Lactation 

Is the process by which milk is synthesized and secreted from the mammary glands of the postpartum female breast in response to an infant sucking at the nipple. Breast milk provides ideal nutrition and passive immunity for the infant, encourages mild uterine contractions to return the uterus to its pre-pregnancy size, and induces a substantial metabolic increase in the mother, consuming the fat reserves stored during pregnancy.

  • Structure of the Lactating Breast

    Mammary glands are modified sweat glands. The non-pregnant and non-lactating female breast is composed primarily of adipose and collagenous tissue, with mammary glands making up a very minor proportion of breast volume. The mammary gland is composed of milk-transporting lactiferous ducts, which expand and branch extensively during pregnancy in response to estrogen, growth hormone, cortisol, and prolactin. Moreover, in response to progesterone, clusters of breast alveoli bud from the ducts and expand outward toward the chest wall. Breast alveoli are balloon-like structures lined with milk-secreting cuboidal cells, or lactocytes, that are surrounded by a net of contractile myoepithelial cells. Milk is secreted from the lactocytes, fills the alveoli, and is squeezed into the ducts. Clusters of alveoli that drain to a common duct are called lobules; the lactating female has 12–20 lobules organized radially around the nipple. Milk drains from lactiferous ducts into lactiferous sinuses that meet at 4 to 18 perforations in the nipple, called nipple pores. The small bumps of the areola (the darkened skin around the nipple) are called Montgomery glands. They secrete oil to cleanse the nipple opening and prevent chapping and cracking of the nipple during breastfeeding.

  • Changes in the Composition of Breast Milk

    In the final weeks of pregnancy, the alveoli swell with colostrum, a thick, yellowish substance that is high in protein but contains less fat and glucose than mature breast milk. Before childbirth, some women experience leakage of colostrum from the nipples. In contrast, mature breast milk does not leak during pregnancy and is not secreted until several days after childbirth.

    Colostrum is secreted during the first 48–72 hours postpartum. Only a small volume of colostrum is produced—approximately 3 ounces in a 24-hour period—but it is sufficient for the newborn in the first few days of life. Colostrum is rich with immunoglobulins, which confer gastrointestinal, and also likely systemic, immunity as the newborn adjusts to a nonsterile environment.

    After about the third postpartum day, the mother secretes transitional milk that represents an intermediate between mature milk and colostrum. This is followed by mature milk from approximately postpartum day 10. As you can see in the accompanying table, cow’s milk is not a substitute for breast milk. It contains less lactose, less fat, and more protein and minerals. Moreover, the proteins in cow’s milk are difficult for an infant’s immature digestive system to metabolize and absorb.

    The first few weeks of breastfeeding may involve leakage, soreness, and periods of milk engorgement as the relationship between milk supply and infant demand becomes established. Once this period is complete, the mother will produce approximately 1.5 liters of milk per day for a single infant, and more if she has twins or triplets. As the infant goes through growth spurts, the milk supply constantly adjusts to accommodate changes in demand. A woman can continue to lactate for years, but once breastfeeding is stopped for approximately 1 week, any remaining milk will be reabsorbed; in most cases, no more will be produced, even if suckling or pumping is resumed.

    Mature milk changes from the beginning to the end of a feeding. The early milk, called foremilk, is watery, translucent, and rich in lactose and protein. Its purpose is to quench the infant’s thirst. Hindmilk is delivered toward the end of a feeding. It is opaque, creamy, and rich in fat, and serves to satisfy the infant’s appetite.

    During the first days of a newborn’s life, it is important for meconium to be cleared from the intestines and for bilirubin to be kept low in the circulation. Recall that bilirubin, a product of erythrocyte breakdown, is processed by the liver and secreted in bile. It enters the gastrointestinal tract and exits the body in the stool. Breast milk has laxative properties that help expel meconium from the intestines and clear bilirubin through the excretion of bile. A high concentration of bilirubin in the blood causes jaundice. Some degree of jaundice is normal in newborns, but a high level of bilirubin—which is neurotoxic—can cause brain damage. Newborns, who do not yet have a fully functional blood–brain barrier, are highly vulnerable to the bilirubin circulating in the blood. Indeed, hyperbilirubinemia, a high level of circulating bilirubin, is the most common condition requiring medical attention in newborns. Newborns with hyperbilirubinemia are treated with phototherapy because UV light helps to break down the bilirubin quickly.

  • The Process of Lactation

    The pituitary hormone prolactin is instrumental in the establishment and maintenance of breast milk supply. It also is important for the mobilization of maternal micronutrients for breast milk.

    Near the fifth week of pregnancy, the level of circulating prolactin begins to increase, eventually rising to approximately 10–20 times the pre-pregnancy concentration. We noted earlier that, during pregnancy, prolactin and other hormones prepare the breasts anatomically for the secretion of milk. The level of prolactin plateaus in late pregnancy, at a level high enough to initiate milk production. However, estrogen, progesterone, and other placental hormones inhibit prolactin-mediated milk synthesis during pregnancy. It is not until the placenta is expelled that this inhibition is lifted, and milk production commences.

    After childbirth, the baseline prolactin level drops sharply, but it is restored for a 1-hour spike during each feeding to stimulate the production of milk for the next feeding. With each prolactin spike, estrogen and progesterone also increase slightly.

    When the infant suckles, sensory nerve fibers in the areola trigger a neuroendocrine reflex that results in milk secretion from lactocytes into the alveoli. The posterior pituitary releases oxytocin, which stimulates myoepithelial cells to squeeze milk from the alveoli so it can drain into the lactiferous ducts, collect in the lactiferous sinuses, and discharge through the nipple pores. It takes less than 1 minute from the time when an infant begins suckling (the latent period) until milk is secreted (the let-down). The image below summarizes the positive feedback loop of the let-down reflex.

    The prolactin-mediated synthesis of milk changes with time. Frequent milk removal by breastfeeding (or pumping) will maintain high circulating prolactin levels for several months. However, even with continued breastfeeding, baseline prolactin will decrease over time to its pre-pregnancy level. In addition to prolactin and oxytocin, growth hormone, cortisol, parathyroid hormone, and insulin contribute to lactation, in part by facilitating the transport of maternal amino acids, fatty acids, glucose, and calcium to breast milk.

Stay together after the birth

Keeping your baby with you after the birth will promote a feeling of closeness and a strong hormonal response that is linked with breastfeeding success.  In many cases it is even possible to have your baby with you immediately after a caesarean birth.

Get your position and attachment right

The first few days after the birth offer the best opportunity for you and your baby to learn to breastfeed. Your breasts are still soft for a few days after the birth, then as breast milk changes from highly nutritious colostrum to mature milk, your breasts can become quite full and firm. Try and use the first few days to get your position and attachment right, this may help to avoid potential problems down the track.

Consider Different Ways to Latch

To breastfeed, your baby needs to “latch on.” This is when your baby is properly attached to your breast with his mouth wide open over your nipple, covering most of your areola, and his nose, lips, and chin close to your breast.

Here are two ways to get your baby to latch on when breastfeeding:

  1. After getting into a comfortable breastfeeding position, cup your breast with your hand and guide the nipple to stroke your baby’s lip. This action stimulates your baby’s natural rooting reflex to open his mouth wide and suckle. Make sure to bring your baby close to your breast and aim your nipple toward the roof of his mouth.

  2. “Baby-led” latching or “laid-back” breastfeeding involves you lying on your back and placing your baby on your chest with your baby’s cheek close to your breast. Your baby will naturally explore his surroundings, find your nipple, and latch on.Breastfeed Right After Birth

It’s beneficial to breastfeed your little one very soon after he is born. Newborns are typically ready to nurse within the first hour after birth.

Those first feeds nourish your baby, of course, and get you both started in figuring out this new skill and routine of breastfeeding. Other benefits include the following:

  • The milk that comes through in the first few days is actually colostrum —a thick, yellow fluid that’s packed with protein and antibodies that support your baby’s growth and development.

  • Breastfeeding encourages the release of the hormone oxytocin, which may help you bond with your baby, and help you feel more confident about your nurturing abilities.

  • Skin-to-skin contact during breastfeeding helps stabilize your baby’s body temperature, heart rate, breathing, and blood sugar levels.Be patient

Breastfeeding is a skill that both you and your baby are learning and for some mothers and babies it is harder than it is for others. Like anything new, it takes time and patience. Relaxation is important for both you and your baby. If you find you are getting frustrated or angry at yourself while you're trying to breastfeed, stop and try again in a little while. If your baby is distressed, and if it is possible, ask someone to keep them distracted until you are ready to try again. You could also express for this feed and try feeding from the breast for the next feed.

Ease the Pain of Engorgement

Engorgement is when the blood vessels in your breasts are swollen and your milk ducts are overfilled with milk, causing discomfort and even pain. It can happen if your baby doesn’t nurse often or efficiently.

The best prevention strategy is to feed your baby whenever she’s hungry, and to make sure she nurses from both of your breasts. The idea is to drain your breasts regularly in order to keep them from becoming painfully hard and swollen. You don’t want to have your breasts become so engorged that your baby can’t latch on properly.

Here are a few more tips for dealing with engorgement:

  • Express your breast milk manually or pump some milk to help relieve the pressure before nursing your baby

  • Massage your breasts to help the milk flow

  • Soak a hand towel in warm water and place it over your chest before you breastfeed You could also take a warm shower. Warmth can help the milk flow.

  • If you find that heat doesn’t work, try using a cool compress in between or after each breastfeeding session

  • Mix up your breastfeeding positions to help drain different areas of your breasts.

Check That Your Baby Is Getting Enough Breast Milk

You’re probably wondering if there’s an easy way to check that your baby is getting enough nourishment. Here are five tips for checking that your newborn is getting a sufficient amount of breast milk:

  1. Listen for your baby swallowing while nursing, typically after several sucks.

  2. Keep an eye on your baby to see if he appears satisfied for a few hours after the feeding session. For example, your baby’s arms will most likely be relaxed with open palms, signaling that he is full and content.

  3. Before a feeding, your breasts may feel full and firm, but after a feeding they will feel softer. This is a sign your little one has been fed. As time goes by you’ll notice this difference less. You may think your breasts are completely empty of milk, but know that your breasts are always in the process of producing milk.

  4. A very accurate sign that your baby is getting enough to eat is steady growth. Your healthcare provider will check your baby's weight, length, and head circumference at each checkup. Know that it’s normal for a newborn to lose up to 10 percent of his birth weight in the first few days, but by the end of his second week, he should be back to gaining weight at a steady pace.

  5. Keeping track of your little one’s wet and dirty diapers helps you know he's eating well. In your baby’s first month, he may produce about six or more wet diapers a day with light-colored urine, and have three to four bowel movements a day that are soft and yellowish in color. Later on, the frequency of bowel movements may decrease.

If you’re ever concerned that your baby isn’t eating enough, call your healthcare provider—don’t wait for the next scheduled checkup.

Get Prepared for Breastfeeding in Public (If You Choose To!)

At some point, you may like to breastfeed your baby while you’re in a public place. Here are some tips for breastfeeding in public:

  • Wear clothing that allows you to easily access your breasts, like a loose top or a button-down shirt

  • You may wish to use a nursing cover, oversized scarf, or light blanket to cover yourself when you’re breastfeeding. Practice this at home so that you and your baby can get used to it.

  • Breastfeed while wearing your baby in a sling or soft baby carrier. Not only is this practical, it also keeps your baby comfortably close to you.

  • Find a women’s lounge or a dressing room in a department store so that you have somewhere peaceful to breastfeed.


Avoid Alcohol and Smoking, and Limit Certain Foods

The following tips are reminders that as long as you’re breastfeeding, you’re passing on what you eat and drink to your baby, which means certain things need to be avoided or limited to ensure your baby isn’t affected in a negative way:

  • Limit your caffeine intake to 200 mg a day. Caffeine can irritate your baby and affect his sleep.

  • Limit consuming seafood that’s high in mercury like swordfish, king mackerel, and tilefish

  • Avoid smoking, since nicotine can interfere with your baby’s sleep and health. Secondhand smoke also increases the risk of Sudden Infant Death Syndrome (SIDS) and respiratory illnesses in your baby.

  • Avoid drinking alcohol, as it’s not safe for your baby. If you do happen to have the occasional drink, wait two to three hours for it to leave your system before breastfeeding. “Pumping and dumping” your milk won’t speed up the removal of alcohol from your breast milk.

Feed on demand or according to need

While you are establishing your breastfeeding your baby will feed between seven and twelve times in 24 hours. This will settle over time. Frequent and effective feeding will help you to make enough milk for your baby.

Try Different Breastfeeding Positions

There are a variety of breastfeeding positions you could use to help your baby latch on better and help empty your breasts more effectively.

Here are four breastfeeding positions to try:

  • Cradle hold. This is the most traditional hold that many moms try first. Cradle your baby with the arm that’s on the side your baby is nursing from. Her head should be resting in the bend of your elbow, facing your breast, and her body should be turned inward to you. Be sure to always support your baby’s head as it will be a while before she can hold her head up on her own.

  • Cross-cradle hold. This is similar to the cradle hold, except here you’re holding your baby with the arm opposite to the breast she is nursing on. Support your baby’s head with your hand and have her bottom in the bend of your elbow. Your other arm can support your breast from underneath. You’ll want your baby’s body turned inward to you. This position is very good for newborns who are having trouble latching.

  • Football hold. Just like it sounds, this position involves tucking your baby under your arm as if you were holding a football. You’ll want to hold your baby to your side at the level of your waist while supporting her back with your arm. Her head should be tilted up toward your breast. This position can work well if you’ve had a cesarean section, if you have large breasts, or if you’ve had twins and want to feed your babies simultaneously.

  • Side-lying position. While lying on your side, place your baby next to you, and lift your breast up to within your baby’s reach so she can easily access your nipple. This position is convenient for those late-night feedings (just be sure to put your baby back in her crib to sleep afterward). It’s also a good position to try if you’ve had a cesarean section.Keep baby in the room with you

There are many benefits to having your baby in the room with you in the hospital and at home; including that it reduces the risk of sudden infant death.

It also promotes breastfeeding. Having your baby in the same room as you will help you to recognise when your baby is hungry, tired or in need of a cuddle; it will make it easier for you to know when your baby is ready to feed.

It is important to provide a safe sleep environment for your baby night and day.

Avoid teats, gummies, and complementary feeds

Because your new baby is still learning to breastfeed, they can become confused if they are offered a teat or gummy. If your baby has fluids other than breast milk they will breastfeed less, and your breast milk supply will decrease. Frequent, unrestricted suckling at the breast will satisfy your baby and ensure that your milk supply continues to meet your baby’s needs.

Don’t Give Up Breastfeeding If You Have Mastitis

Occasionally a clogged milk duct can get infected. This is a condition called mastitis, and the symptoms include fever- and cold-like symptoms; swollen, painful breasts; breasts that feel hot when touched; a hard lump on your breast; and red streaks on the skin of the breasts.

Care for Your Nipples

Tender nipples are not unusual during the first few weeks of breastfeeding. Eventually this tenderness will likely go away. To help reduce or prevent nipple discomfort, follow these breastfeeding tips:

  • Make sure your baby is latched properly by checking that your baby’s mouth is open wide, covering your areola and not just the tip of your nipple

  • Change up your baby’s breastfeeding position from time to time.

After your baby breastfeeds, try these aftercare tips for your nipples:

  • For a soothing effect, let some breast milk dry on your nipple

  • If you live in a humid climate, expose your breasts to sunlight as the hot air can help alleviate sore and cracked nipples

  • Use bra pads in between feedings, especially if your breasts tend to leak. Just don’t use ones lined with plastic as those can trap moisture, which can cause friction and irritation.

  • When bathing, wash your breasts with water and avoid the use of soaps, shampoos, or other cleansers that irritate your skin

  • Ask your healthcare provider to recommend an ointment or cream that can help treat or prevent sore, cracked, or bleeding nipples.

Increase Your Milk Supply, If Needed

To help increase your milk supply, here are four things you can do:

  1. Breastfeed more often, as this will result in your breasts producing more milk

  2. Pump after nursing, as this can help stimulate your breasts to produce more milk

  3. Drink plenty of water and eat a nutritious diet

  4. Try to reduce stress and relax. For example, take some time for yourself every day, even if it’s just 15 minutes.

Here are some reasons why you may have a low milk supply:

  • You might not be breastfeeding often enough (remember that newborns feed about 8 to 12 times a day). Breastfeeding or pumping too infrequently may signal your breasts to produce less milk.

  • If your baby was born prematurely, your preemie may not be strong enough to nurse enough milk from your breasts. This can lead to a decrease in milk production.

Contact your lactation consultant or healthcare provider for more personalized advice on increasing your breast milk supply.

Wait With Introducing a Pacifier

Giving your baby a pacifier can help soothe her between feeds; however, offering it in those first few weeks can have a negative effect on your milk supply, and discourage your baby from wanting to nurse.

Experts recommend waiting until your baby has gotten used to breastfeeding before offering a pacifier.

Of course, you may use a pacifier sparingly to comfort your baby earlier than that, like when she’s getting a vaccination, but you could also offer her your clean pinky finger to suckle on for comfort during these short periods.

Pay Attention to Your Nutrition and Well-Being

Maintaining a healthy lifestyle is just as important now that you’re breastfeeding as it was when you were pregnant, and at other times in your life.

Here are some tips to help you stay on track:

  • Eat healthy, well-balanced meals while breastfeeding. Include lots of fruits and vegetables. To make breast milk, your body may need about 450 to 500 extra calories a day (2,500 calories total) if you're at a normal weight.

  • Take a multivitamin/herbal supplements

  • Drink plenty of water. Aim for at least eight glasses a day to stay hydrated since breastfeeding uses a lot of fluid. Stay away from sugary drinks, even juices. Coconut water & fresh juicing are the best options.

  • Rest up as much as you can and try to sleep when your baby sleeps to take advantage of those opportunities for rest.

Breast milk only for the first six months

When babies are exclusively breastfed, they need no other food or drink until at least six months of age. You can be confident that your baby is receiving enough breast milk in the early weeks if they have six or more heavy, wet nappies and at least one bowel motion a day. It’s also a good sign if your baby settles after most feeds.

The Benefits of Breastfeeding

Breastfeeding offers many benefits for babies and mothers. Breast milk is packed with nutrients and antibodies that help boost your baby’s immune system, and breastfeeding can help you form a strong bond with your little one.

Because of these great benefits, it’s worth trying some of these breastfeeding tips and tricks, and speaking to a lactation consultant or your healthcare provider for personalized advice if you need help with breastfeeding.

Each woman's and each baby's experience is different, with some new moms finding that breastfeeding takes a little more effort than others. Whether breastfeeding comes fairly easily or presents a few challenges for you, know that you’re doing great and that things will fall into place over time.

Arm Yourself With the Right Nursing Supplies

Anything that can help make your life simpler and more comfortable while you breastfeed your baby is a welcome addition. Here are some things to consider buying:

  • A well-fitting nursing bra can give your breasts the right level of support and make it possible to feed your baby without completely undressing. You may wish to stock up on nursing bras before your baby is born. Think about buying a size bigger, because your breasts may be larger after you give birth.

  • Breast pads can come in handy as your breasts might leak a little milk from time to time. Avoid plastic liners that can irritate your nipples. If you don’t want to buy pads, you can fold up a piece of absorbent cloth or use a handkerchief.

  • You'll need a breast pump, bottles, and breast milk storage bags so you can pump milk and store it for later.

  • You may like the extra comfort of a nursing pillow.

  • A rocking chair or glider can help make breastfeeding more comfortable for you, and the rocking or gliding motion might help soothe your little one.

  • A footstool can help raise your legs and lap higher and get your baby even closer to your breasts. If you buy a nursery glider, it may come with a matching ottoman or a built-in footrest.

Breastfeed From Both Breasts Equally

If your baby has a preference for one breast, it’s a good idea to offer him the other breast at the next feeding to make sure that both your breasts get emptied equally.

Here’s a handy tip: If you tend to forget which breast your baby last nursed from, attach a safety pin to the bra strap of the other side after a feeding to remind you which side is next.

If your baby still wants to nurse from only one breast, you could pump from the other breast to relieve pressure and ensure that your breast milk supply doesn’t dwindle.


In the meantime, there are a few home remedies you can try:

  • Apply a warm compress of wet or dry heat to the lump, or take a warm shower

  • Offer your baby the breast with the blocked duct and let him nurse for a long period, as this can help drain the blocked duct. Don’t worry—it’s safe for your baby to nurse, as the infection can’t be passed onto him. In fact, continuing to breastfeed may actually help the infection clear sooner.

  • Massage the lump at the same time as you nurse your baby

  • Wear loose-fitting tops or don’t wear a bra for a few days

  • Pump any remaining milk after nursing your little one to help drain the blocked duct

  • Take every opportunity to rest and drink lots of water.


Follow Your Baby’s Cues When It Comes to Breastfeeding

Every baby is different, and yours may want to feed more or less often than other babies, so don’t worry if your baby doesn’t follow the schedule you had expected beforehand.

There is no feeding schedule that you must follow to the letter. Instead, pay attention to your baby’s hunger signals. Keep in mind that how often your baby wants to feed will also change over time, and may go up and down periodically as a result of things like growth spurts.

Signs your baby is hungry may include when she

  • is awake and alert

  • puts her hands to her lips

  • sucks on her fingers

  • flexes her arms with her hands in a fist

  • whimpers and moves her arms and hands

  • nuzzles your breast.

Crying can be a late sign of hunger, so try not to wait until your baby starts to cry to feed her.

In your baby’s first weeks, your newborn will likely want to feed as often as every 2 to 3 hours (8 to 12 times per day). She may spend 10 to 15 minutes nursing on each breast, or she may even breastfeed for longer stretches.

Extended nursing sessions, as well as feeding more often for a period of time, may be a sign of cluster feedings, which typically happen in the evenings during growth spurts, for example.

Consider Using a Breast Pump

You may need or want to pump if

  • circumstances make it difficult for you to feed your newborn; for example, if your baby is born prematurely and is in the NICU

  • your breasts are engorged after or between feeds

  • you have mastitis; pumping can help relieve the discomfort associated with this condition

  • your baby wants to nurse from only one breast and not the other

  • you would like to have some extra breast milk stored so that someone else, such as your partner or a babysitter, can bottle-feed your baby

  • you’re heading back to work and plan to pump during the day.

There are many different breast pumps available; another option is to choose hand expression. If you’re having trouble deciding, speak with your lactation consultant or healthcare provider for advice. Your lactation consultant can also help you learn how to master hand expression or how to use your new breast pump.

At first, your baby may be a little leery of feeding from a bottle, especially since it will be new to him, but eventually he will get used to it. In some cases, your baby may refuse to take a bottle from you, but he’ll happily take it from your partner or a babysitter. So it’s worth trying different approaches.

Position you and your baby nose to nipple, belly to belly

Make sure that your baby's stomach is touching yours, so they do not have to turn their head to latch. And point your nipple at their nose, not at their mouth, so they'll lift their head up, open their mouth wide, and latch on deeply.

Support your baby's neck

Don't push the back of your baby's head. That triggers their instinct to resist and chomp down. Instead, put your hands at the nape of your baby's neck, and bring them swiftly to your breast.