Breastfeeding gives your baby the optimum first food for meeting his or her nutritional and growth needs. But even though you know you're doing what is best for your baby, you'll probably have questions as you begin breastfeeding. The information given here will address some of your concerns and help you and your baby have a satisfying breastfeeding experience.

Getting Started

As soon after birth as possible, put your baby to the breast. For the first one or two hours after birth, most newborns are alert and ready to nurse. The colostrum secreted by your breast in the last months of pregnancy and in the first days after delivery is the ideal first food for your baby.

To begin nursing, make yourself comfortable and hold the baby in your arms with his body entirely on its side. His lower arm will be around your waist, and his head will be in the bend of your elbow. Support your breast with your free hand, placing your thumb above the areola and your four fingers below it. Keep your fingers off the areola so they do not get in the way of the baby's mouth. Gently tickle the baby's lips with your nipple centered toward his mouth. His mouth should cover most of the areola. The baby's head, abdomen and buttocks should be in a straight line and his abdomen should be against your chest. It's normal for the tip of his nose to touch your breast while nursing. If the nostrils are blocked, lift up on the breast with the supporting hand or lift his buttocks higher. You may need to reposition the baby a few times before he latches on properly. Some babies need to learn how to suckle the breast even though they're born with reflexes that help. If you feel as though the baby has only the nipple in his mouth, remove him from the breast by gently putting your finger in the corner of his mouth between the gums until the suction is broken. Reposition the baby and try again.

Use the football, or clutch, hold after a cesarean birth or to help a small baby latch on. Place pillows at your side to support the baby, who'll be next to you, with feet and legs behind you. Support her back and neck with your arm, using your other hand (on the opposite side) to support your breast. Tickle her lips, center your nipple toward her mouth and pull her in close to you.

You also might find the side-lying position comfortable for nursing. In this position, lie on your side with the baby on her side next to you. Her abdomen should be next to yours, with her head at the level of your breast. Tickle her lips gently to signal the baby to open her mouth.

Frequent feedings, 10-12 times in a 24 hour period, during the first few days encourage milk production with minimal engorgement. You'll know your baby is suckling well when (1) the feedings are not painful, (2) you can hear your baby swallowing, (3) the baby's nose and chin touch the breast. In the first few days, your baby may fall asleep at the breast and not nurse for long. Don't be discouraged; the baby may need to sleep more than he needs to eat at this point. If the baby latches on correctly and is nursing well, you won't need to limit feeding time.

What do I do when my nipples are sore?

Positioning your baby properly at the breast can help prevent nipple soreness. Limiting time at the breast generally doesn't prevent sore nipples, and delaying a feeding can cause the baby to nurse frantically and less effectively. If your nipples become sore, change the nursing position to help relieve pressure spots.

If soreness is caused by cracked skin, expose the nipples and areolae to the air for a few minutes after nursing. Express breast milk by hand and let the milk dry on the nipples to promote healing. Avoid washing the nipples and areolae with soap, and don't use nipple shields, which can decrease the amount of milk an infant gets.

How do I handle engorgement?

You can expect some degree of breast fullness in the first few days of full milk production, which generally occurs two to five days after birth. The fullness results from the production of milk and the increased blood flow to the breasts. Occasionally the breast may become very full and very hard. When a breast is engorged, the full areola may cause the nipple to flatten and make nursing difficult for the baby.

If your breasts become engorged, use moist heat (warm compresses or a warm shower) on your breasts and gently massage them before nursing. Hand express or pump milk until the areola softens, then encourage the baby to nurse. Breastfeed frequently during this period and after nursing apply cold packs briefly to the breasts to relieve swelling.

How can I tell if my baby is getting enough?

Most breastfed babies nurse eight to twelve times in 24 hours during the first two weeks of life. The baby should wet at least six diapers in 24 hours and appear satisfied after each feeding. A breastfed baby doesn't always eat on schedule; on some days, your baby will seem to want to nurse all the time. Don't give formula, water or sugar water to the baby unless your doctor tells you to. The days of frequent feedings correspond to his growth spurts and allowing your baby to breastfeed as he wants during these days will increase your milk supply to meet his increased demand. If you have any concerns or problems with breastfeeding your baby beyond those covered in this guide, or i f the suggestions given here don't seem to be working, call your pediatrician's office for advice.

This parent guide was prepared by Judith vogelhut, RN, BS, CPNP, IBCLC, Nurse Coordinator, Johns Hopkins BreustJeedinig Center, Baltimore.