Breastfeeding Tips: Embracing Imperfection and Finding Support
By Dr. Chesney Kennedy with assistance from Rebecca Harris, RN, IBCLC (International Board of Lactation Consultant)
For this article, I have collaborated with my friend Rebecca Harris, a Lactation Consultant, Registered Nurse, and mother of three who resides and practices in the San Francisco Bay Area. Rebecca became a lactation consultant around the same time I became a pediatrician, and we had the pleasure of working together at the same pediatric clinic. With 20 years of breastfeeding experience, Rebecca possesses an encyclopedic knowledge of all things breastfeeding.
Rebecca and I used to joke that most mammals wake their sleepy newborns for feeding by licking their cheeks, and maybe humans could give it a try too! Of course, this “licking” method is not evidence-based for humans—it’s our untested, humorous theory. Let us know if you try it! In the meantime, the tips below are designed to be both evidence-based and practical. We hope you find these approaches helpful and enjoyable.
Embracing imperfection in breastfeeding
As I write this article, I reflect on my 20 years of observing breastfeeding parents. The main message I want to convey to each breastfeeding parent is to allow yourself plenty of room for imperfection as you learn to breastfeed.
Most parents I serve in my Boulder and Longmont pediatrics practice do not live in an extended family situation, surrounded by grandparents and aunties who are always around to help a baby latch onto the breast. Most families live in single-family homes and are lucky if they have helpers nearby, so there can be a sense of isolation. On top of that, many of the breastfeeding parents I work with have been perfectionists their whole lives—excelling in school, careers, and hobbies. They expect breastfeeding to go just as smoothly.
However, my observations over the years have taught me that birthing and breastfeeding can be areas of life over which we do not have much control. It can feel humbling and aggravating when our assumptions of how it should be do not pan out. Most breastfeeding parents have a deep, innate sense that breastfeeding should always feel beautiful, natural, and accessible. If that were the case, we wouldn’t need lactation consultants in every hospital and birth center.
Overview of breastfeeding tips and resources
Let this article be a starting point for your breastfeeding journey. Your breastfeeding plan will ultimately be unique to your situation, shaped by intuition and support. In this article, we will cover the following topics:
- Benefits of breastfeeding
- Building your support team
- What to expect in the first week after your baby is born
- A breast milk-making plan
- The triple feeding plan
- Nipple pain and mild engorgement tips
- What to avoid while breastfeeding
- How to clean pump parts\Helpful pumping accessories
- Breast milk storage
- How to warm up breast milk
- Reputable website resources
- Great books for parents on baby’s first year
- Boulder County (and surrounding area) offerings for breastfeeding support, lactation consultants, parent support groups
“Whatever path you choose will be right for you—even if it isn’t what you initially imagined. So, give yourself plenty of room for imperfection as you learn how to breastfeed.”
Benefits of breastfeeding
Breastfeeding your baby has so many health benefits for both the breastfeeding baby and the parent. Studies show that breastfed babies have lower risks of asthma, Type I diabetes, and sudden infant death syndrome. Breastfed babies are also less likely to have ear infections and stomach bugs. The antibodies passed to your baby from the breast milk help babies develop a robust immune system. Breastfeeding parents have a lower risk of developing breast cancer, ovarian cancer, Type II diabetes, and high blood pressure.
Some parents are unable or choose not to breastfeed (or exclusively breastfeed) for various reasons. There is absolutely nothing wrong with that, either. We are fortunate to live in a time when we have excellent formulas and donor breast milk.
Whatever your feeding plan is (or evolves into) for your baby, we can support you in the direction you wish to go.
Building your support team
I encourage breastfeeding parents to gather their team of lactation consultant(s), medical provider(s), and trusted friends and family for help and support.
I also encourage every breastfeeding parent to trust themselves. I have seen breastfeeding parents who breastfeed easily from day one (rare). I have seen breastfeeding parents who have hired three different lactation consultants in the first month until they figured it out and thought they might lose their minds…but they didn’t. I have seen breastfeeding parents who decide that the process of breastfeeding is not good for their own mental health, and so they opt for formula instead (or a combination of breastfeeding and formula). I could go on…there are so many different scenarios. All of these paths are fine.
Most importantly, the breastfeeding parent’s emotional and physical health should be optimized as their baby grows. Whatever path you choose will be right for you—even if it isn’t what you initially imagined. So, give yourself plenty of room for imperfection as you learn how to breastfeed.
What to expect in the first week
When your baby is born – whether it is in a hospital, birth center, or your home, a lactation consultant will visit at some point to help you get started with breastfeeding. If you are not offered this service automatically, request it. Most hospitals and birth centers have lactation nurses you can continue seeing after you leave. I recommend setting up an appointment with a lactation nurse before you leave the hospital and continuing to see them at least weekly until you feel completely comfortable with breastfeeding. The Lactation Network is a national organization that contracts with insurance providers to allow breastfeeding parents six free lactation support appointments. Visit their website at https://lactationnetwork.com/
After your baby’s birth, breast milk takes around 3-5 days to come in fully. At times, it can take longer. We sometimes see this when moms experience stress, cesarean section, diabetes, or thyroid conditions. We can support you through this.
Your baby does not need much milk in the first couple of days. Babies are born with large glycogen supplies in their liver, keeping their blood sugar levels up. The milk volume will almost double daily in the baby’s first week. Here are typical volumes of what full-term babies need each day after birth. This is helpful if you need to supplement with pumped breast milk, donor breast milk, or formula during the first week of life. Often, no supplementation is necessary, but sometimes it is… and that is okay! You can decide whether or not to supplement with help from your pediatrician or lactation consultant.
Count your baby’s diapers as evidence of adequate intake. In general, the average amount for each feeding is (8-12+ feedings within 24 hours):
| Day of Life | Amount per feeding | Number of wet urine diapers | Number of poos |
| 1 | 2-10 ml | At least one | At least one |
| 2 | 5-15 ml | At least two | At least one |
| 3 | 15-30 ml | At least three | At least one |
| 4 | 30-60 ml | At least four | At least one |
| 5 | 40-60 ml | At least five | At least one |
| 6 | 50-60 ml | At least six | At least one |
- Notes for intake: 30ml = 1 ounce
- Notes for output: Between days 2 and 3, baby’s stool changes from black to green, then to yellow, with a yellow “seedy” look by day 5.
You may need to supplement less as your milk supply increases and the infant’s latch and sucking improves. Please follow up with your pediatrician or lactation consultant to ensure your infant gains weight appropriately and that your milk supply can be assessed.
A breast milk-making plan
Keep in mind that a breastfeeding plan is dynamic. A lactation consultant and your pediatrician will assist you with making adjustments as your milk supply develops and your baby grows into breastfeeding.
Spend time skin-to-skin, cuddling with your baby as often as possible. Skin-to-skin contact helps raise your prolactin level and naturally increases your milk production. It also helps boost your oxytocin level, a hormone that helps your milk to let down.
More breast stimulation and removal = more milk
Attempt breastfeeding at least 8-12+ times within 24 hours or every 0-3 hours. This will continue for about the first two weeks. All babies lose some weight right after birth. This is normal! Your baby will have a check-up at 2-3 days of age, and your pediatrician will ensure that the baby has not lost too much weight. At your two-week check-up, your pediatrician will check to see if your baby has regained their birth weight. Many parents are surprised to learn that babies are mostly nocturnal for the first six weeks after birth, so they may want to feed often at night. This is normal and to be expected. On days 2-4, you may experience “cluster feeding” when babies want to feed about every 30 minutes throughout the night, and this may continue when your baby is going through growth spurts within the first year of life.
A breastfeeding plan generally looks like this:
- Breastfeed on demand at least 8-12+ times per 24 hours (This may be every 0-3 hours).
- Alternate which breast the breastfeeding parent starts with. The breastfeeding parent can use a rubber band on their wrist to keep track.
- Breastfeed on one side for as long as the baby is actively feeding (usually about 10-20 min). Offer both breasts at each feeding.
- Hand-express for comfort, if needed. Watch this video on how to express your first milk.
The “Triple Feed” method
This plan be necessary in the following situations, which are pretty common:
- If a baby loses more than 10% of their birth weight within the first few days of life.
- If a baby isn’t removing breast milk well from the breast.
- If the breastfeeding parent is working on building their milk supply.
The Triple Feed Plan looks like this:
- Nurse on demand, at least every 3 hours.
- Pump right afterward for 10-15 minutes. Gently massage breasts while pumping. Suction should be comfortable at the highest level.
- Offer back your expressed milk via a syringe, cup, or bottle.
Record times, lengths of feeds, and amount of expressed milk fed to baby for at least the first two weeks.
Note: To shorten this cycle, have a helper feed your baby the pumped breast milk (from your previous pump session) while you are pumping new fresh milk. Pumped breast milk is safe to stay at room temperature for 4-6 hours, so it is fine to sit on the counter and be used for the next feeding.
Tips for nipple pain or mild engorgement
- Visit this website overview of mastitis and engorgement
- If you can, continue to breastfeed on demand at least every three hours. Try using reverse pressure softening or a little hand expression to help soften the areola, which relieves discomfort and makes it easier for the baby to latch.
- Watch this video showing reverse pressure softening
- If needed for missed feedings or in place of a breastfeeding session, pump your breasts for up to 10 minutes
- Offer all your expressed breast milk back to your baby via bottle, finger feeder, or cup.
Avoid these things that are known to reduce breast milk supply
- Smoking
- Caffeine
- Birth control pills and injections
- Decongestants, antihistamines
- Severe weight loss diets
- Mints, parsley, sage (excessive amounts)
Cleaning pump parts
- After using your pump parts, give them a good hot rinse and let them dry in a clean place away from bathroom or kitchen use and splatter
- Once a day, do a good scrubby wash on all parts
- Never wash the tubes, as they are for suction only
- You can also put milky pump parts in the refrigerator and use them un-rinsed at the next pumping session
Helpful pumping accessories
- Photo of baby, item of baby’s clothing, or the recorded sound of baby crying (these stimulate milk letdown reflex)
- Hands-free pumping bra
- High-quality breast pump or hospital-grade pump with breast milk storage bags
- Insulated tote with cooler packs to cool, store, and transport breast milk
Storing breast milk: The rule of fives
A general rule of thumb is breast milk lasts:
- Five hours at room temperature.
- Five days in the refrigerator.
- Five months in the freezer.
Warming up breast milk
- To warm refrigerated breast milk, place it in a bowl of warm tap water surrounding the bottle, adding warm water if needed. The milk needs to be heated enough to remove the chill. Never microwave breast milk
- Frozen milk can be thawed in a bowl of warm water, adding warm water as the water cools
- Frozen milk can be thawed in the refrigerator, but once the last ice crystals have melted, it must be used within 24 hours. Do not refreeze breast milk
- It is desirable to store some milk in feeding-size portions and have some in 1-2 oz increments to defrost as needed
Breastfeeding resources
Reputable website resources
- Kellymom.com — Latching, positioning, plugged ducts, mastitis, dairy, and other food sensitivities
- La Leche League International
- La Leche League – Safe Sleep
- Babycenter.com — Breastfeeding tips are under the “Baby” tab. They also have a great section on starting solid foods.
- Jane Morton, MD, IBCLC: Maximizing Milk production with a hospital-grade pump
- Working Moms – “Work and Pump”
- Global Health Media – A good latch video
- SimpliFed.com — Virtual breastfeeding support
Books for parents in baby’s first year
- Happiest Baby on the Block by Harvey Karp, MD (sleep and soothing)
- Baby411 by Ari Brown and Denise Fields
- What to Expect the First Year by Heidi Murkoff
Local breastfeeding support, lactation services, and parent support groups
- Avista Hospital Lactation Department
- Birth Center of Boulder
- Boulder Community Health Lactation Support
- Boulder Medical Center lactation appointments: Erin Harper-Sanchez, CNM
- CommonSpirit Longmont United Hospital Lactation Consultant
- UCHealth Birth Center at Longs Peak Hospital
After all this advice, and I know these can be challenging times…I wish you happy moments with this sweet new person in your life. Cheers!
References
- Diana West, IBCLC, Diane Wiessinger, and Teresa Pitman from La Leche League International. The Womanly Art of Breastfeeding. July 13, 2010
- Diana West, IBCLC and Lisa Marasco, M.A., IBCLC. Making More Milk, The Breastfeeding Guide to Increasing Your Milk Production. November 18, 2019
- World Health Organization. Breastfeeding. Available at: https://www.who.int/health-topics/breastfeeding (Accessed on December 18, 2020)
Dr. Chesney Kennedy, MD – Pediatrician
About Chesney Kennedy, MD
Pediatrician in Longmont and Boulder
Dr. Chesney Kennedy is your dedicated partner in pediatric healthcare, serving families in Longmont and Boulder, Colorado. With a solid commitment to the well-being of children and teenagers, she goes above and beyond to create an inclusive and welcoming environment for all, including the LGBTQIA+ community, ensuring that everyone feels comfortable and respected in her practice. Specializing in:
General Pediatrics
- Newborn Care
- Well-Child and Preventive Care
- Personalized Primary Care: Tailored healthcare solutions to address the unique needs of each child
- Sick Visits
- Mental Health: Support for depression, anxiety, and ADHD
- Sports Physicals
- Vaccinations
Teens
Dr. Chesney’s services for teens include:
- Birth Control: Providing a range of options, including IUDs, Nexplanon®, birth control pills, Depo shots, and counseling
- Emergency Contraception: Offering Plan B
- Heavy Periods: Dr. Kennedy is here to address and manage heavy and irregular menstrual cycles
- Pregnancy Options & Counseling
- Sexually Transmitted Infections: Offering testing, diagnosis, and treatment