Breastfeeding 101

Positioning

Effective positioning is key to successful breastfeeding. While there is no single "correct" position, the most important factors are finding a position (or positions) that is comfortable for the mother and allows the infant to latch and feed effectively. The baby should be positioned tummy-to-tummy with the mother, with their neck and back well-supported. The baby’s head should be tilted back slightly, positioned higher than their hips, and their feet should be supported. The mother should also be comfortable and relaxed, with her feet supported. The laid-back position can be particularly helpful as it encourages the baby’s natural breastfeeding instincts. Additionally, skin-to-skin contact offers numerous benefits for both mother and baby.

Latch

A proper latch is essential to prevent breastfeeding challenges such as nipple pain or trauma and to ensure effective milk transfer. Factors that can influence the latch include breast and nipple anatomy, the mother’s labor experience, breastfeeding knowledge, and the infant’s oral anatomy, gestational age, and birth experience.  

Babies should be fed on demand (without strict schedules) when they show hunger cues. Newborns typically feed 8–10 times in 24 hours, which is considered normal. To encourage the baby to latch, gently brush their lips with the nipple to trigger the rooting reflex. Allow the baby to feed for as long as they desire, though very long feeds (40+ minutes) may indicate an issue. An ideal feeding state for the baby is quiet and alert.  

A good latch is asymmetrical: the lower lip covers more of the areola, the chin is pressed into the breast, the nose is free, the head is tilted back, the lips are flanged, and the mouth is wide open. A proper latch should be pain-free for the mother. Signs of an ineffective latch include tight or pursed lips, dimpled cheeks, a flattened or misshapen nipple after feeding, or clicking/smacking sounds.  

If achieving a good latch is difficult, consider an oral assessment of the baby’s mouth structure and function.  

Milk Transfer

Observing signs of milk transfer is crucial when evaluating a breastfeeding session. Indicators include a wide jaw motion with a pause for swallowing, an audible "ca" sound during swallowing, and a coordinated suck-swallow-breath pattern. Non-nutritive sucking, on the other hand, is faster and involves little to no swallowing. To encourage more active drinking, the mother can perform breast compressions while the baby is sucking but not swallowing. Both breasts should be offered at each feeding until the baby is satisfied.  

Elimination patterns also provide insight into milk transfer. In the early days of life, expect specific patterns for urine and bowel movements, including the transition from meconium to seedy, yellow stools. The baby’s demeanor during and between feeds can also indicate whether they are drinking effectively.  

Weight is another important factor in assessing milk transfer. Newborns typically lose some weight after birth (less than 10% of their birth weight) but should regain it by days 10–14. After that, babies are expected to gain approximately 30 grams per day until 3 months and 20 grams per day from 3–6 months, following their growth curve.  

Pumping

For mothers who pump, optimizing pumping sessions is essential. This includes selecting the right pump, ensuring proper flange fit, using hands-on pumping techniques, and adjusting pump settings for effective stimulation and suction. For parents who are combination feeding, every feeding session away from the breast should be replaced with a pumping session to maintain milk supply.  

Galactagogues  

If the baby is not latching well or there are signs of poor milk transfer, galactagogues may help increase milk supply. Herbal supplements like moringa (2 grams, 2–3 times daily) and goat’s rue (2 grams daily) can be tried. Additionally, incorporating fermented foods (e.g., kefir, yogurt, sauerkraut, miso) and prebiotic-rich foods (e.g., flaxseed, oats, garlic) into a balanced diet may be beneficial. If these measures are ineffective, Domperidone (30 mg, three times daily) can be prescribed as a pharmacological option.  

Complementary Therapies

Complementary therapies, such as imagery, relaxation techniques, and biofeedback, can play a valuable role in a holistic breastfeeding care plan. Breastfeeding is a team effort, and the support of family, friends, community, and support groups should not be underestimated. Emphasizing parental self-care, stress management, a nutritious diet, and adequate hydration is also crucial. A team-based approach, including referrals to OB/GYNs, general practitioners, allied health professionals (e.g., chiropractors, osteopaths, massage therapists, physiotherapists, naturopaths), and mental health practitioners, can provide comprehensive support.  

Supplementation 

If the above strategies do not achieve or maintain adequate milk intake for the infant’s growth and development, supplementation may be necessary. The supplementation plan should be tailored to the unique needs of each mother-baby dyad, their situation, and feeding goals. Supplementation can be temporary or permanent and may involve expressed breast milk, donor milk, formula, or a combination. It can be delivered through various methods, such as a lactation aid, finger feeding, syringe feeding, or bottle feeding.  

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