When you have early breastfeeding problems, it can feel as if it’s “all gone wrong” and the dreams you had about feeding your baby are in ruins. Fortunately, babies are very adaptable and resilient, and so are their mothers! With time, patience and, if necessary, skilled help, it is almost always possible to get feeding back on track after a difficult start. It is always possible to have a close, warm, happy feeding relationship with your baby – even if it might look different from what you had expected. It is important to act quickly, as soon as there are signs that things aren’t going well, but even if more time has passed, things can still get better.
Some examples of early difficulties:
- You had a more complicated birth. Babies born with the aid of forceps, for example, often take a few days to recover and feed well. If you needed a lot of pain relief in labour, your baby may be sleepy at first.
- Your baby was born early, or small for their gestational age. See also breastfeeding premature babies and late preterm babies (those born between 34 and 37 weeks).
- You and your baby were separated after birth because one or both of you needed medical care.
- Your baby is very sleepy and doesn’t have enough energy to breastfeed. See also sleepy baby and newborn jaundice.
- Your baby gets frustrated or upset when they try to breastfeed. See also my baby won’t breastfeed and the unhappy breastfed baby.
- Breastfeeding is very painful for you. See also nipple pain.
- Your baby has a physical challenge such as tongue-tie.
- Your baby is growing more slowly than expected. See also my baby needs more milk.
- Your milk production is lower than you would like it to be. See also my baby needs more milk.
You have plenty of time
Parents sometimes worry that if their baby isn’t breastfeeding well, or at all, in the first few hours, days or weeks after birth, it will never happen. While breastfeeding in the first hour after birth is ideal, the window of opportunity for babies to start breastfeeding, and to get better at it, is much longer than this. The early feeding reflexes, which keep babies seeking and attaching to the breast, last for at least two to three months. Where there is milk, there is always the possibility of breastfeeding.
First things first
Sorting out breastfeeding problems can feel overwhelming. There seems to be so much to do, and you might feel you have to do it all at the same time! It is helpful to know what is urgent and what is less urgent. This can help you to work out what to do in what order, and how best to use your time and energy.
If it’s taking time for breastfeeding to get going:
- Keep your milk flowing
- Keep your baby fed
- Keep your baby close
This useful summary can be downloaded as a free A4 poster here.
- Keep your milk flowing
Understanding how milk production works
It is possible to restart your milk production after stopping breastfeeding. It is even possible to start milk production if you have never been pregnant! [i] But it is usually much easier to get your milk supply going if you have just given birth – your body expects to make milk at this time.
It is easiest to increase milk production in the first month or so after birth, when your breasts are most receptive. After this, it usually becomes more difficult, because your body is not expecting to make more milk. Even so, some women are able to get a big increase in their milk production later than this. It’s always worth giving it a go, if you want to!
Milk production usually increases quickly in the early days after birth and reaches almost peak production by about 10 days. By about a month after birth, most women are making as much milk as their babies will ever need. Babies need about the same amount of milk each day from one to six months of age (from about six months, as they start eating other foods, the amount of milk that they need starts to reduce).
When your baby is born, even if they are born early, you are already making milk. After birth, milk will only keep on being made if milk is being removed from your breasts. If no milk is removed, your milk will dry up within about two weeks. Your breasts will adjust to make the amount of milk that is being removed from them.
If your baby is feeding well and taking as much milk as they need to feel satisfied and grow well, you will continue to make plenty of milk for your baby – or two or more babies, if you have more than one!
Whenever a baby is not feeding well enough to take as much milk as they need, or is not feeding at the breast at all yet, the risk is that your breasts will adjust to making less milk than your baby needs. This is why, if your goal is to breastfeed your baby exclusively (only on your milk) when they are ready, it is vital to make sure that you remove enough milk from your breasts in the early days and weeks after birth. You are removing enough milk if your baby is growing normally and producing wet and dirty nappies as expected, without needing anything other than your milk.
Why breastfeeding might be difficult at first
The most common reason for a baby not to feed well is that they are not quite getting a deep enough mouthful of breast. When this happens, breastfeeding might hurt, the skin on your nipples may become damaged and/or your nipples might look pointy, like a new lipstick, when your baby comes off the breast. Skilled face to face breastfeeding support usually helps most in this situation.
Another common reason for babies not to feed well is that they don’t yet have enough energy. They may be keen to breastfeed, and feed well for a short time, but they get tired before they get as much milk as they need. This group may include babies who were born early, had a more difficult birth, are small, unwell, jaundiced, tongue-tied, etc. They need more time and support (and medical treatment if necessary) until they are ready to breastfeed fully.
Some mothers are not able to make all the milk their babies need. Reasons for this include:
- A history of infertility due to hormonal imbalances.
- Past breast surgery, especially breast reduction.
- Breast hypoplasia/Insufficient Glandular Tissue (IGT). Breasts may be unusually small, unevenly sized, long and thin, with a wide space between them. There may be no breast changes, such as increase in size and tenderness, during pregnancy and after birth.
- Very large blood loss after birth – enough to make you very unwell.
- PCOS (polycystic ovary syndrome).
- Thyroid problems (over- or under-active).
- Obesity (BMI over 30).
If any of these apply to you, you may still be able to make enough milk for your baby. However, if your breastfed baby isn’t growing well, and any of the reasons above apply to you, it is very important to find skilled breastfeeding support quickly.
If you have done all you can to:
- Help your baby attach deeply to the breast
- Make sure your baby feeds at least 8-12 times in 24 hours
- Keep your baby active at the breast by using compressions and switching sides when your baby stops actively feeding (you can find out how to do both of these here)
but your baby still isn’t growing as expected, or there are other reasons to think that your baby is not getting all the milk they need, then it is important to start expressing your milk quickly. Your baby also needs to be checked by a doctor. Most babies who grow slowly are well, but occasionally slow growth can be a first sign of underlying illness, so it’s important to rule this out.
Turning feeding around – changing direction
When a baby is breastfeeding but is not feeding efficiently yet and is growing slowly, it is tempting to spend more and more time trying to breastfeed your baby. This can end up being a negative cycle:
- because not enough milk is being removed, milk production decreases;
- because milk production is decreasing, the milk is harder for the baby to remove;
- because the baby is getting less milk than they need, their energy decreases;
- because they are feeding with less energy, breastfeeding becomes less effective and less milk is removed.
Expressing your milk creates a positive cycle:
- because more milk is being removed, your breasts make more milk;
- because milk production is increasing, the milk is easier for your baby to remove;
- because your baby is getting more milk, their energy increases;
- because your baby is feeding with more energy, breastfeeding becomes more effective and more milk is removed.
If your baby is spending a lot of time breastfeeding but is not growing as expected, you may need to limit their time at the breast, to give you enough time to express. Breastfeed while your baby is actively feeding, with deep sucks and swallowing after every one-two sucks. When your baby is only swallowing after every three sucks, or more, they are no longer actively feeding, and it would be more efficient to end the feed and express milk instead. A baby who breastfeeds “all the time” is probably asleep and not feeding actively for much of this time (light, fluttery sucks, very little swallowing).
This protects milk production by removing more milk from your breasts than your baby is able to take on their own. If your goal is for your baby only to have your milk, your aim will be to express enough milk so that your baby can grow as expected and seem satisfied just on your milk.
How often to express
If your baby is able to get almost enough milk at the breast, you might only need to express once or twice a day. If next time your baby is weighed, they are still growing slowly, increase the number of expressions.
If there is a big gap between the amount of milk your baby is able to get at the breast and the amount your baby needs, you will need to express more often, if your goal is for your baby to be fed only or mostly on your milk. If your baby is not breastfeeding at all, you would need to express at least 8-12 times in 24 hours, which is how many times most babies need to breastfeed.
You don’t need to express regularly (most babies don’t feed regularly), just whenever you can. The important thing is how many times you express in 24 hours – it’s up to you when you do it. Experiment to see what works best. It’s fine to take a break for a few hours to go out or to sleep! More, shorter expressions often work better than fewer, longer ones and it’s fine to stop in the middle of expressing, if you need to do something else. You might find that you get a new flow of milk when you start again. Even if you only have a few minutes, it’s worth expressing.
How to express
For most women, the best tool for doing a lot of expressing (more than once or twice a day) is a double electric breast pump. Manual and single pumps are very small tools for this very big job, though some people find that they can express plenty with a small pump, or just using their hands. You can find more information about how to express milk here.
Mothers who need to express milk beyond the early weeks may find that they can reduce the number of times they express, while still getting the same amount of milk. You can read more about this (sometimes called the “magic number”) here and find out why it varies so much between women here. Some mothers can get all the milk they need just by expressing two or three times in 24 hours! Some mothers feed their babies exclusively on expressed milk. You can read more about this in the book “Exclusively Pumping Breastmilk”.
- Keep your baby fed
Babies always feed as well as they can – they are never “lazy” or uncooperative! If feeding is not going well yet, it is because it is difficult for your baby at the moment. They need extra support with feeding until they are able to do all the work by themselves.
If your baby is able to do almost all the work of feeding, breast compression and switching sides when they are no longer actively feeding may be enough to help them get all the milk they need at the breast.
If your baby is unable to get all the milk they need at the breast even with some help, they will need extra milk, for the time being.
How much milk do babies need?
In the first 24 hours of life babies need an average of about 7ml (1 ½ teaspoons) of milk per feed. This roughly doubles every day for the first few days. If you are expressing your milk, for example because your baby was born early, it helps to know how much to aim for:
500ml of milk in 24 hours by 10 days old;
750ml of milk in 24 hours by two-three weeks old.
Some babies need more or less milk than this – these are average amounts. Some babies need as much as 1300ml of milk in 24 hours.
If your baby was born early, they might need much less milk than this at the moment, but this gives you an idea of how much milk they are likely to need when they reach term age and size. It is important to aim for these amounts in the early weeks (if your goal is to feed your baby only on your milk) because it becomes more difficult to increase milk production later on. It is helpful to keep a record of how much you are expressing, so you can see how things are changing over time. If you are not expressing anything like these amounts yet, it is important to find a skilled feeding supporter quickly.
What kind of milk?
The first choice of extra milk is always a mother’s own expressed milk, which is tailor-made for her baby. The second choice is donated milk from another mother. The safest way to get donated milk is from a registered Milk Bank.[ii] When these are not available in the amounts needed, infant formula milk may be necessary.
When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that they need formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy they need to breastfeed well. You can read here about how to use formula milk strategically to support breastfeeding. It is often possible to reduce the amount of formula milk that your baby needs, as they get better at breastfeeding and your milk supply increases. If you need to use formula milk during the whole time your baby is fed only with milk, you may be able to reduce it after your baby starts eating other foods as well, from about six months.
How to feed extra milk to your baby
There are many options for feeding your baby extra milk. You can find information about choosing and using bottles, cups and more here and about nursing supplementers (a tool that enables you to feed extra milk at the breast while your baby breastfeeds) here. Your feeding supporter can help you decide which options might work for your baby.
- Keep your baby close
Breastfeeding provides more than just milk – it gives you and your baby lots of time to touch, gaze at and enjoy being with each other. These, much more than the milk itself, are what builds strong connections between breastfeeding mothers and their babies. Mothers (and dads, co-parents and other key adults) are able to build strong relationships with their babies when they are feeding in other ways, too.
Skin to skin contact is an amazing way for your baby to connect with the important people in their life. Babies held skin to skin are calmer, more relaxed, warmer, cry less and have more stable heart rates and breathing than babies who are wrapped up. They are also protected against infection by being exposed to the “good bacteria” on your skin. And it feels lovely! You can read more about the magic of holding your baby skin to skin here.
“Wearing” your baby in a sling or carrier is a great way to keep your baby close while you get on with other things. Being carried gives your baby many benefits, including more to look at, physical exercise, and less crying. You can read more about carrying your baby here.
When breastfeeding is stressful
When breastfeeding is difficult for your baby it may become stressful for both of you. Babies who have had stressful experiences at the breast can develop negative associations with breastfeeding. This might happen, for example:
- When a baby is in pain or discomfort after birth.
- When a more sensitive baby is handled in a way they don’t like.
- When milk supply is low, or a baby has a physical restriction that makes attaching and sucking difficult.
A baby who is finding feeding hard may become upset:
- A short time into the feed, when milk flow slows down.
- At the start of the feed, when milk doesn’t come straight away.
- When offered the breast.
- When put in a breastfeeding position.
- When they see the breast.
When feeding isn’t going well, babies may come to associate the breast with feeling hungry and frustrated. They may develop a preference for another feeding method, such as a bottle, if they associate it with feeling full and satisfied.
If you and your baby are in this situation, you might need a “breastfeeding break”. You could stop trying for a few days, while expressing your milk to keep your baby fed and protect your milk supply. When you’re both ready, you can try again.
Happy time at the breast
However hard feeding has been, your baby can still discover that the breast is a great place to be, where they feel calm, relaxed and satisfied. Here are some things you could try:
- If your baby has been refusing to feed, then try offering the breast when they are calm rather than when they are already hungry or upset. If your baby is having extra milk, give some or most of their feed by cup, bottle, etc. before letting your baby finish the feed on the breast.
- Laid-back breastfeeding. Allowing your baby to find their own breastfeeding position and to attach themselves can work especially well for babies who have had stressful experiences of being “put” to the breast.
- If you are giving extra milk, try giving it with your baby’s cheek resting against your bare breast.
- Consider using a nursing supplementer so your baby can have extra milk while they breastfeed. This can be helpful when milk supply is low.
- “Breast-sleeping”. Let your baby end a feed by sleeping with their cheek pillowed on the breast. Babies who are having all their milk by cup, bottle, etc. can enjoy doing this too.
- Take a bath with your baby. Low lighting and relaxing music can help set the scene! Some babies will find their own way to the breast, and even if they don’t latch and feed, the bath can be a good place to learn to feel comfortable near the breast.
- Consider sleeping with your baby. Some babies will attach and feed in their sleep, if the breast is near enough to smell and feel when they stir in the night. Always consider sleep safety before sleeping with your baby in your bed. It is never safe to sleep with a baby on a sofa.
Babies are hardwired to breastfeed
Breastfeeding is an essential survival behaviour and all healthy babies will continue to try for many weeks after birth. As long as your milk supply is protected, and your baby is fed, you and your baby have plenty of time to learn to breastfeed. You can find a feeding relationship that works for you both – even if it isn’t quite what you imagined before your baby arrived. ‘Successful breastfeeding’ can look like many different things for different families.
Getting skilled support can help, as can hearing from other mothers who had a difficult start with breastfeeding and have found their way through it. La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby or trying to do so. Please don’t feel awkward about needing to give your baby extra milk, in any way you need to, at an LLL meeting! We would love to meet you and your baby. You can find your nearest group here.
Jayne Joyce & Emily Tammam