Frequently Asked Questions about Breastfeeding




When will my milk come in?

Mature milk production begins about 30 hours after delivery, but may not be evident for two to five days. Timing varies depending on your baby's ability to latch-on properly and how frequently and effectively your baby sucks. Generally, the more babies you have had, the sooner your milk "comes in." Keep in mind that until mature milk is present, your baby is receiving rich colostrum "starter milk," which has three times the protein of mature milk and is just right for meeting your baby's needs during those first few days.

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What is Colostrum?

Also known as "first milk" or "immune milk," Colostrum is a form of high-protein milk produced by the mammary glands in late pregnancy and the few days after giving birth. Colostrum is also high in carbohydrates and antibodies, and low in fat (as fat can be difficult for newborns to digest). Newborns have very small digestive systems, and colostrum delivers its nutrients in a very concentrated low-volume form. It has a mild laxative effect, encouraging the passing of the baby's first stool, which is called meconium.

The appearance of Colostrum will differ from your regular breastmilk. Colostrum is much thicker than milk and pale yellow in color. There is a chance it can stain your clothing so cotton nursing pads are highly recommended during the last few weeks of your pregnancy.

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What is "milk let-down," and when will it happen?

Milk let-down, or milk ejection reflex (MER), is a hormonal release. During MER your body pushes milk out of the alveoli and the milk ducts into the nipple area. Some women feel a physical sensation and others do not. It varies from woman to woman. If you need to encourage let-down or are having discomfort due to engorgement, applying heat can help, for example a heating pad or a hot shower.

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I haven't had my baby, but I'm leaking fluid from my breasts. Is that normal?

Yes, it’s a normal by-product of pregnancy and lactation to leak milk even before you deliver. Although some women never experience leaking, it is a very individual occurrence. Use breast pads inside your bra to help keep you comfortable and your clothes dry.

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Are there foods to avoid while breastfeeding?

Although you will get plenty of unsolicited advice about dietary restrictions while you are breastfeeding, there aren't any foods that a mother should routinely avoid. Babies can be fussy and can have excess gas - just because babies are fussy and babies have gas, not because you had broccoli for dinner last night. Occasionally, a baby may be sensitive to something in the mother's diet. The most common sensitivities are to protein antigens that are found in cow's milk, soy, wheat, fish, corn, eggs and nuts. If you believe your baby is reacting to something in your diet, eliminate that food for two or three weeks, they try it again. Generally speaking, you should eat a healthy, well-balanced diet, with no restrictions. Any food (even chocolate!) in moderation is usually fine.

If you notice your baby becomes fussy or has irregular bowel issues after you've eaten a certain food, simply try avoiding that food for a while (for example, Broccoli). After a few weeks you can slowly re-introduce broccoli into your diet and observe your baby's behavior after feeding. If he or she seems fine the original indigestion was probably a coincidence. If your baby experiences discomfort again you may need to avoid that particular food while you are breastfeeding. If you have any questions or concerns, always seek the advice of your healthcare professional.

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If I'm feeling tense, how can I relax while nursing?

While the milk-producing hormone prolactin has a natural relaxing effect on the breastfeeding mother, sometimes additional help is needed. Setting up a special "breastfeeding station" in your home may help create an environment in which you can unwind.

Select a comfortable chair (a big easy chair or rocking chair with arms is nice), and a footstool to raise your lap. Surround yourself with everything you might need: pillows, telephone, books, nutritious nibbles, juice, water and extra diapers. Try relaxing to soothing classical music or use the relaxation techniques you learned in your childbirth class. If you have a toddler who demands your attention, set up your nursing station on the floor or in the child's room. Include an assortment of pastime supplies, such as special toys, snacks, books and music.

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When should I start breastfeeding?

Start breastfeeding as soon after birth as possible, ideally within the first half-hour after delivery. If you choose to give birth in a hospital setting, many hospitals offer the services of a lactation consultant to help you get started. You will want to speak with your hospital administration to see if they will provide you with lactation specialist. If your hospital does not offer this service they should be able to recommend a local specialist.

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How often should I breastfeed, and how long do I breastfeed per session?

Babies need to be nursed as often as they indicate a desire to breastfeed. Watch for your baby's cues. Rooting, brushing a hand across his face, or making little sucking motions are all indications that it is time to breastfeed. Babies will demonstrate feeding cues for up to 30 minutes before they start crying. Crying can cause your baby to have an uncoordinated suck, making it more difficult to initiate feeding.

Most babies need to breastfeed at least 8 to 12 times in 24 hours for the first few weeks. Once you and your baby are synchronized, the frequency and duration of feedings per day will decrease. This process takes about six weeks, just about the length of time it takes for you to completely recover physically from the birth process! Breastfeed as long as your baby wants to on the first breast; your baby will let you know when he is finished, either by spontaneously coming off the breast or by drowsily moving into non-nutritive "nursing." You can burp the baby and offer the other breast. If your baby takes it, fine; if not, that's fine too.

There aren't any "rules" about having to take both breasts at a feeding. The next time the baby is ready to feed, you can offer the side baby finished on or didn't take. Keep in mind that sometimes babies love to be put to the breast simply for closeness and comfort, not because they are necessarily hungry. For the first week or feeding sessions may range from 20-45 minutes, but this time will decrease as you and your baby develop a regular feeding schedule.  Generally speaking, most babies will breastfeed every 2 to 3 hours for 5 to 15 minutes per breast.

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How will I know when my baby wants to eat?

Look for signs such as sucking fingers or fist, fretful sounds, open lips, or turning head to the side with mouth open to suck when the side of baby’s mouth or cheek is touched. Most babies will simply become 'fussy' when they are hungry.

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How do I know if my baby is getting enough milk?

Weight gain is the most accurate way to tell. A 4-8 oz. increase per week is normal, but it varies. After the first month or so, you will intuitively know that your baby has been satisfied by his heavier look and weight. Some babies love to be held and nursed frequently as a way of helping them to adjust to life outside the womb. In fact, the first three to four months of life for all babies is a transition from the womb to the world. During "increased appetite" days, set aside other commitments to focus your energies on your baby.

Your baby will breastfeed more frequently in response to sudden growth spurts. Babies can grow as much as 1/2 inch in a 24-hour period. No wonder they need to breastfeed frequently for several days! Breastfeed as frequently as your baby indicates a desire. Your milk supply will soon catch up to the increased need. Giving bottles of formula at this time will only sabotage the natural supply and demand cycle, and you will be unable to catch up with your baby's needs.

Also, keep track of diaper changes, which may start at one or two wet diapers per day. Breastfed babies will generally produce more diapers than formula-fed babies. After your milk supply increases, baby should have five to seven wet diapers and three to five bowel movements every day. The color of the stools can vary from yellow to tan with a mustard-like consistency. Urine should be pale yellow to almost clear in color.

While breastfeeding, you will feel your baby sucking vigorously and hear him swallowing. Many mothers (though not all) feel a tingly or pinching sensation with the milk ejection (let-down) reflex. Often baby will drift off to sleep at the breast, a good indication that he is satisfied.

Your breasts may feel full before a feeding, less full after. You may leak between feedings or leak on one side while feeding on the other.

Sometimes a baby will seem satisfied at the breast, but when put down, will start to fuss and root again. This behavior is not necessarily an indication that your milk supply is inadequate. Your baby may simply enjoy being held and cuddled, and not want to give it up for a crib or an infant seat. Using a baby sling or front baby carrier during the day will keep him cuddled next to you while you go about your daily routine.

Sleep when your baby sleeps to recharge your system after these high-need periods. "Wearing" your baby in a sling or front carrier may be helpful. Just as a toddler needs a periodic hug and kiss to make the world right again, a newborn may need to be cuddled and even nursed for a while. As babies get older, they learn other ways of self-comforting, and breastfeeding sessions generally become shorter and less frequent.

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What if I don't have enough milk for my baby, or my baby is gaining weight poorly?

Most delays in milk production result from an upset in the supply and demand balance. Avoid giving supplemental bottles. Temporarily postpone your other commitments to focus your energies toward establishing a breastfeeding routine with your baby. Try:

  • Take your baby to bed with you. Nap- and night-nursing are time-tested remedies for enhancing a baby's weight gain.
  • Remember the law of supply and demand, and increase the frequency of feedings to at least one every two to three hours. Wake your baby during the day if baby sleeps more than three hours. Even a sleepy baby will nestle at your breast and stimulate milk production.
  • Look at, caress, and groom your baby while breastfeeding. These maternal behaviors stimulate milk production.
  • Undress your baby before feeding to allow skin-to-skin contact. This action may help awaken sleepy babies and stimulate less-enthusiastic nursers.
  • Watch for your baby's feeding cues and capitalize on the times when baby seems ready to eat.
  • Don't try to wake your baby from a deep sleep; wait until he is in a light sleep or drowsy state.
  • Try "switch-nursing" to encourage more enthusiastic breastfeeding if your baby seems to fall asleep quickly. Also called the "burp and switch" method, switch-nursing allows your baby to feed on the first breast until the suck diminishes and baby's eyes begin to close. Take the baby off your breast, burp and latch-on the other breast. When sucking diminishes, take baby off, burp and switch again so baby nurses at least twice on both sides.
  • Double-nursing is another effective method for increasing the volume and fat content. Feed your baby until baby is content; keep baby upright instead of putting baby down to sleep; burp baby well, and 10 to 20 minutes later, breastfeed a second time. Be sure to keep baby upright for 10 to 20 minutes after a feeding to allow the trapped air bubbles to be burped up, leaving room for a "topping off."
  • Above all, relax during breastfeeding to permit an effective milk ejection reflex.

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Does my baby need bottles?

Giving your baby supplemental or "relief" bottles in the early days may lead to nipple confusion/preference and can adversely affect your milk supply. Unless you are advised to do so for a medical reason, you should not give a breastfeeding baby bottles of water or formula for the first 3 to 4 weeks. If supplementation is necessary, it can be done with a small medicine spoon or a specialty feeding cup. Giving bottles every day or every other day so your baby "gets 'used' to taking a bottle" is not necessary. After the first few weeks, giving baby a bottle of expressed breast milk periodically, when it is convenient for both of you, is all you need to do. If your baby balks at taking a bottle, you can always feed him using a specialty feeding cup or a medicine spoon.

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I plan to breastfeed, so why should I use a breastpump?

A breast pump helps if you are separated from your baby (for instance, while working), if you become engorged, if you need to increase a low milk supply, or if baby has trouble latching on because of inverted or flat nipples.

Breastpumps are helpful in stimulating, maintaining and expressing milk in cases involving working mothers or mothers with engorged breasts, and premature or sick infants. Breastpumps are available in a variety of types, depending on your preferences and needs.

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Can I buy or borrow a pre-owned breast pump?

Many mothers have asked if they can safely sell, purchase, or use a previously owned breastpump.  Breastfeeding is certainly the best way to feed your baby, and is the gold standard of infant nutrition. There is some evidence, however, that certain serious viruses* may be transmittable through breastmilk. For this reason, it is not advisable to use a previously owned breastpump. Breastpumps are single-user products, or personal care items, much like a toothbrush, and are registered with the FDA as single user items.

For safety, breast pumps should never be shared, resold, or lent among mothers.  Each mother who wishes to express milk with a pump should use a clean, uncontaminated breastpump. This is the safest way to eliminate any risk of cross-contamination.

Rental pumps such as the Medela Lactina® are made to be safely used by repeated clients who each use their own clean personal rental kit, therefore avoiding any possible cross-contamination.

We are invested in continuing health and safety of mothers and babies. Many mothers who wish or need to express milk regularly find that using a high quality breastpump can help avoid the costly alternative of using artificial baby milk, which sometimes approaches or exceeds $1000 for the first year of baby's life. Mothers who pump frequently may find that the cost of a high quality breastpump, when compared to the price of artificial baby milk is reasonable, and a wise investment in the present and future health of their children and themselves.

1. *It is believed by some physicians and researchers that human breastmilk can possibly contain viruses if the mother is infected. Such viruses may include CMV (Cytomegalovirus), HIV-Human Immunodeficiency Virus (AIDS), and HTLV-1 (Human T-Cell Leukemia Virus Type 1).

1. Ruth A. Lawrence, MD, Breastfeeding: A Guide for the Medical Profession
(St. Louis, Missouri: Mosby-Year Book, Inc., 1999), pp. 225.

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I have an uncomfortable fullness in my breasts. What can I do about it?

Try breastfeeding your baby more often or use a breast pump to relieve that hard, hot, or painful feeling known as engorgement. A hot shower can also encourage the let-down of excess milk.

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My nipples hurt so badly I may quit breastfeeding. Is there something I can do for relief?

Sore nipples are a common complaint at first and may indicate that your baby is not positioned properly at the breast. If you are using a breastpump, you may have an incorrectly-fitting breast shield. Lanolin ointment can provide great relief of sore, dry or cracked nipples. You may also talk with your doctor about using a nipple shield.

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When should I wean my baby?

Around the world, babies are breastfed an average of two to three years; there is, however, no "right" time to wean. Weaning is an individual decision for each mother and baby. Most babies will not show signs of wanting to wean before eight to nine months at the earliest. The American Academy of Pediatrics recommends breastfeeding exclusively for the first four to six months, gradually introducing new foods after that time. Breast milk for at least a year is preferred, using formula if you wean before that time.

When you or your baby decides to wean, you should do so gradually to prevent the discomfort of engorgement and to help maintain your baby's sense of security. Dropping one feeding every few days and replacing it with formula or cow's milk (depending upon your baby's age), will allow your breasts to adjust to the decreased demand in comfort. Most mothers drop the late night or early morning feeding last as this feeding is often a special snuggle time with the baby.

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This is general information and does not replace the advice of your physician or healthcare provider. If you have a problem you cannot solve quickly, seek help right away. Every baby is different, and your baby may not be average. If in doubt, contact your physician or other healthcare provider.

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