Breastfeeding: a calm start

Breastfeeding is natural, but it is also a skill that you and your baby learn together. Most difficulties in the first two weeks come down to position and latch, and they ease quickly with a little support.

The first hour and the first days

• Hold your baby skin to skin straight after birth, or as soon as you can after a caesarean. Many babies find the breast within the first hour, and that early feed helps your supply get started.
• The first milk, colostrum, is thick and yellow and comes in teaspoon amounts: exactly what a newborn stomach holds, and rich in antibodies. Healthy babies do not need water or formula top-ups unless a doctor advises it.
• Feed on demand, 8–12 times in 24 hours, including at night. Early cues are stirring, turning the head and hands to the mouth; crying is a late sign.
• Your milk "comes in" around days 3–5, and the breasts may feel full, heavy and warm. Feed often, use warmth briefly before a feed to help the flow and a cool compress afterwards for swelling. If the areola is too firm to latch, hand-express a little first. This settles within a day or two.

A good latch

Hold the baby close, tummy to you, with the nose level with your nipple. Wait for a wide open mouth, then bring the baby to the breast quickly, chin first. Signs that it is right:

• a wide mouth with lips turned out and the chin touching the breast;
• more areola visible above the top lip than below it;
• round cheeks, slow deep sucks with pauses and audible swallowing;
• no pain after the first few seconds. If it hurts, slip a clean finger into the corner of the mouth to release and try again.

Try different positions: the cradle hold, the cross-cradle (easier control of a newborn's head), the rugby or underarm hold (comfortable after a caesarean and for twins) and lying on your side for night feeds, moving the baby back to their own sleep space afterwards.

Is my baby getting enough?

• At least six wet nappies a day from day 5, and stools that turn yellow by day 4–5.
• Audible swallowing during feeds and a baby who settles after most of them.
• Birth weight regained by 10–14 days, then steady gain at the nurse's weigh-ins.
• Softer breasts after the first weeks, frequent feeds and evening cluster feeding are not signs of low supply. During growth spurts at about two to three weeks, six weeks and three months your baby feeds more for a few days and your supply catches up.

Sore nipples, blocked ducts and mastitis

• Sore nipples are almost always a latch problem. Ask the nurse to watch a feed, vary positions, express a few drops of milk onto the nipple after feeding and let it dry, and use purified lanolin if you like. Cracks that do not heal, or white patches in the baby's mouth, need a doctor's look.
• A blocked duct feels like a tender lump. Keep feeding, start on that side, point the baby's chin towards the lump, massage gently towards the nipple, use warmth before and cool after, and avoid tight bras.
• Mastitis is a red, hot, painful area with fever and flu-like aching. See a doctor the same day; antibiotics, if needed, are usually compatible with breastfeeding. Keep feeding from that breast: the milk is safe and emptying the breast is part of the treatment.

Expressing, storing and formula

• Express by hand or pump if you are separated from your baby, going back to work or need to relieve fullness. As a simple rule, expressed milk keeps about 4 hours at room temperature, 4 days in the fridge and 6 months in the freezer. Thaw in the fridge or warm water, never in a microwave, and throw away what is left in the bottle after a feed.
• If formula is needed, for medical reasons or by choice, prepare it safely: wash your hands, use sterilised bottles, boil water and let it cool for no more than 30 minutes so it is still at least 70 °C, add the exact amount of powder, cool to body temperature and test on your wrist. Use within two hours and discard leftovers.

You, your family and where to get help

• Eat your normal balanced food and drink to thirst; no special diet is needed. Keep taking potassium iodide 200 µg daily while breastfeeding, as Uzbekistan is an iodine-deficient region. Keep caffeine moderate (about two cups of coffee a day) and avoid alcohol.
• Many medicines are compatible with breastfeeding, but check with your doctor or pharmacist before taking anything, and say that you are feeding.
• The WHO recommends exclusive breastfeeding to six months, then family foods alongside breastfeeding to two years or beyond.
• Ask early: the patronage nurse, your polyclinic paediatrician, a lactation consultant or a mothers' support group can usually fix a problem in one visit.
• Family makes the difference. Husbands and grandmothers can bring food and water, change nappies, settle the baby, manage visitors and protect your rest. Encouragement helps more than suggestions of formula; traditional advice about "weak milk" or herbal teas is best checked with the nurse first.

This article is general information, not medical advice. Talk to your doctor about your own situation.