Getting Breastfeeding Off to a Good Start

By Erin Talaska, MD

By now, the benefits of breastfeeding are pretty well- known, so I won’t bore you with the details. But if you have decided to breastfeed, here are some tips to develop a good nursing relationship with your little bundle of joy. If you are blessed with a baby that has a wide mouth, instinctively perfect latch, and your colostrum and engorgement comes with your first feed, then you may not need to continue reading. But if you are worried about nursing challenges, and want to try to nip them (sorry, bad pun!), continue on, my friend.

First, regardless of how your birth story ends, try to get that golden hour of skin to skin with your babe. My babies were all born via cesarean births (long story), but even in the operating room, skin to skin can be done.  In fact, I encourage skin to skin with your babe as often as possible in the hospital/birth center and once you go home. If you are awake, “wear” your baby as much as you can to promote that closeness and stimulate your milk production, and unwrap the baby for feeds to keep him or her awake.

Nurse on baby’s demand.  Supplementation will adversely affect your milk supply in those early weeks when your nursing relationship is being established. If, for medical reasons, your baby needs to be supplemented, pump during those feeds.  While it may be frustrating to have supplementation, please remember that the first priority is to feed your baby by whatever means necessary! You can always give baby the pumped milk as the supplement if needed thereafter.  If you need to have someone give a bottle for another reason, try to do so sparingly, and pump to empty the breasts during that bottle feed.  Remember, breast milk production is typically established by a “demand and supply” mechanism- baby demands, and your breast supplies milk in accordance with those demands. If you are frequently meeting baby’s demands with a supply of formula or bottled breast milk, your breasts don’t feel that demand, and they decrease supply. This is especially difficult during those early “cluster-feeding” timeframes, but if you are up to it, then your milk supply will benefit in the long run.

Speaking of supply, within one week of birth (usually sooner), the breasts will begin to engorge due to production of breast milk as well as increased circulation. Many women sense engorgement as aching or discomfort from the underarms to the upper outer portions of the breasts. The breasts will feel firm and lumpy when full. (This puts it mildly- engorgement hurts like hell!)  The breasts leak. Your babe may nurse more vigorously at this point. Once your nursing relationship is well-established, engorgement will is not be as uncomfortable, and you will leak less breast milk.  (By the way, there are “milk-catching” products that can be placed in the bra like nursing pads. I was able to get as much as 2-3 oz of extra milk per day- which is great if you, like me, have cried over spilt milk!)  It can be hard to measure the amount of breast milk is getting. If your baby is emptying each breast with feedings, is happy and sleepy after a feeding, and is gaining weight, he or she is getting enough.  However, if you are too engorged, your babye may have a hard time latching and starting feeds. You may need to pump (gently- aggressive, too frequent pumping can lead to over-production and near-constant engorgement) or manually express a little milk to soften the breast prior to feeding.

If you are encountering challenges, my best advice is to see a lactation consultant (LC) as soon as possible. Waiting too long can end in frustration for both you and baby, and it decreases the chances of accomplishing your breastfeeding goals.  I can go on and on about all the possibilities, but here is a brief summary of some early challenges I see (or have experienced myself), and how they can combine and snowball into a nursing struggle.

Latch issues are very common, and we are all different.  For example, my babies couldn’t latch well with Boppy or nursing support pillows. The Baby-led latch technique was a revelation! I stood to start each feed, which enabled me to get out of my baby’s way. Then, I checked the latch, and sat down for the remainder of each meal. If your natural latch comes more easily with side-lying, cradle/cross cradle holds, so be it! Use what works for you and baby.

Your nipples may be sore in the first week, but once a good nursing relationship develops, the pain should diminish. I made the mistake with my second daughter of delaying my visit with an LC until she was almost six weeks old! We had chronic latch issues that I had allowed to continue until my breasts were in agony, she was frustrated and refusing the breast, and my supply plummeted.  While we were able to solve those issues with hard work, I was never able to give her exclusively breast milk as I had hoped.  I avoided this with my third by seeing my LC early and often!  Remember, continued nipple pain and flattened or triangulated nipples after feeding can be a sign of poor latch, which if allowed to continue, will frustrate both you and babe.  

Good luck Momma! May your milk flow freely!


image00Erin M. Talaska, MD: I am a board-certified general OBGYN practicing in Omaha, Nebraska. I grew up in Colorado (go Broncos!), graduated from Colorado State University (Go Rams!),  then worked in Salt Lake City, where I met my wonderful husband, Jimmy, who makes balancing work and life possible. While I dearly miss mountains, I have made the Midwest my home since medical school and residency at Creighton University. My passions are to help women and babies through safe labor and birth, to educate women on how to be their healthiest and happiest selves throughout their lives, and to perform minimally invasive surgical procedures.

My life’s accomplishment is being Mommy to three smart, funny and beautiful kids (yes, I’m biased)-Meagan, 4, Lucy, 2, and Jack, 15 mos. I can be found most evenings singing, begging, and bribing my children to sleep.  I am a sports, book, food, and wine enthusiast. I strive to become an exercise enthusiast someday…


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