Breastfeeding

Part of Midwifery and Childbirth

Establishing breastfeeding in the first hours and days after birth to ensure infant nutrition and immune protection.

Why This Matters

Breastfeeding is not a lifestyle choice in a survival context — it is a life-or-death necessity. Before reliable safe water, formula, and refrigeration, an infant not breastfed faced severe risks from waterborne disease and malnutrition. Even in modern contexts, breastfed infants have significantly lower rates of gastrointestinal illness, respiratory infection, and infant death.

Breast milk is a complete nutritional and immunological system tailored to the infant. Colostrum — the first milk produced — is dense with maternal antibodies, particularly IgA, which coats the infant’s gut and respiratory tract and provides passive immunity against the pathogens in the mother’s environment. This protective effect begins within minutes of the first feed.

Most breastfeeding difficulties are preventable or correctable with the right knowledge and support. The birth attendant who helps a mother establish successful breastfeeding in the first 24-48 hours saves infant lives.

The First Feed

Initiate breastfeeding within the first hour after birth. The “golden hour” of skin-to-skin contact immediately after delivery, with the infant placed on the mother’s chest, promotes instinctive feeding behavior in the infant and milk let-down in the mother.

Sequence:

1. Dry and warm the infant. Place skin-to-skin on mother’s chest.
2. Allow the infant to exhibit feeding cues: rooting (turning head, opening mouth), hand-to-mouth movement, suckling movements.
3. Support the mother to bring the infant to breast — not the breast to the infant. The mother’s back and arms should be supported so she is comfortable.
4. Help the infant latch (see below).
5. Colostrum volume in the first days is small — this is normal. Do not supplement with anything unless clear medical indication.

Achieving a Good Latch

A poor latch is the root cause of most breastfeeding difficulties: nipple pain, insufficient milk transfer, and eventually low milk supply. Teaching correct latch technique prevents these problems.

Signs of Good Latch

• The infant’s mouth is wide open, like a yawn
• The lower lip is flanged outward (turned out)
• The chin touches the breast
• More areola (the dark circle around the nipple) is visible above the infant’s lip than below
• The nose is free (not pressed into the breast) — the infant breathes freely
• Cheeks are rounded, not sucked in
• You can hear swallowing
• The mother feels strong tugging but not sharp pain

Latching Technique

1. Position: Mother sits comfortably supported, or lies on her side. Infant faces the breast, tummy to tummy with mother.
2. Support the breast: Mother uses a hand to support the breast if needed — cup the breast from below with a C-hold (fingers below, thumb above, well back from the areola).
3. Trigger the gape: Touch the infant’s upper lip with the nipple until the mouth opens wide.
4. Bring infant to breast: When the mouth is wide open, bring the infant’s chin to the breast first, then his or her lips should close over a wide area of areola — not just the nipple.
5. Check and adjust: If the latch is shallow (infant has only the nipple), gently insert a clean finger into the corner of the infant’s mouth to break the seal and try again.

Common Latch Problems

Shallow latch: Infant has only the nipple in the mouth. The nipple becomes flattened, pinched, and painful. Causes nipple soreness and insufficient milk transfer. Solution: break latch, re-latch with wider mouth opening.

Nose pressed in: Infant appears to struggle to breathe. Pull infant’s bottom closer to the mother’s body — this tilts the head back and frees the nose.

One-sided latch: Infant is taking more of one side of the areola. Causes cracked nipple at the tight spot. Adjust positioning.

Positioning Options

Cradle hold: Infant lies across mother’s chest, head in the crook of her arm. Classic position. Requires the arm to support the infant’s weight throughout feeding.

Cross-cradle hold: Infant’s head is cradled in the hand opposite to the feeding breast. Gives the mother more control of the infant’s head and is especially useful in the early days.

Football hold: Infant is tucked under the mother’s arm, like a football. Useful after cesarean (less pressure on incision), for large-breasted women, and for premature infants.

Side-lying: Mother and infant lie face-to-face. Very comfortable for night feeds and for recovery from delivery. Both can rest while feeding.

The First Week

Colostrum (Days 1-3)

The first milk is colostrum — thick, yellowish, and produced in small volumes. A newborn’s stomach is the size of a marble and holds only 5-7 mL. Small colostrum volumes are correct.

Colostrum transitions to mature milk at 2-5 days after birth, often accompanied by breast engorgement (“the milk coming in”) — breasts become larger, firm, and warm.

Feed Frequency

Newborns need to feed 8-12 times per 24 hours — approximately every 2-3 hours. This frequency is essential to:

• Establish milk supply (supply is regulated by demand)
• Prevent dangerous newborn hypoglycemia (low blood sugar)
• Clear bilirubin to prevent severe jaundice

Signs the infant is feeding well: Audible swallowing during feeds. At least 6-8 wet nappies (urine) per day by day 4. At least 3-4 yellow seedy stools per day by day 4. Weight regain by day 10-14 (newborns lose up to 7-10% of birth weight in first 3-5 days; this is normal).

Common Problems and Solutions

Sore or Cracked Nipples

Almost always caused by poor latch. Correct the latch and soreness should resolve within 24-48 hours.

Immediate relief: Apply a small amount of expressed breast milk to the nipple after feeds (it has healing properties). Allow to air dry. Lanolin or calendula salve can soothe cracked nipples.

If cracked nipples become infected (red, warm, pus): This is mastitis or abscess — treat aggressively. Warm compresses, continue feeding from that side (stopping makes it worse), massage toward the nipple while feeding. If not resolved in 24-48 hours, antimicrobial herbs internally (echinacea, garlic) and externally (calendula, raw honey applied between feeds).

Engorgement

When milk comes in at day 2-4, breasts may become very firm and uncomfortable. The infant may struggle to latch on an engorged breast because it is too hard.

Solutions: Feed frequently — every 2 hours. Before feeding, apply warm compress for a few minutes to encourage let-down. Hand-express or massage a little milk out before latching to soften the areola enough for the infant to latch.

Cold compresses between feeds reduce swelling. Cabbage leaves (chilled) tucked into the bra provide relief — this is a traditional remedy with genuine anti-inflammatory effect.

Perceived Low Milk Supply

The most common reason women stop breastfeeding. In the majority of cases, supply is adequate — the infant is feeding correctly and gaining weight. True low supply is uncommon.

Assess first: Is the infant gaining weight? Producing adequate wet and dirty diapers? If yes, supply is adequate regardless of how the mother perceives it.

Support supply: Feed more frequently. Ensure good latch (efficient feeding drives supply). Oats, fenugreek, and fennel seed tea are traditional galactagogues (milk-supply-supporting herbs) — evidence is limited but they are safe.

True supply issues: Often linked to poor latch, supplementation with other fluids (which reduces demand and therefore supply), illness, or severe stress. Identify and address the root cause.

Wet Nurse and Cross-Nursing

If a mother cannot breastfeed (death, severe illness, inadequate supply after all interventions), another woman who is lactating can nurse the infant. This is biologically normal and was the historical solution to infant feeding emergencies before formula. A community of breastfeeding women can collectively support orphaned or ill infants when biological mothers cannot feed.