Breastfeeding Initiation

Breastfeeding Initiation: A Professional Guide to Establishing Milk Supply

The first hours and days after birth are a critical window for establishing breastfeeding. Understanding the physiological process of lactogenesis (milk production) and practical techniques for successful initiation can help new mothers navigate this important period. This guide provides evidence-based information on how to start breastfeeding and what to expect during the first feeds.

*Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult your midwife, lactation consultant, or healthcare provider for concerns about breastfeeding.*

1. Understanding the Stages of Milk Production

Before discussing techniques, it’s helpful to understand the physiological stages your body goes through:

Key point: Your body has been preparing for breastfeeding since mid-pregnancy. The first feeds are about colostrum—small volumes but rich in antibodies and nutrients. Progesterone withdrawal after birth provides the trigger for lactogenesis in the presence of high prolactin levels .

2. How to Initiate Breastfeeding After Birth

The First Hour After Birth

WHO and UNICEF recommend initiating breastfeeding within the first hour of birth . This window is critical for both mother and baby.

Immediate steps:

1. Skin-to-skin contact immediately after birth
– Place baby naked (with a warm blanket over both of you) on your chest
– Continue uninterrupted for at least the first hour or until after the first feed
– Benefits: stabilises baby’s temperature, heart rate, and blood sugar; triggers instinctive feeding behaviours

2. Allow baby to self-attach
– Most healthy newborns placed skin-to-skin will instinctively crawl toward the breast and self-attach
– This process may take 20-60 minutes—be patient
– Avoid rushing or forcing the baby onto the breast

3. Offer the breast
– If baby shows feeding cues (rooting, sucking movements, hand-to-mouth), gently guide them to the breast
– Aim for the first feed within the first hour

What if baby doesn’t feed immediately?
– Continue skin-to-skin—it’s still beneficial
– Hand express colostrum and offer on a spoon or with a syringe
– Seek help from midwife or lactation consultant

Important research note: A 2023 study found that delaying breastfeeding initiation to >1 to ≤24 hours after birth is **not associated with decreased breastfeeding duration** compared with initiating at ≤1 hour, for both vaginal and cesarean deliveries . While early initiation remains recommended, this may reassure mothers who experience delays.

First 24-48 Hours: Colostrum Phase

During this period, your breasts produce colostrum—thick, yellowish, nutrient-dense first milk.

Feeding frequency:
– Newborns need 8-12 feeds in 24 hours
– Feeds may be frequent and irregular
– Follow baby’s cues, not the clock

What to expect:
– Small volumes (baby’s stomach is the size of a cherry at birth)
– Colostrum is concentrated—small amounts meet baby’s needs
– Wet nappies: Day 1: 1-2, Day 2: 2-3, Day 3: 3-4 (increasing as milk comes in)

Physiology note: Failure of early removal of colostrum from the breast is associated with high milk sodium and poor prognosis for successful lactation . Frequent feeding helps establish supply.

Day 3-5: Milk “Coming In”

As milk volume increases, breasts may feel full, firm, and warm—this is called engorgement and is most common 3-5 days after birth .

Continue:
– Frequent feeding (8-12 times/24 hours)
– Responsive feeding—watch baby, not the clock
– Skin-to-skin contact to stimulate milk production

3.First Feed: What to Expect and What to Do

Before the Feed

Position yourself comfortably:
– Sit or lie down in a relaxed position
– Use pillows to support your back and arms
– Bring baby to breast, not breast to baby
– Ensure you’re relaxed—tension can inhibit let-down

Try different positions:
– Laid-back position (biological nurturing): Lean back in a chair or bed, baby lies on top of you tummy-to-tummy. This triggers newborn reflexes and helps baby self-attach .
– Cross-cradle hold: Sit upright, support baby’s back and neck with opposite hand to the breast being used. Good for newborns learning to latch .
– Side-lying hold: Lie on your side with baby facing you. Useful for rest and cesarean recovery .

During the Feed

Achieving a good latch (the “asymmetric” latch):

The key to effective, pain-free breastfeeding is a deep, asymmetric latch where baby takes more of the areola with the lower jaw than the upper.

How to achieve a good latch:
1. Support breast with hand (C-hold: thumb on top, fingers below, well back from areola)
2. Tickle baby’s lips with nipple to encourage wide opening
3. When mouth opens wide like a yawn, bring baby quickly onto breast—**baby goes to breast, breast does not go to baby**
4. Aim nipple toward baby’s palate (roof of mouth)

For flat or inverted nipples:
– Roll the nipple between your fingers before feeding
– Hand express or briefly pump before latching to draw out nipple
– Babies “breastfeed,” not “nipple feed”—their suck can draw the nipple in

Signs baby is feeding effectively:
– Jaw movement right back to the ear
– Swallowing sounds (soft “kah” sound)
– Feels like gentle tugging, not pinching
– Breasts feel softer after feed

After the Feed

– Allow baby to finish naturally (may come off spontaneously)
– If you need to break suction, insert clean finger into corner of baby’s mouth
– Express a drop of milk and rub onto nipple—helps healing
– Change feeding positions for next feed to drain all breast areas

4. First-Time Feeding: Key Points to Remember

It’s a Learning Process for Both of You

– Breastfeeding is a learned skill for both mother and baby
– It’s normal for early feeds to feel awkward or take practice
– Most challenges resolve with time and support

Pain Is Not Normal

– Mild tugging sensation at latch-on is normal during the first week
– Initial soreness should wear off 15-30 seconds after baby latches
– Persistent pinching, cracking, or bleeding nipples indicate a problem
– If soreness continues beyond the first week or worsens, seek help

Baby’s Output Matters More Than Input

– Wet nappies and stool frequency are better indicators than perceived milk intake
– Day 1-2: 1-3 wet nappies, meconium stools (black, tarry)
– Day 3-4: 4-6 wet nappies, transitional stools (greenish-brown)
– Day 5+: 6+ heavy wet nappies, yellow seedy stools (breastfed)

Responsive Feeding Is Key

– Feed when baby shows early hunger cues (rooting, sucking fists, lip smacking)
– Crying is a late hunger cue—try to feed before baby reaches this stage
– Avoid scheduled feeding—follow baby’s lead

Avoid Supplements Unless Medically Indicated

– Avoid water, formula, or glucose water unless prescribed
– These interfere with milk supply and may increase allergy risk
– If supplementation is medically necessary (e.g., low blood sugar, dehydration), expressed breast milk is first choice

Use Both Breasts

– Offer first breast until baby comes off or slows sucking
– Offer second breast (baby may or may not take it)
– Alternate which breast you start with at each feed

Manage Engorgement

If breasts become hard, sore, and too full when milk comes in:
– Hand express a little milk before feeding to soften areola
– Apply something cool to breasts after feeds to reduce swelling
– Feed frequently—empty breasts signal continued production

Look After Yourself

– Keep water within reach during feeds
– Eat regular, nutritious meals
– Rest when possible—tiredness affects milk production
– Limit caffeine and avoid alcohol
– Accept help from others

5. Common First-Time Challenges and Solutions

6. When to Seek Help

Contact your midwife, health visitor, or lactation consultant if:

– Baby has fewer than expected wet nappies
– Baby is unusually sleepy and difficult to wake for feeds
– Baby has jaundice (yellow skin/eyes) that worsens
– You experience severe pain throughout feeds
– Breasts become red, hot, or you develop fever (possible mastitis)
– You’re worried about your baby’s feeding or weight gain
– You’re feeling overwhelmed or struggling emotionally

Most breastfeeding difficulties are resolvable with prompt, skilled support.

7. Summary: First Week Breastfeeding Checklist

Key resources:
– Association of Breastfeeding Mothers: www.abm.me.uk
– La Leche League: www.laleche.org.uk
– National Breastfeeding Helpline: 0300 100 0212

*References available upon request. Key sources: WHO/UNICEF Baby Friendly Initiative , NHS Start for Life, PubMed studies , New Zealand Ministry of Health , Norwegian Directorate of Health .*