When you’re pregnant with your first child, you research birth plans, think about baby names and fantasize about the day when you’ll finally get to hold your little one.
But what do you do to prepare for breastfeeding? Chances are not much.
“I think most women are really underprepared for the challenges that breastfeeding can bring for them and for their babies,” says Kelsey Stevens, a board-certified lactation consultant at the Childbirth Center at UW Medical Center – Northwest, which has earned the Baby-Friendly designation for its work promoting and supporting breastfeeding.
While Washington’s breastfeeding rates are well above the national average — 92.4 percent of babies have been breastfed compared to 83.2 percent — that doesn’t mean it’s easy.
“You used to grow up seeing your mom, sisters, aunts and cousins doing it, and it was a skill you learned without knowing,” Stevens explains. “Now first-time moms are going in lacking a lot of those skills. Many have never seen a woman breastfeed other than something they read or practice in a class.”
That lack of familiarity — plus a variety of other factors like anatomy, milk supply and your support system — often results in unexpected baby-feeding difficulties. Some moms eventually forgo breastfeeding after struggling for a few weeks or months.
But it’s not all spilled milk. Breastfeeding is incredibly rewarding and very much worth the effort.
Studies show that breastfeeding has long-term health benefits for babies and their moms, and it’s a one-of-a-kind bonding experience that only you can share with your little one.
“In Seattle, just as we tend to have a lot of moms wanting natural births, we see a majority of people have the desire to breastfeed,” says Mary Lou Kopas, chief of midwifery at the Childbirth Center at UW Medical Center – Northwest.
To help you better prepare for when your little one arrives, Stevens and Kopas share their top breastfeeding takeaways for first-time moms.
Breastfeeding starts right away
After your baby is born, the first few hours are crucial for skin-to-skin bonding time as well as establishing a solid breastfeeding relationship.
“Traditionally in hospitals, they used to separate mom and baby right away to take measurements and things like that,” Kopas says. “Nowadays, we know better. If the baby’s not in distress, we try not to intervene. Newborns have a lot of instincts to find the breast if we get out of their way.”
What Kopas is describing is something called baby-led latching, where newborns instinctually root around for the nipple when they’re ready to nurse. Letting this first feeding happen naturally and with minimal stress helps ensure a positive association with breastfeeding for both baby and mom.
But if you’re not able to go the baby-led latching route because you or your baby need some initial medical intervention, don’t worry. You can still have a good breastfeeding relationship, even if you have to wait a few extra hours.
“I encourage all moms to see a lactation consultant when they’re in the hospital,” Stevens says. “We can help you get started and make sure nursing is comfortable.”
A good latch goes a long way
In breastfeeding terms, a good latch is when baby’s mouth attaches to the breast in the correct position, allowing your little one to effectively suck and draw out milk.
“Baby’s chin should be buried into the breast and the lips should be flared with a seal over the breast,” Stevens says. “Baby’s mouth should be wide.”
Positioning the lips and mouth this way lets your baby form a seal, extend the tongue and draw your nipple and areola deep for efficient nursing.
If that sounds like a whole lot to visualize, that’s because it is. Getting a proper latch can take a ton of practice and coordination for you and your baby — no easy feat considering one of you may only be a few hours old.
When the latch is a poor one, sometimes because the baby can’t draw the nipple deep enough into the mouth, it causes frustration on both sides.
“Some babies are patient and keep trying until they get it right and sustain the latch,” Kopas says. “But other babies are quicker to panic and start crying, which can be challenging for the mother. We coach them to try not to get frustrated along with their baby, but instead to calm and soothe them and try again.”
Another sign of a poor latch? If nursing is painful.
“In the early days, most moms have some nipple pain because the baby is feeding frequently,” Stevens explains. “After that, you might have some initial discomfort in the first 5 to 15 seconds while baby is latching, but the pain should minimize, and it should feel comfortable during the rest of the feeding.”
If it hurts to breastfeed and that pain lasts the entire nursing session, ask your doctor, midwife or lactation consultant to check your baby’s latch.
And if you’re already home with your baby, keep in mind that many hospitals like Northwest offer breastfeeding support groups for new moms to practice breastfeeding with the help of a certified lactation consultant.
Anatomy issues may complicate things
Practice or not, sometimes your anatomy or baby’s anatomy can make breastfeeding a challenge.
Inverted or flat nipples, as well as underdeveloped breasts, can make getting a good latch more difficult. (Yet another reason why it’s important to practice breastfeeding and ask questions while at the hospital.)
“There are a few different techniques you can try, like rolling or pumping to stimulate your nipples to draw them out,” Kopas says.
Other times, babies are pre-term — aka born before 37 weeks of pregnancy, as is often the case with twins or other multiples — and face a steeper learning curve.
“They don’t have the muscle mass, they don’t have the coordination and they’re sleepier,” Stevens explains. “They’re just not as good at breastfeeding.”
When this happens, it can take a little extra effort to help baby get the technique down, and you may need to pump or express milk by hand early on to help increase your milk supply.
Some babies are also born tongue-tied, a breastfeeding buzzword that means the flap of skin (called a frenulum) connecting the tongue to the bottom of the mouth is too short. This can hinder your baby’s ability to extend the tongue and suck effectively.
If the tongue-tie is severe, a doctor or lactation consultant may suggest cutting the frenulum so that baby can get a better latch.
Your milk supply is about demand
Many new moms are surprised that their breasts don’t produce tons of breastmilk right away. In reality, it can take anywhere from three to five days for your breasts to ramp up production.
“In the first three days, the early milk is called colostrum,” Stevens says. “Moms are often surprised that the quantity is so small, but it’s sufficient for most babies and has an important purpose for the infant gut.”
Why does it take so long for the rest of your milk to come in? It’s all about supply and demand.
When your baby first starts to nurse, that stimulation gives your breasts the message to start producing milk. The more you breastfeed, the more milk you’ll make.
That’s why moms with pre-term babies who may not have the strength to nurse as much early on need to add in extra stimulation to build up their supply.
What about those herbs, supplements and specialty lactation foods that claim to increase your milk supply? Well, the results are mixed.
“There’s a lack of clear evidence that they work,” Stevens says. “The best thing you can do to increase your milk supply is to work on getting baby feeding well and adding in pumping or hand expressing afterward, if needed.”
Nursing moms need good support
If it takes a village to raise a child, the same is true for breastfeeding.
Stevens and Kopas both stress that moms need a good support system in place to help them on their breastfeeding journey.
This can be a family member or partner who takes care of your baby while you’re pumping, a trusted health expert who can provide guidance about technique and latch, other new moms who are struggling with the same things as you or all of the above.
“It’s important to be in a supportive environment with people who can say, ‘We’re here for you and you’re doing the best you can,’” Stevens says.
Remember to be kind to yourself
Despite all your best efforts, breastfeeding may not go as you had hoped or planned. And that’s perfectly fine.
Sometimes breastfeeding just isn’t possible, like if baby needs extra medical care or you need to return to work right away.
“We recognize that babies are still able to thrive from formula or expressed breastmilk,” Stevens says.
The thing is, you might not expect the onslaught of emotions that come when your breastfeeding plans go awry.
“Breastfeeding is really closely tied to how we perceive ourselves as mothers,” Stevens explains. “Moms who wanted to breastfeed, but can’t, may have to go through some sort of grieving process. There’s a lot of guilt and emotion tied up with it.”
Still, she says, it’s important to be kind to yourself and remember that you’re doing the very best you can for your child.
“You’re a good mom if you can keep your baby fed,” Stevens says. “You may be surrounded by a million other things that make it so you can’t breastfeed, and I try really hard to be supportive of these moms. Breastfeeding is a huge important factor, but it’s not the only thing. There are so many things that you can do that impact your child.”
Editor’s note: This article has been updated to reflect Northwest Hospital is now UW Medical Center – Northwest, a second campus of the University of Washington Medical Center in Seattle.