In the UK as many as 81% of mothers initiate breastfeeding, however by 6 weeks of life only 55% are still doing any breastfeeding at all. Something is amiss. As a lactation consultant is important for me to empower families in the antenatal period to understand how breastfeeding works, know the practicalities of breastfeeding new-borns and to know how to tell it is going well.

In this article I will share helpful tips that will support you to know if breastfeeding is working well for you and what you can do if you and/or your baby is struggling.

Signs that your baby is breastfeeding well

This video shows a new-borns baby breastfeeding well

1. Baby is well latched

A well latched baby will be close to you and the breast with their body in a straight line through their shoulders and hips. There should not be a space between you and your baby. Their chin should be touching the breast, doing this will help your baby more easily find the nipple, it will also help to cue in their feeding reflexes such as mouth opening in a wide gape and will support them to get a deep latch.

Your baby will have large volume of breast tissue in the mouth (not just the nipple) and just a small amount of areola will be visible at the top and nothing underneath. This is called an asymmetrical latch.

2. Baby is transferring milk

At the start your baby will do a few fast fluttery sucks to trigger the milk ejection (let down) reflex) and start the flow of milk. As the milk flows the sucks will change to deeper, slower and more rhythmic sucks with the jaw dropping lower into the chin. Your baby may have short pauses of sucking across the feed and revert back the the fast fluttery sucks at times but overall you should be seeing mostly the deeper sucks across the feed. You should also hear swallowing once your milk has come in. You may also notice that there is milk gathering in the corner of your baby’s mouth at points during the feed

3. Maternal signs

Especially in the early days there are signs in the mother’s body that would indicate baby is feeding and sucking well. They may include noticing that the nipple is longer and wet after a feed (but not compressed). In the days following delivery you can feel period like cramping during feeding and may notice an increase in blood flow/loss following a feed.

Some mothers feel their milk ejection (let down) reflex as a tingling sensation. This isn’t always the case, so don’t worry if you can’t. Lactating women will trigger a let down in both breasts at the same time so noticing milk dripping from the other nipple during feeding is a sign that something milk flow is occurring. In the early days breasts can be engorged and get full between feeds, this can be helpful as you should be able to notice that your breast is softer at the end of the feed than it was at the start. Do note this is only a sign of good milk transfer in the first few weeks as it can be harder to tell once lactation is established – more about this and other myths around low milk supply on my online course Breastfeeding: beyond getting started.  

Wet and dirty nappies

The milestones described in the infographic are all a minimum, more is good, plentiful wee’s and poo’s are a great sign that your baby is drinking milk

How do you know what a heavy nappy is? Pour 3 tablespoons of water into a newborn nappy.

This is the what it should feel like by day 5. If your baby is not achieving their milestones in the first week, do not wait.

Contact your midwife and get support

While you are waiting for support you can do the following to help your baby to take more milk

• Skin to skin contact.

• Feed more often.

• The more you feed the more milk your baby will get. This includes waking your baby to feed at least every 3 hours

• Work on positioning and getting a good latch, this will help your baby transfer milk more effectively.

• Ensure you offer both breasts at each feed, you can keep switching as often as needed.

• If it is going to take some time before your baby can be assessed then you can hand express or pump milk after feeding and give that to your baby after a breastfeed.

Weight gain

The other key sign that breastfeeding is going well is that your baby should be gaining weight as expected. It is normal for babies to lose weight in the first few days after birth and a weight loss of up to 10% on day 5 can be classed as expected, although it may be helpful to get someone to check how breastfeeding is going if baby has lost 8% or more on day five. You should be expecting your baby to have regained their birthweight by 3 weeks of age. After that your baby is expected to broadly stay on their growth centile, with a drop of two or more centiles (for most babies) being classed as faltering growth (1)

Should I expect pain during breastfeeding?

In short no and this is a sign that all is not as it should be.

Some women may notice discomfort (or pain depending on your pain threshold) in the first few days/week of breastfeeding. This occurs when the baby latches and usually lasts up to 30 seconds, after which the feeling lessens and is no longer noticeable. This can be normal.Any pain beyond this is not normal and isn’t something you need to grin and bear, you don’t need to wait it out while dreading each feed. It is a sign that something isn’t right. It is a sign to seek support.

Signs that you need to get help?

• Pain that lasts throughout a feed
• Pain that lasts beyond the initial few days/week
• Damaged nipples
• Mishappen nipple at the end of breastfeeding
• Nipple whitens after feeding and feels like stinging

Why is it painful?

In the early days is usually related to the latch. A latch that isn’t deep enough will impact on the position of the nipple in the mouth which will result in pain.

What can I do?

• Seek support, sometimes just a small adjustment is needed to make a big difference

• Work on positioning and attachment

• You do not need to suffer. Seek support but if you are finding that pain or trauma to the nipples is unbearable then it is ok to take a break.

• Hand express/pump in place of feeds

• Feed the milk to your baby via syringe, cup or bottle using paced bottle feeding

Support options

If breastfeeding is not going as expected or if you are looking for reassurance and support for your breastfeeding journey then there are options available to you

-       National breastfeeding helpline

-       Find a lactation consultant

-       Speak to your midwife or health visitor and ask for referral to your local infant feeding team or signposting to local breastfeeding support groups, drop ins or cafes

-       1:1 breastfeeding support with me

-       Breastfeeding: Beyond getting started online course

References