Breast care and feeding

While many of the mechanics and benefits of breastfeeding are well understood, “there is still so much we don’t understand about breastfeeding,” acknowledges Dr. Laurie Jones, pediatrician and founder of Dr. MILK (Mothers Interested in Lactation Knowledge). What we do know is that every time your baby latches to you, a conversation starts between your baby’s saliva and your mammary glands. And that’s where the magic begins.

Benefits for the lactating parent

There are many compelling reasons for parents to breastfeed. The skin-to-skin contact is good for you and your baby, and breastfeeding produces the hormones oxytocin and prolactin, which can be soothing and stress-relieving. 

“Breastfeeding is not recognized as preventative medicine for the mother,” Dr. Jones says. But the benefits are myriad, including lowering the risk of you developing the following:

Benefits for the baby

Breast milk is pretty amazing. It contains all the nutrients babies need during their first six months of life—and, remarkably, no more than they need. It’s capable of something called chrononutrition, where it adjusts to meet your baby’s demands based on age, health, and time of day. And because babies can regulate how much breast milk they consume, you can’t over-breastfeed your baby. 

Your breast milk also exposes your baby to the wide range of nutrients and flavors that you consume, not to mention your natural immunities. 

Breastfeeding lowers the risk of your baby developing the following:

Breastfeeding is not all or nothing: Any amount you can do carries benefits for both you and your baby. There are many ways to breastfeed, including breastfeeding exclusively, pumping exclusively, supplementing with formula, and applying any combination of any of these methods, which is known as “inclusive breastfeeding.”

If you’ve chosen to breastfeed to any extent, there are a few practical tips and tools that can go a long way in helping you establish a good routine, mechanics, supply, and knowledge around when to get certain kinds of support. We’re here to help you learn and practice these.

A golden first hour

In the immediate hour after birth, any time when babies are both skin-to-skin with and connecting their mouths to the mother’s nipple is shown to promote breastfeeding. This is known as the Golden Hour¹, though really the first five days of a baby’s life are crucial in establishing breastfeeding.

When babies are born, especially following an unmedicated delivery, if they’re placed on your stomach, they may do the “breast crawl” and find your nipple. They don’t even need to have a successful latch to help kickstart your breastfeeding journey. Expressing colostrum, often referred to as “liquid gold,” by hand while your baby licks will do the trick. But babies do have a suckling instinct, and many are able to latch (though not necessarily perfectly or even strongly) right after birth.

As valuable as the golden hour and first few days after birth are in promoting breastfeeding, it’s important to know that if you are unable to have this experience for whatever reason—including your baby being in the NICU—you can still do your best to stimulate your baby’s presence and sucking needs. You can, for example, try to stimulate your senses by hearing a recording or watching a video of your baby crying, or by smelling a hat your baby wore just after birth, to encourage your letdown.

If at any point in your early postpartum hours and days, you feel that you need support—anything from establishing a good latch with your baby to counseling over a traumatic birthing experience to grieving the loss of this golden hour—reach out to your provider, and ask for the help you need.

The mechanics of breastfeeding

Babies are born with a sucking reflex. When their mouth touches a nipple, they open it, then squeeze their gums, jaws, and cheek muscles. Once their mouth is fully over a nipple, they move their tongue from front to back in a wave-like motion, pressing the nipple against the roof of their mouth, while their jaw holds the breast and creates a vacuum that pulls the milk from the breast into their mouth and toward their throat.

In order for babies to compress a nipple between their tongue and the roof of their mouth, they need a good amount of the nipple areolar complex in their mouth. There isn’t a textbook amount that’s just right—many factors, including the baby’s palate and cheek strength, work together to make this possible for all body types. It can help to visualize pointing a nipple to the roof of your baby’s mouth so that it reaches back to the roof of your baby’s soft palate.

A good latch stimulates the nerve endings in the nipple and areola, which signal the pituitary gland in your brain to release two hormones: prolactin and oxytocin.

Prolactin prompts your alveoli to turn proteins and sugars from your blood supply into breast milk. Meanwhile, the number of prolactin receptors on milk-making cells increase as a baby, pump, or hand stimulates the breast². 

This is why, in the first few weeks after birth, if your goal is to increase your milk production, you should let your baby feed or suckle on your breast on demand, rather than on a pacifier, says Dr. Laurie Jones, a pediatrician and founder of Dr. MILK (Mothers Interested in Lactation Knowledge).

Oxytocin, meanwhile, triggers your breasts’ small clusters of alveoli sacs, called lobules, to release the milk stored in them, and it widens the milk ducts for easier flow to the nipple. You might feel tingling, fullness, or a tightening in your breasts, followed by a sense of calm and love as your baby suckles. In the days following delivery, it’s also common to feel cramping while breastfeeding as your uterus contracts. Learn more about the mechanics of breastfeeding.

Positioning

How you hold your baby to your breast can help establish a good latch. It can also help establish good posture for your own back, neck, and shoulders. (A breastfeeding pillow, such as a Boppy or My Brest Friend, can help support your arms and lower back while bringing your baby’s head higher up toward your chest, so you don’t need to hunch over.)

Some breastfeeding positions over time have acquired nicknames. This includes the laid-back hold³, which encourages a newborn baby to crawl to the breast (in moves known as the breast crawl) for the first feed. A few factors can affect the positions you try, including milk flow, your baby favoring one side or position (sometimes due to torticollis), and any injuries you might have sustained to your wrist, back, or shoulder.

Pumping

There are many reasons people choose to pump. Pumping can mitigate the difficulties of latch or supply, can help you get back to work while maintaining your supply, and if you are separated from your baby for any length of time after giving birth, is actually a precondition to breastfeeding. Some people, of course, choose to exclusively pump.

Every breastfeeding experience is a partnered dance between you and your baby. It’s one you learn together, as you navigate changing tempos and routines. And despite how practiced you become, each breastfeeding partnership is unique; if you have another baby, get ready to learn all over again!

If breastfeeding feels like an intimidating mystery at first, you’re not alone. You may be tempted to compare your experience to your mom’s, or a friend’s, or that of someone you follow on social media, but doing this can actually lead to more confusion than validation. Take whatever time you can to focus on yourself and your baby, as you begin to understand and build confidence in your supply. 

One of the marvels of breastfeeding is that your breasts naturally adjust to your infant's demands. Your hormones are linked to your baby's feeding times, hunger cues, and how much they suckle and feed.

If that sounds good, but you have no idea how to do it, we’re here to help you:

The basics of milk production

Most breastfeeding journeys follow a fairly predictable trajectory. During pregnancy, your hormones stimulate the production of colostrum. This early thick yellow milk, which you produce during your baby’s first two to four days, helps build your baby’s immune system to fight potential infections. It packs a powerful punch, including white blood cells, antibodies, and proteins¹. This is protection at its finest—it’s no coincidence that many people call colostrum liquid gold.

About three to five days after delivery, your mammary glands begin producing thinner milk that appears whiter, bluer, or grayer, though some colostrum remains in your milk for up to six more weeks. At about two weeks postpartum, this “transitional” milk becomes “mature” milk that has all the fat and nutrients your baby needs for the first six months². As you breastfeed, your body naturally produces the nutrients and quantities your baby needs.

When your baby cries out of hunger, your brain releases oxytocin, or the letdown hormone, explains Dr. Nicole M. Avena, a neuroscientist. When your baby begins suckling, this oxytocin stimulates your milk to come out and start flowing. And when breastfeeding, your baby’s suckling and removal of milk from your breast stimulates your body to produce more milk, replacing what your baby has consumed.

Because your newborn’s stomach grows from roughly the size of a cherry at birth to the size of an egg in the first month, your baby can only take in so much milk at a given time. In general, this means that when babies cry to be fed, they need to be fed—no matter the hour. And these first four to six weeks are pretty crucial; the more often you stimulate and empty your breasts of milk over a 24-hour period, the more milk you are telling your body to make.

One of the marvels of breastfeeding is that your breasts naturally adjust to your infant’s demands. This is because your hormones are linked to your baby’s feeding times and hunger cues³, along with how much your baby is suckling and feeding. Learn more about breastfeeding mechanics.

How milk production works over the long term

From the time your transitional milk comes in a few days after birth, until your baby is four to six weeks old, you’re setting your supply. Dr. Laurie Jones, a pediatrician and founder of Dr. MILK (Mothers Interested in Lactation Knowledge), advises feeding on demand during this period.

“Those first four weeks are crucial to establishing your supply,” she says. “It’s the Wild West of feeding—mayhem, on demand.”

Feeding on demand enables your baby to tell your breasts how much milk to make, thus establishing an appropriate supply. At the same time, it enables you to not worry about maintaining a tight schedule for breastfeeding or pumping sessions—let alone tracking them.

“Babies’ caloric burn actually goes down as they get bigger,” Dr. Jones says. “It’s an amazing system.”

If you’d like to support your supply, there are a few things you can do to help. These range from hydrating and maintaining additional calories in your diet, to having skin-to-skin time with your baby, to engaging in activities that reduce your stress while you feed or pump.

You should never stress about calculating or tracking your magic number—it isn’t even something you’ll know until after your supply reaches a steady state. Think of it as a principle that can help guide your understanding of how frequently you might need to breastfeed or pump to maintain your supply, especially if you’re going back to work, or as your baby starts sleeping longer stretches at night.

"You can't negotiate with the physiology of your breasts,” Dr. Jones says. “You may have to empty three times between 8 p.m. and 8 a.m., and other people need to empty four times. Some people need to empty zero to one time at night—and you may hate those people," she says with a laugh.

Managing underproduction

There are a variety of reasons, both medical and circumstantial, why some people either have an insufficient supply of milk or are unable to breastfeed. Being unable to breastfeed can stem from contracting an infectious disease such as HIV or tuberculosis, or galactosemia (a metabolic condition where babies can’t break down and digest milk)⁴.

Underproduction often results from a lack of parental leave or support, slipping below your magic number of removals each day, having multiples, or using certain medications or drugs. Breast surgeries or natural conditions resulting in insufficient or underdeveloped glandular tissue (in breasts of any size), or that affect the nerves and structure of your nipple and areola, can also impact your supply. So can a tongue tie or other physical challenge to your baby’s latch. 

Signs that you are underproducing breast milk include a downward trend in your baby’s growth—or even weight loss, after the first few days of life—and a clear desire from your baby for more milk. (One way a baby can communicate this is with clenched fists, instead of open hands, at the end of a feed.) 

If you believe you have, or will have, an insufficient supply of milk, you should meet with a lactation consultant to establish a safe feeding plan and optimize your milk production to align with your personal feeding goals.

Managing overproduction

Overproduction, on the other hand, occurs when your breasts produce more milk than your baby needs and can process. You won’t overproduce breast milk, if you only breastfeed on demand, but you may begin to overproduce, if you overstimulate your breasts—i.e., if you are pumping for your premature or low-birth-weight babies, and are having to guess their needs.

While oversupply puts you at greater risk for clogged ducts, engorgement, or mastitis, you can store and/or donate excess milk, as well as work with a lactation consultant to learn how to safely taper your supply. When you have an oversupply of breast milk, you may also experience milk leaks, sleep deprivation due to frequent milk expression needs, and even dysmorphia (where you don’t feel in control of your body).

When to get help

Certain breast care conditions that can crop up over the course of your breastfeeding journey require immediate attention. If, for example, your breasts develop redness with one or more lumps, and you experience a fever or other flu-like symptoms, you may have developed mastitis, and you should contact your provider right away. (Check out our breast care troubleshooting guide to learn more about the most common conditions related to breastfeeding.)

Meditation is another avenue you can explore. These 5- to 10-minute meditations have been designed to help you feel calm and centered as you breastfeed and/or pump, which can in turn improve your supply⁵.

Even the smoothest breastfeeding journeys can have a few bumps in the road. And even if you’re an experienced breastfeeder, each baby (and each breastfeeding relationship) is unique. 

About 70 percent of mothers experience breastfeeding difficulties, mostly during the first month¹. The good news is that many breastfeeding issues are pretty straightforward. But because many are time-sensitive, and you may feel unsure about what you might even need to address (let alone how), it’s important to quickly reach out for lactation support.

Here’s what to know about the various types of breastfeeding support you can get—and how to maximize it to keep you and your baby healthy and comfortable.

Who’s there to help

OB-GYNs focus on your health, pediatricians focus on your baby’s health, and family medicine doctors can do both. While many of these physicians diagnose and prescribe antibiotics for conditions such as mastitis or thrush, none of them specialize in breastfeeding. For issues with latch, engorgement, and other common breastfeeding challenges, they often either incorporate lactation consultants into their practice or refer patients to them. 

You can start working with lactation consultants (IBCLCs or CLCs), which specialize in all things related to breastfeeding, while pregnant to develop a feeding plan. Once your baby arrives, they can help you establish your supply and routine by working with you on your positioning and helping you troubleshoot latch challenges (including tongue ties and inverted nipples). They can help you cope with related breast issues such as milk blisters or plugged ducts. Most insurance plans today cover some visits with a lactation consultant.

Postpartum doulas, partners, caretakers, and friends are also a crucial part of your lactation support team. They can help you implement your feeding plan at home and help take care of you (like rubbing your feet, or watching the baby while you shower or nap!), your household (like doing laundry and prepping meals), and your family (like picking your toddler up from preschool).

When to get help

Ideally, you’ll begin assembling your care team during your pregnancy. Between prenatal visits to your OB-GYN or midwife, try to interview both pediatricians and lactation consultants to find good fits before your baby arrives.

The first 24 to 48 hours are a great time to get as much help as possible from the specialists taking care of you. A provider supporting the birth of your child typically examines your newborn’s mouth to check for potential issues such as a lip tie, and, as you begin breastfeeding, also will take a look at your latch. If you haven’t lined up a lactation consultant, most hospitals and birthing centers have one on staff to help you and your baby get off to a good start with breastfeeding.

During your own postpartum appointments (typically at weeks two and six) and your baby’s first checkups with their pediatrician, you can bring up anything that might be on your mind related to breastfeeding. This can include pain, long feeds that go beyond 45 minutes, and questions around your supply. In some cases, these specialists can help; in others, they may refer you to a lactation consultant.

Breastfeeding can change day to day, especially in the first six weeks. If something doesn’t seem right, the sooner you get help, the better. Also bear in mind that you don’t need to have a problem (or even think that you have one) to get support. You can schedule time to simply ask questions or get reassurances.

How (and where) to find help

The highest-credentialed professional to help support your lactation needs is an International Board Certified Lactation Consultant (IBCLC); other great options include a Certified Lactation Counselor (CLC) or Certified Lactation Educator (CLE). Whoever you work with, this will be your primary specialist to help you address all your lactation needs.

While you can search on your own for lactation specialists in your area, your own providers will likely have consultants they can refer you to—and some providers have lactation consultants on staff. You can also use online resources that offer easy-to-schedule televisits, such as SimpliFed. (With lactation support, time is often of the essence.)

Breastfeeding has many established benefits, but it can come with challenges. The good news is that you can troubleshoot many of them on your own. Just try to be proactive about getting medical and lactation support before and during your breastfeeding journey so that you can address any concerns quickly and breastfeed comfortably.

One tricky reality? Pain in the first couple weeks of breastfeeding is extremely common—three out of every four new moms report it¹—but you shouldn’t actually have to suffer through it. That’s right: Breastfeeding often hurts, but it shouldn’t². A lot of people aren’t getting the help they need.

This is where troubleshooting comes in. If you find breastfeeding to be painful at any point, there’s likely something happening that is fixable, such as your positioning or your baby’s latch. In fact, certain issues—sore nipples, engorgement, and plugged ducts—have pretty straightforward solutions if you promptly address them. And you can soothe tired and sore nipples with balm, or relieve pain with heat, massage and showers.

If you find that anything is difficult to troubleshoot on your own, or you feel unsure about what or how to properly do something, contact your provider for additional assessments and advice by phone, televisit, or in person. It can be exhausting to make yet another appointment, but many of these issues are time-sensitive, and you deserve the right kind of help.

You might also find that you are facing certain conditions that impact how much milk you produce. Rest assured that your sleep and diet are actually unlikely to play a role. Your body is meant to lactate after pregnancy, often on little sleep and in a wide range of conditions where your nutritional intake may not be ideal.

You can start by running through a basic checklist to help your supply. It’s also good to be aware of certain issues that can impact it. These include lack of parental leave or support, the use of certain drugs and medications, and something called “insufficient or underdeveloped glandular tissue,” or “hypoplastic breast tissue.” This condition occurs when, for a variety of reasons, a breast’s milk-making tissue does not develop as expected in utero, during puberty, and/or during pregnancy, and it can occur in breasts of any size.

Despite your best efforts, it’s also possible to find yourself sick with a virus (e.g., a cold, flu, or Covid-19) or another illness when breastfeeding. While dealing with any illness when you have a baby can feel discouraging, most do not require you to stop breastfeeding.

There are many reasons why you might also stop lactating, and sometimes they are beyond your control, from being prescribed certain medications, to having an unsupportive work environment, to having a miscarriage, stillbirth, or abortion.

No matter what issues you may face during your breastfeeding journey, remember that a range of medical experts can help—and the sooner you reach out, the better.

“Make sure you ask for help when you need help,” says Emily Varnam, a midwife assistant and birth and postpartum doula. “When you get help early, you get solutions early. A lot of interventions that are offered—a prescription, a new position, or even just knowledge—can have a big impact.”

You might not realize it, but breastfeeding often comes with both mental-health benefits and challenges. These range from elevated levels of a calming hormone to reduced hours of sleep.

While you are focused on taking care of your baby, it’s easy to ignore or put aside your own needs. But depression and breastfeeding are not mutually exclusive, and it’s important to be in tune with and prioritize your mental health throughout your breastfeeding journey. 

Mental-health benefits of breastfeeding

There are many protective physical benefits to breastfeeding for a parent. And much of it pertains to how hormones affect the body. For example, breastfeeding promotes the release of oxytocin, the “love hormone,” which helps with bonding and reduces stress by balancing levels of cortisol, known as a stress-oriented hormone. (Elevated levels of cortisol are often associated with postpartum mood disorders and sleep disruptions¹,².)

The oxytocin released while breastfeeding also helps make sleeping—when possible—easier, deeper, and more rejuvenating. This is important because lactating parents are more likely to wake frequently to feed the baby. 

“Oxytocin calms the nervous system, and it's in opposition to cortisol,” says Emily Varnam, a midwife assistant and birth-and-postpartum doula.

The effect that sleep has on parents’ mental health cannot be underestimated. Even when you and your little one are down to one nighttime feeding session, breastfeeding can have a positive impact on your mental health by helping you sleep more soundly.

Mental-health challenges of breastfeeding

There’s nothing about breastfeeding itself that puts your mental health at risk; instead, it’s more about the experiences and circumstances surrounding it that can impact your state of mind. Put plainly, the psychological impacts of breastfeeding can heavily weigh on your mental health. 

You may feel a high level of emotional and social expectations around breastfeeding. Many parents feel that they should know how to breastfeed without instruction, that it should come naturally and effortlessly, and that it should be a blissful experience free of challenges, pain, or confusion—all with a bountiful supply of milk. That’s how breastfeeding is often portrayed in popular culture and social media, at least. 

The reality is that breastfeeding can have challenges, and it does not always “come naturally.” Breastfeeding can certainly be wonderful. However, it might also come with challenges that impact your frame of mind, including:

Regardless of what your breastfeeding targets may be, there are things that might impact your ability to breastfeed comfortably or for a sustained period that you simply cannot control. Breast physiology can impact milk supply; issues such as insufficient glandular tissue (mammary hypoplasia), an infant tongue tie, or a past history of sexual abuse can also complicate feeding efforts. For any number of reasons, you might need to modify aspects of how you breastfeed in order to continue—or stop breastfeeding altogether well before you planned to do so. 

The environment in which you’re nursing can also impact your journey. If you don’t have much logistical or educational support, breastfeeding can be more difficult. Complicating it all, you might feel guilt, sadness, or shame, if you can’t breastfeed—or if you choose to stop, even if you are able to. 

Ultimately, please remember that any reason you want or need to stop breastfeeding is a valid one. 

How pre-existing mental-health conditions can impact breastfeeding 

If you’ve struggled with mental-health issues in the past, it’s recommended that you let your providers know. They can help you get extra support to ensure that you are taking care of yourself while meeting your breastfeeding targets. 

You might need support to cope with any or all of the following challenges: 

If you do not have sufficient targeted support with both initiating and sustaining breastfeeding, you have an increased risk of earlier than planned (or desired) cessation of breastfeeding. Earlier cessations, in turn, can contribute to the development of perinatal mood disorders³.

Even if you don’t have an established history of mental-health issues, it’s good to be aware of factors that are associated with or can contribute to postpartum mental-health challenges:

Varnam says she tends to check in more often with postpartum patients who have a history of mental-health issues or any of these risk factors.

“A big part of this is making sure that if they have existing treatment, that it is safe for breastfeeding, so there are no disruptions,” she says. “And if they don’t, to make sure they have simple steps to activate a plan, if needed.”

Unexpected mental health struggles while breastfeeding

If you experience a sense of dread, shame, anxiety, sadness, anger, or other negative emotions when you begin to breastfeed, you may be dealing with something called dysphoric milk ejection reflex, or D-MER. It’s a physiological response to a milk letdown that causes negative emotions to surface. It’s a bit puzzling as to exactly how and why it happens.

“The causes are not completely understood. It’s thought to be a result of the interaction among the breastfeeding hormones oxytocin, prolactin, and dopamine,” says Chris Raines, a perinatal psychiatric nurse practitioner.

The response can last a few minutes or up to about 10, and it typically disappears on its own. If you are having D-MER episodes, talk to your provider. 

It’s important to remember that you’re not a bad parent for having this response to breastfeeding, Raines says. What you’re experiencing is uncontrollable. Becoming aware of it, and accepting it as a temporary state that occurs when breastfeeding, will help you cope with it. 

Mental-health implications of complications in pregnancy and childbirth

Challenges in pregnancy and childbirth can have a lasting impact—one that you can’t always foresee. If you’ve delivered your baby, and everyone is healthy, you might think that you’re out of the woods. 

“Many people have heightened anxiety from being on high alert for a long time that doesn’t go away. That anxiety can spill into a breastfeeding relationship,” Varnam says. “Because there’s so much to figure out—and ways it can go wrong—people can get hyperfocused on it.” 

Some parents also intently focus on lactation, something they have a sense of control over, “when other things are going wrong—for example, if you are pumping while your baby is in the NICU,” she says. 

This kind of experience is the result of trauma: It doesn’t necessarily indicate or correspond with a standalone perinatal mood or anxiety disorder (PMAD) or pre-existing mental-health issue, Varnam says. 

One example is how pregnant women cope with hyperemesis gravidarum (HG), a prolonged state of nausea and vomiting that begins during pregnancy and ends when you deliver. HG can lead to an expectant mother’s anxiety and hypervigilance about nutrition. 

This mental-health issue can spill over into the postpartum period, even if the nausea itself does not. Depending on the duration and severity of HG while pregnant, it can take months to recover from, Varnam says, and can potentially lead to disordered eating, which in turn could potentially impact one’s ability to breastfeed.

Gestational diabetes, which is treated in part by closely monitoring the sugars consumed during pregnancy, can lead to a similar hyperfocus on nutrition. And other traumatic experiences, such as previous pregnancy loss or infertility, can also leave a negative impact on your mental health and complicate your breastfeeding relationship. 

Balancing mental health and breastfeeding

You might find that you need to alter your feeding plans to accommodate your mental health. This may mean reducing the number of breastfeeding sessions per day, supplementing breastfed milk with pumped milk, donor milk, or formula. It may even mean stopping breastfeeding altogether. All feeding options and plans should be discussed, and it is never appropriate to put the health and well being of the baby solely on your shoulders. 

Sleep is vital to mental health and recovery. In some cases, the feeding schedule required to maintain your milk supply may impede your recovery and ability to regulate your nervous system. 

Another thing that can impact your nervous system: all the light touches you receive all day (and night!) from your baby. When you’re feeding your baby multiple times a day, you can become overstimulated. This can contribute to being what occupational therapist Larissa Geleris calls being “touched out.”