Three Rules for Breastfeeding Success
(You define "success" for your and your baby's breastfeeding experience)
Getting breastfeeding right can feel overwhelming. However, it all boils down to these three basic principles:
Rule 1: Feed the Baby
A well-fed baby is:
Easy to wake and keep awake during feedings most of the time
Actively sucks and swallows (you should be able to hear the swallows)
Looks satisfied after nursing
Is happy to feed every 2–3 hours and then sleep (more frequent feeding can be normal during growth spurts, and for a few hours once a day, but for newborns, it may mean they're not feeding well)
Has moist lips and visible saliva inside of the mouth
Does not lose too much weight in the first few days (i.e., baby is around the green line in the NEWT)*
Gains about an ounce/day (after Day 4)
Is back to birth weight by Day 10
Has 6–8 wet diapers a day, light or pale yellow urine
Has 3–5 dirty diapers a day (can be fewer than this depending on their age)
Softens your breasts after feeding
*While a 10% weight loss has been considered acceptable, this 2014 lecture by Christina Smillie, MD, IBCLC, explains why this is actually excessive weight loss and can result in long-term breastfeeding problems.
If you want to your baby to have only your milk, you will need to have enough. A well-fed baby has the energy to breastfeed well and keep up your milk supply. But if your baby doesn't get enough milk, they may not have the energy to feed properly and may sleep more. This can make your milk supply decrease, which can be hard to fix.
If your milk supply is currently low (which will be addressed in Rule 2: Making Enough Milk), it's important to add additional milk (human milk or formula) to make sure they get enough fluid and calories to stay hydrated and grow well. The sooner you start, the better chance of success you will have.
When a newborn is not showing signs of being well fed, and is
gaining weight slowly or hardly at all
usually unsatisfied after breastfeeding
sleepy (or fussy) at the breast most of the time
having more than twelve or fewer than eight breastfeeds a day
usually feeding for a long time (>40 min) or very short time (<10 min) and very frequently (<2 hourly),
there may be an issue with either your current milk supply or their ability to transfer the milk that you have.
Note: sometimes these are signs of an underlying medical problem; always check with your pediatrician if your baby is not feeding well.
If your baby typically has a worried expression on their face while breastfeeding, often with a furrowed brow, this can be a sign they're not getting enough milk.
Occasional cluster feeding (a few hours of more frequent feeding) is normal for babies who are gaining weight well; but when your baby is nursing all the time and still not gaining, they (and your breastfeeding success) would benefit from increasing your baby's milk intake.
Many people think pumping, bottles, or formula use should be a last resort; that you always need to wait until “breastfeeding is established,” a term which is somewhat vague, or until your milk supply increases enough to be sufficient. However, when it comes to a baby with clear signs of unsatisfied hunger, a little help is needed. The average newborn burns about 300–400 calories/day (110–120 kcal/kg/day), which is provided by this much milk. To provide the energy to meet their daily needs, plus extra for growth, it is important to feed them until satisfied every time. An underweight baby will need even more calories to catch up.
Rule number one for solving the problem is to feed the baby to satisfaction at each and every feeding. There is no advantage of waiting until your baby shows late signs of low breast milk intake, such as poor hydration, infrequent pooping, or persistent lack of weight gain. Keeping your baby well fed is an investment in their future energy to breastfeed well. Listen and watch for swallows while baby is on the breast (see videos below). Breast compressions will help your baby drink more while breastfeeding.
When the speaker says "there...there...there," watch baby's chin to see what swallows look like:
Source: International Breastfeeding Center. Used with permission.
Swallowing sounds like little puffs of air: "kuh...kuh...kuh," as shown here:
There are many ways to supplement that will not disrupt breastfeeding; click here to learn more.
Rule 2: Maximize Milk Production
A full milk supply usually makes breastfeeding much easier. A full supply is defined as the amount of milk it takes for your baby to lose no more than 4–7% of their birth weight (5–8% for c-section babies; see the NEWT for specifics), then gain about an ounce a day from Day 4 to four months of age. This is usually accomplished by at least 25–27 oz (750–800 ml) of milk production per day by Day 14, and 29+ oz (850+ ml) or more by Day 40.
With a full supply, your baby will not have to work that hard to take large gulps of milk, will stay awake without you having to constantly stimulate them, and will become satisfied after feedings and gain weight appropriately.
To know if you are producing this amount, you can do one of these two things: (1) 24 hours of weighted feeds with a scale accurate to 2 g (you will probably have to rent it, as most commercial scales do not have this level of accuracy); (2) pump and bottle-feed for 24 hours with a high-quality double electric breast pump.
You may have heard that "babies are more effective than pumps." For most mother–baby pairs, pumping is in fact just as effective as the baby; this scientific review of evidence on breast pumps reported that “a healthy breastfeeding infant removes approximately 80% of the total ingested human milk volume in 5 minutes, and an efficient breast pump removes 85% of the available milk in the breast in 15 minutes.” So the well-nursing baby may be quicker, but the end result is about the same. A pump may even be better in some cases; pumps don't get tired, which is important if your baby is not transferring milk well. (Occasionally a mother who is exclusively breastfeeding and not used to pumping will have a hard time getting milk to flow with a pump, but for the majority of mothers, pumping provides a good estimate of milk production.)
Make or buy a hands-free pumping bra so you can relax, multitask, or massage your breasts while pumping:
There is usually a solution to low milk production, and it is (almost) always to empty the breasts more frequently and thoroughly. (Note that the breasts are a constantly running milk factory and can never be 100% emptied. Aside from feeding the baby sufficiently, establishing your milk supply is the most time-sensitive aspect of breastfeeding success.
Babies can learn to latch at a more relaxed pace and can often learn to latch even after a few months go by, but in the first 10–14 days after birth, your body is actively trying to figure out how much milk to make, based on how much is taken out of the breasts and how frequently. After that, it may be more difficult (or even not possible) to develop a full milk supply. Everyone is different though; the only way to know for sure is to try.)
How to Increase Milk Production
Every 3* hours:
Breastfeed for about 15 min (or until baby stops swallowing, whichever comes first).
Other parent or support person bottle-feeds baby
Mother pumps her breasts about 15 minutes.
*Please feel free to customize this to meet your own needs, and take a look at a modified version that prioritizes your sleep (self-care is important in helping your body be well enough to produce milk).
Feeding in this way is called “triple feeding,” because you are doing three things—breast, bottle, and pumping. It is a typical plan for babies who are not breastfeeding well, and/or mothers who have a low milk supply. I suggest trying this plan for 3–4 days, and if it is not working for you, get more individualized advice by scheduling an appointment. It is not a long-term solution. It's too hard to sustain and cuts into time when you could be bonding with baby or sleeping.
Keep in mind that mothers who are pumping while others bottle feed the baby sometimes feel isolated and disconnected from their baby—it can feel like your only role is to be a milk provider while everyone else gets the fun and bonding. Make sure you get time to snuggle. You can also bottle-feed when you wish. Time with you is more important to your baby than the number of ounces of milk you produce.
Source: Kristin Coghlan. Used with permission.
Power pumping mimics cluster feeding with short, frequent pumping sessions for about an hour. It is ideal to do between the hours of 12 and 6 a.m., but sleeping enough is more important to your milk production (and you deserve it!), so be flexible. Here are some additional pumping strategies.
What About Foods, Drinks, and Supplements?
Many cultures have foods, drinks, and herbs they use to help with milk production. While none of these have been studied sufficiently in humans, dairy research shows that diet alterations can improve milk yield in cows, so it's possible. Trying various culturally recommended foods is unlikely to be harmful and could help, but be wary of companies that sell expensive herbal blends and cookies; there is no regulation or evidence of effectiveness and safety.
The Academy of Breastfeeding Medicine states that because "current research of both pharmaceutical and herbal galactogogues [milk boosting substances] is still relatively inconclusive and all agents have potential adverse effects," they "cannot recommend any specific galactogogue at this time."
Remember, Oversupply is a Thing!
As a milk factory, many mothers' breasts are capable of producing more than one baby needs—much more. Oversupply sounds like a good problem to have—however, it can actually be so difficult that some mothers choose to stop breastfeeding, due to constantly leaking breasts, practically drowning the baby at feedings, frequent uncomfortable engorgement, and baby often being gassy and miserable due to lactose overload. (Reducing supply is usually not usually hard though, so don’t feel like you have to stop breastfeeding if you don’t want to!)
What if nothing works?
Unfortunately, not everyone can produce a full milk supply, just like not everyone can get pregnant or give birth vaginally. If for biological or logistical reasons, you cannot increase your supply sufficiently, you can still breastfeed with supplementation. If your supply is very low, this technique may help you establish a mutually enjoyable breastfeeding relationship in spite of it. You are not alone, and it is not your fault:
This is often a devastating blow to mothers who had wanted to exclusively breastfeed. It’s important to understand that your baby will not be harmed (most babies thrive) drinking properly prepared formula, and your bond with your baby will be just as strong. Human milk has many wonderful qualities—but science milk is pretty amazing too. It’s still normal and ok to be sad and grieve your loss. No one should minimize your feelings.
Rule 3: Keep Something Good Happening at Breast
If your baby likes breastfeeding, they will want to continue—regardless of your current milk supply.
However, when your baby struggles to latch or fights when you offer your breast, it can seem hopeless. Feeling sad or frustrated is understandable—it's hard not to feel rejected as a mother. You might also feel guilty for wanting to keep trying to breastfeed when it seems like your baby doesn't want to. (They do, they just don't know it yet!)
Your baby's difficulty latching is not your fault!
It's common, and usually solvable. There's probably nothing wrong with your breasts or nipples (and even if they are hard for your baby to manage, like with flat nipples, that's not your fault either!). Learning to tie their shoelaces might be hard and frustrating too, but it's worth the struggle. Helping your baby learn to breastfeed is worth it too.
Why do some babies not latch?
Sometimes a baby can have trouble latching onto their mother's breast. There are a few reasons why this can happen. Some babies might have nipples that are flat or go inward (inverted). Others might not know how to suck properly. A baby could also have a tongue tie that makes it hard for them to latch on.
Sometimes, a baby's mouth might be too small to latch onto their mother's bigger nipples. If a mother's breasts are very full and tight, it could also make it hard for a baby to latch. Lastly, a baby might be too tired or upset to breastfeed.
Let's talk about babies who can attach to the breast, but sometimes don't. It could happen that they latched when they were born, but seem to have forgotten how to do it, or only latch sometimes and not always.
Try latching when you and your baby are calm and relaxed
However, if your baby cries and fights when they come near the breast, this requires a different approach. Here are some reasons why a baby may do this:
The baby may have had a bad experience during a previous breastfeeding attempt where they were treated roughly.
The baby may be very impatient and want to be fed right away.
The baby may have learned that it's easier to get milk from a bottle than from the breast.
Sometimes, there could be a physical reason for a baby crying, like a birth injury, so it's important to tell their doctor.
The most important thing to do (aside from feeding the baby and keeping up your milk production) is to help your baby feel comfortable and happy being near your breast. To do this, you can start with leaning back and cuddling skin-to-skin
for a few days. Your baby may naturally try to latch on in this position. If so, just let your baby explore and try latching on their own, without any pressure. Follow their lead and stop if they get frustrated. Keep a bottle handy; sometimes a few sucks provides a "reset."
Help your baby learn to trust the breast as an easy and reliable source of food
The goal here is to help baby transition to baby being satisfied feeding at the breast. You can use either of these methods:
Supplemental nursing system (SNS):
There are two ways to use bottles, depending on how much milk you're making:
If you're making enough to meet most of your baby's needs, give a small bottle of milk first, to satisfy their hunger a little. Then, when they are feeling more relaxed (but still a bit hungry), try to breastfeed them. This is like having an appetizer with the bottle, followed by the main meal at the breast.
If you're making a small amount, give your baby an almost full bottle of milk, like a meal; then, offer the breast as a dessert.
You may need to experiment to see which works best for you and your baby. The important thing is that—unlike breastfeeding first (or trying to) then following with a bottle—the baby experiences fullness at the breast.
Curved tip syringes can be bought on Amazon or at a pharmacy. They work well in the first days when the baby just needs a few tablespoons of milk. They're also good for moms with plenty of milk and a fast letdown; they help baby get started, then your milk flow will take over.
SNSs work well for many mothers who need to supplement long-term and don't want to use a bottle. They can be difficult to use for babies whose hands get in the way, and they are harder to clean. Cleaning well is essential, as bacteria can hang around in the tube if there is any milk residue.
If you have been able to develop a full supply, the supplement can be gradually reduced until it's no longer needed. But if your milk supply remains low, it might take longer—or not be possible—to stop supplementing. If using a bottle or supplemental syringe/tube remains part of your feeding plan, you're still every bit a breastfeeding mom.
Eventually, your baby will learn to love breastfeeding, and you can continue as long as you and your baby want to.