Breastfeeding: A Complete Guide to Getting Started Right

Breastfeeding is the natural way to feed a newborn, in which the parent produces milk perfectly adapted to the baby's nutritional, immunological and emotional needs at every stage. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life and continued breastfeeding alongside complementary foods until age two or beyond.

However, "natural" does not mean automatic. Many parents need information, support and guidance for breastfeeding to work well. This guide draws on evidence from the WHO, the American Academy of Pediatrics (AAP) and certified IBCLC lactation consultants to help you begin with confidence.

What Happens in the First Hours After Birth?

Immediate skin-to-skin contact after delivery is the first step towards successful breastfeeding. The AAP recommends placing the newborn on the parent's chest for at least the first hour of life because:

• It stabilises the baby's body temperature, heart rate and blood sugar.
• It activates the rooting reflex: the newborn is capable of crawling to the nipple and latching on independently (the "breast crawl").
• It stimulates the production of colostrum, the first milk, rich in antibodies and growth factors.

Dr. Jack Newman, one of the world's leading breastfeeding medicine physicians, emphasises that this early contact not only promotes breastfeeding but lays the foundation for attachment and bonding.

How Do You Achieve a Correct Latch?

The latch is the cornerstone of breastfeeding. A poor latch causes pain, cracked nipples, insufficient breast drainage and, over time, supply problems. Signs of a good latch, according to IBCLC guidelines, include:

• Wide-open mouth: the baby takes in a large portion of the areola, not just the nipple.
• Lower lip flanged outward: like a suction cup.
• Chin touching the breast: the nose remains free or barely grazes.
• Full cheeks: not hollowed.
• Swallowing sounds: audible swallowing without clicking.

If the latch is not correct, gently break the suction by inserting a clean finger into the corner of the baby's mouth and try again.

How Do You Know the Baby Is Getting Enough?

This is one of the greatest sources of anxiety for breastfeeding parents. The AAP establishes the following reliable signs of adequate intake:

• Nappies: at least 5-6 wet nappies per day from the fourth day of life onward.
• Stools: stools transition from black meconium to yellow, seedy stools within the first days.
• Weight: after the initial physiological loss (up to 7-10 % of birth weight), the baby should regain birth weight by days 10-14.
• Behaviour: the baby appears satisfied after feeds and has periods of alert wakefulness and calm sleep.

Unreliable signs include: frequent crying (which may have many causes), breasts feeling "empty" (the breast adapts to demand) and high feeding frequency (it is normal for a newborn to feed 8-12 times a day or more).

Is It Normal for Breastfeeding to Hurt at First?

Mild tenderness during the first few seconds of latching is common in the early weeks as tissues adapt. However, intense or persistent pain is never normal and always indicates a correctable problem:

• Incorrect latch (the most common cause).
• Tongue-tie (short lingual frenulum) in the baby.
• Thrush (burning pain, shiny nipple).
• Nipple vasospasm (pain after the feed, white nipple).

If pain does not resolve with latch correction, seek help from an IBCLC or your paediatric care team.

What Mistakes Should You Avoid When Starting?

• Separating parent and baby after birth without a medical reason.
• Imposing schedules: breastfeeding works on demand, not every three hours.
• Giving formula "just in case": without medical indication this can interfere with supply establishment.
• Introducing a dummy too early: the AAP suggests waiting until breastfeeding is well established (3-4 weeks) before offering a dummy if desired.
• Comparing with other babies: every breastfeeding pair has its own rhythm.

When Should You Seek Professional Help?

The AAP and IBCLC consultants recommend seeking specialist help if:

• Pain does not improve after correcting the latch.
• The baby has not regained birth weight by two weeks.
• There are fewer than 4 wet nappies per day after the fourth day.
• The parent has fever, redness or a painful lump in the breast (possible mastitis).
• There is a history of breast surgery or hormonal conditions that may affect supply.

In the US and UK, you can find IBCLC consultants through the USLCA (United States Lactation Consultant Association) or the LCGB (Lactation Consultants of Great Britain). La Leche League offers free peer support groups worldwide.

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Frequently Asked Questions

How often should a newborn breastfeed? On demand, without watching the clock. Typically 8-12 feeds per day, but some babies feed more frequently, especially during growth spurts. The AAP advises against imposing fixed intervals.

Do I need to prepare my breasts before birth? No. The AAP and IBCLC guidelines confirm that there is no need to "toughen" nipples or apply pre-birth treatments. The breast prepares physiologically during pregnancy.

Can I breastfeed while taking medication? In most cases, yes. The LactMed database (maintained by the US National Library of Medicine) allows you to check the compatibility of almost any drug with breastfeeding. Always consult your healthcare provider before stopping breastfeeding due to medication.