Feeding
The first two weeks of breastfeeding
Almost everything difficult about breastfeeding happens in the first fortnight, and most of it has a mechanical explanation.
The gap between how breastfeeding is described and how the first two weeks actually go is where most people stop, and a substantial proportion of that gap is fixable.
What is happening physiologically
Colostrum is produced in the first days: small in volume, thick, and exactly what a newborn stomach can handle.
The volume looks alarmingly small and is not a sign of insufficiency.
Milk "comes in" around day two to five, driven by hormonal changes after the placenta is delivered, and this happens whether or not the baby feeds — after which supply becomes demand-driven.
Which is the single most important principle: milk removal drives production, and anything that reduces removal reduces supply.
Positioning and attachment
Where most early problems originate.
Signs of a good attachment: a wide-open mouth taking a large mouthful of breast rather than just the nipple; more areola visible above the top lip than below; the chin touching the breast; cheeks full rather than dimpled; rhythmic sucking with visible swallowing; and no pain beyond the first few seconds.
Signs to correct: pain throughout, a nipple that comes out wedge-shaped or with a white line, clicking sounds, or a baby who slips off repeatedly.
The practical adjustments: bring the baby to the breast rather than the breast to the baby; nose to nipple so the head tilts back and the chin leads; support across the shoulders rather than pushing the head; and try laid-back positions, which use the baby's own reflexes and frequently resolve attachment difficulties without instruction.
Is the baby getting enough
The question everyone asks, with reasonably objective answers.
Nappies: increasing wet nappies over the first days, reaching six or more heavy wet nappies daily by around day five, with pale urine.
Stools changing from meconium to green to yellow by around day four or five, with at least two yellow stools a day in the early weeks.
Weight: some loss initially, with birth weight regained by around two weeks and steady gain thereafter, assessed against a growth chart rather than against another baby.
Feeding: eight to twelve times or more in twenty-four hours, with audible swallowing.
Behaviour: alert periods, and content after most feeds.
What is not a reliable indicator: how the breast feels, how long feeds take, how much can be expressed, and whether the baby will take a bottle afterwards.
Pain
Common in the first days and not something to accept indefinitely.
Initial tenderness for the first few seconds of a feed is usual in the early weeks.
Pain throughout a feed, cracked or damaged nipples, or bleeding indicate a problem with attachment that needs assessing rather than enduring.
Nipple shields have a place and are best used with support, since they can affect transfer and supply.
Tongue tie is a genuine cause of feeding difficulty in some babies, is over-diagnosed in others, and assessment should be by someone experienced with a proper functional assessment rather than a glance.
Engorgement and blocked ducts
Engorgement around day three to five is common: breasts become full, firm and tender.
Frequent feeding is the treatment; cold compresses between feeds and gentle hand expression to soften the areola enough for attachment both help.
Recent guidance has moved away from aggressive massage and heat, which can worsen inflammation.
A blocked duct presents as a tender lump; feeding, gentle handling and cold rather than vigorous massage are the current recommendations.
Mastitis — a red, painful, hot area with flu-like symptoms and fever — needs prompt medical attention, and feeding should continue.
Getting help
Early rather than at crisis point.
Lactation consultants, midwives, health visitors, peer support groups and national helplines exist in most countries, and the difference a skilled observation of a single feed makes is frequently decisive.
The majority of people who stop breastfeeding in the first weeks report that they did not want to stop, which is a service failure rather than an individual one.
If it is not working
Worth stating plainly.
Combination feeding is a legitimate option and is not all-or-nothing.
Expressing and bottle-feeding breast milk is breastfeeding.
Formula feeding is safe, and the guilt that surrounds this decision does considerably more harm than the decision.
What matters is that the baby is fed and that the person feeding them is not being destroyed by the process.
General information only, not medical advice. Consult a midwife, health visitor or qualified lactation consultant about feeding difficulties, and seek urgent care for signs of mastitis or a baby feeding poorly.
