of success. This way you can also keep better track of your baby's wet and dirty diapers as he should have one to two wet and dirty diapers the first couple of days, increasing to three or more dirty and six or more wet diapers by the fourth or fifth day. Keeping track of the diapers will let you know that your baby is getting enough to eat.

It is normal for a baby to lose weight immediately following his birth, however you should also be sure to find out what your baby weighs when you leave the hospital and have him weighed again a day or two later to see if the weight loss continues or is excessive. If your baby is having the usual number of bowel movements and has regained his birth weight between one to two weeks of age, you are producing enough milk. A typical weight gain is usually 4- to 8-ounces each week for the first three months.

Under rare circumstances, supplementing with formula may be necessary if the baby has very low blood sugar, if the mother is unable to produce enough milk or colustrum, or if the baby cannot latch on or nurse for some reason.  If this is the case you can ask that the formula be given with a dropper or cup or be given with a small syringe drizzled over the breast to avoid nipple confusion.

In the not too distant past pregnant women were advised to "toughen" their nipples with towel rubbing and nipple pulling, or even toothbrush scrubbing. It is now known that the things we were told to do to toughen our nipples only served to make them more likely to get sore. The major cause of sore nipples is poor positioning of your baby at the breast. When the positioning is corrected the pain goes away - breastfeeding should not hurt! Pain is a sign that something isn't right.  If your nipples hurt, seek help immediately from the hospital lactation consultant or your local La Leche League.

Don't wash your nipples with soap as that will dry out the oil secreted by the Montgomery glands, those "bumps" around the areola, that help your nipples to stay supple. If your nipples do seem to be dry or if they become cracked or irritated, it is preferable to use only pure lanolin, like Lansinoh for Breastfeeding Mothers, which can even be applied safely right before nursing your baby.

There is also no reason to massage the breasts in preparation for breastfeeding. Stimulating the breasts can trigger the release of oxytocin which is a hormone involved in labor and can therefore cause preterm labor so breast massage is not recommended.

If your baby seems uncomfortable in one position you should experiment with others. A lactation consultant or La Leche League Leader can help you find positions that work for both of you. Don't force your baby onto your breast by pushing on the back of his head, instead guide him to the breast by holding his head gently at the base of the skull and neck. Use pillows to make yourself comfortable and to support your baby in the proper position.

Request that your baby be given no bottles in the hospital. If he should need to be supplemented for any reason, use an alternative method to deliver the supplement that won't interfere with his ability to breastfeed.

Sometimes what seems to be good positioning is irrelevant if your baby is not latched on well, and sometimes even a minor change in positioning can make all the difference in the world. Whatever position you choose, be sure to leave space for the baby to move his head back if needed as babies tend to not feed well if the back of their heads are held close in to the breast. For this reason, many moms support the baby by the shoulders and neck, putting the thumb on one ear and the index finger on the baby's other ear, and the palm of the hand down on the neck and shoulders. Using this position allows the baby to pivot his head back to breathe in the event that the breast does cover the nose. It is important however, to get the baby's nose up close to the breast for a good latch-on. As long as you can see a little space for his nostrils, the baby will be able to breathe just fine. You could also lift the breast slightly up or press the breast gently down to clear the airway. Some assistance in the first few days will make it much easier to learn proper positioning and latch-on techniques.

Pregnancy changes the breasts in order to prepare for breastfeeding and causes a noticeable change in breast size in most women. Most mothers will return to their former size after pregnancy and breastfeeding, although some mothers will be larger and some will be smaller after their pregnancy, whether they choose to breastfeed or not.

The size of a woman's breasts has very little to do with whether or not she can successfully breastfeed because the difference between large breasts and small ones is typically the amount of fat in the breast, not the amount of milk-producing tissue.  There is much variation among women in size of breasts, how the nipples look, what direction they point and so on - the most important thing as far as breastfeeding is concerned is to find a position that works for you and your baby, the principles are the same regardless.

If large breasts make it difficult for you to breastfeed, you can try using a long scarf that you can tie around your neck and place under one breast to lift and support it.  The scarf can easily be switched from one breast to the other without untying it, which will help you to keep your hands free to position the baby.

Generally speaking, the breasts will be the largest when the mature milk comes in (approximately 3-5 days after birth), when there is also a lot of extra fluid in the breast. After nursing gets established and the breasts are making only what is needed, the breasts may actually get a little smaller. If your baby gradually weans himself, your breasts will also gradually reduce in size. Once weaning is complete, your breasts will likely return to their pre-pregnancy size or they may be slightly larger than they were before having your baby.

Breast augmentation or reduction surgery will not necessarily have an effect on breastfeeding, especially if performed by an experienced doctor with the goal of preserving the ability to breastfeed.  The biggest concern with this type of surgery is that the nerves and milk ducts around the nipples may be severed. Incisions made in the fold below the breast or in the armpit area are not likely to interfere. If the surgery involved detaching the nipples then sewing them back on, then most likely the nerves were severed.  Milk production is a system of feedback based on the baby suckling at the breast and the successful removal of milk.  Many nerves in the nipple area deliver messages about milk needs and stimulate production, if these nerves have been severed then the chances of successfully breastfeeding are greatly reduced.

If you believe you might have breastfeeding issues due to a previous surgery you should contact a good lactation consultant to work with you before your baby is born as you may be able to at least partially breastfeed and supplement as necessary.  There is also an email list you could subscribe to for additional support  known as BFAR, Support and Information for Breastfeeding after Reduction Surgery.  Simple send an email request along with a brief description of your situation to bfar@store-front.com.

Nipples also come in all different sizes and shapes and some are more conducive to breastfeeding than others. The good news, though, is that babies breastfeed rather than "nipplefeed", and your baby doesn't have experience with any nipples when he's born, so he doesn't come with any expectations.

Inverted nipples are really pretty common, and are a result of the normal nipple development process. Many women with flat or inverted nipples will see improvement in the protractability of the nipple during the pregnancy without any intervention. If your nipple pops out when you grasp your breast about an inch behind the nipple with your index finger and thumb, breastfeeding should not be an issue for you.  If it is still inverted you could try wearing plastic breast shells during the last months of pregnancy to help bring out the nipples. These shells are widely available and are not expensive. They are hard plastic rings that fit inside a rounded cup that you wear inside your bra. The ring exerts gentle pressure on the nipples that helps them to protrude. Start with just an hour or so a day and work up to longer periods.

After the baby's birth you can use a breast pump or hand stimulation to help the nipples protrude to make the latch-on easier. Use the pump, or put a cold cloth on the nipple to make it erect, right before you get ready to feed.  Once the baby has latched on, the nipple is drawn up toward the roof of the mouth and the nipple is pulled out by the suction from the baby. 

Once your mature milk comes in, typically 3-5 days after delivery, you may find that your breasts are so full that the nipples appear flatter than usual.  If this is the case, use a pump or express enough milk by hand to soften the nipple and areola enough for the baby to be able to latch on.

• Breastfeeding as soon as possible after birth, preferably within the first hour of life for all infants, including premature and sick newborns, with rare exceptions

• Newborns should be nursed whenever they show signs of hunger, approximately 8 to 12 times in every 24 hour period

• No supplements should be given (water, formula or glucose solution) unless medically necessary

• Breastfeeding exclusively for the first six months, preferably to continue for at least twelve months

A good nursing bra will make breastfeeding much easier and more comfortable.  We recommend that you wait until the last few weeks of your pregnancy and buy one based on your size at that time. Be sure to buy a nursing bra that supports well and doesn't pinch or bind. Take several sizes and styles into the dressing room with you and try on a wide variety until you find the perfect fit.

Because their stomachs are very small and they digest breast milk very quickly and easily, breastfed babies will need to nurse every two to three hours. Although they will continue to need to nurse during the night, you don't necessarily have to wake them every three hours to feed. As long as your baby is producing enough wet and dirty diapers and is staying hydrated, you can let him sleep for longer periods at night if he wants to. You may find that if you can nurse more frequently during the day, allowing the baby to stay on each breast until he is through in order to increase the amount of the fattier hindmilk, your baby may very well stretch out the nighttime feedings. Many babies will cluster feed during the day, which gets them most of their daily calories, and then go one longer four to six hour period at night without waking to be fed. You can help by keeping nighttime feedings as boring and low-key as possible, keep the lights low or off and don't sing or play with your baby. As your baby grows, his need for milk and calories will change and he'll find ways to let you know what he needs.

It would be nice to be able to feed your baby on a set schedule, but babies aren't geared that way.  When your baby was in the womb he was getting everything he needed continuously, in small doses, and he never had to ask for it. Since a newborn's stomach is only about the size of his fist he won't need much but he will need it often.  Your first milk, or colostrum, is very concentrated so a little will go a long way, but plan to nurse often in the early days.  You should breastfeed your baby "on demand" to make sure his needs are being met.  You will learn to read his cues early on and offering the breast will become second nature to you.

Babies do eventually settle into more predictable routines and will begin to stretch out their feedings. Some babies do this earlier than others. In the early weeks, you should plan on at least 10-12 feedings every 24 hours, making sure that he is wetting and dirtying plenty of diapers which indicates that you have a good milk supply. Your baby should be producing 6-8 wet diapers and 2-5 dirty diapers each day, this shows that he's getting enough fluid and calories.

Depending on how quickly your milk lets down, how efficient the baby is at eating and the age of the baby, some babies will finish nursing in five minutes and others in 45 minutes.  As a baby grows he will sometimes have short feedings, sometimes longer ones and sometimes he will just barely latch on before he is done, depending on what his needs are at the time. Keep in mind that your baby will want to nurse more often during growth spurts, typically at three weeks, six weeks, three months and six months. These "cluster" feedings help to build up more milk for future feedings as your growing baby needs more and more calories.

Gas & Spitting Up

Unlike formula, the composition of your milk changes to suit the needs of your baby over the course of the entire breastfeeding experience, as well as throughout each feeding. At the beginning of a feeding, your milk is similar to skim milk. This foremilk is low in fat and calories, but is high in volume and is initially satisfying for a thirsty and hungry baby. As your baby continues to feed from that breast, the milk composition gradually changes to become more like whole milk, and by the end of the feeding, your hindmilk is more like cheesecake - high in fat and calories and low in volume.

Your breasts determine how much milk to make based on how much milk is removed from them, so if your baby removes a lot of milk from your breasts in an effort to get those calories, they will respond by making lots more to replace it. If most of the milk they get is the earlier "skim" milk, it will take more to fill them up than if they get both the first milk and the "cheesecake" at the end. Meals that are mostly foremilk will give your baby an overly full tummy that is more likely to trigger spit-up, and they will make your baby want to eat sooner than he might if he got more fat in one meal.

This problem is sometimes called a foremilk-hindmilk imbalance and it can also cause problems with gas. Although the fat content changes throughout each feeding, the milk sugar, or lactose, stays pretty constant.  Babies typically have enough of the enzyme lactase to digest this lactose they get from your milk, however if your baby is taking in extra foremilk to get the calories his body needs, he's also getting extra lactose. People who are lactose intolerant know that eating more milk products than they have the lactase to digest can cause major stomach aches.  Babies that get more lactose than they have lactase to digest generally have lots of gas pains which can make them pretty miserable. The additional sugar can also cause food to move through baby's system rather quickly so these babies often have green, frothy stools.

This problem is pretty common because many breastfeeding mothers are taught to feed from the first breast for ten minutes or so, then switch to the second breast and allow baby to nurse as long as he wants to. This is actually backwards - you should offer the first breast to your baby for as long as he wants it.  He may go through cycles of actively nursing and swallowing, followed by short rest periods, however this will trigger more milk to be letdown and get the fattier hindmilk to the baby more quickly.  Once he's had enough he will usually come off the breast by himself - you should then burp him and then offer the other breast.  Regardless of whether he takes the second breast or not, you should start on that side for the next nursing session.

When a baby gets all of the calories that he needs in a smaller volume of milk that his tummy can handle more easily, he has enough of the enzyme lactase to digest the lactose he's received.  He also may go longer between feedings because he's getting more calories, and he'll spit up less as well.