Breast milk is the best food for your baby

The 10 steps to support successful breastfeeding serve as the basis for the Baby-Friendly Hospital Initiative, they are:

1. Have a written infant feeding policy that is routinely communicated to all staff and parents.
2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.
3. Discuss the importance and management of breastfeeding with pregnant women and their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to recognise when their babies are ready to breastfeed, offering help if needed.
5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
6. Do not provide breastfed newborns any food or fluids other than breastmilk, unless medically indicated.
7. Enable mothers and their infants to remain together and to practice rooming-in 24 hour a day.
8. Support mothers to recognise and respond to their infants’ cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.

Source: BFHI Australia 2024. Additional material on the Baby-Friendly Hospital Initiative can be accessed on the UNICEF website or Australian College of Midwives (ACM).

For the baby, breastfeeding:

• Is a complete food for the first six months, satisfying thirst and hunger.
• Provides nutrition for optimal growth and development.
• Provides protection against a range of infections, such as chest, middle ear or gastrointestinal infections.
• Reduces risk and severity of allergies, for example asthma and eczema.
• Reduces the risk of diseases in adulthood such as Diabetes Types I and II.
• Reduces the risk of childhood cancers such as lymphoma.

For mothers, breastfeeding may:

• Be more convenient and enhance bonding.
• Assist the uterus to return to normal size after birth.
• Reduce the risk of pre-menopausal breast cancer.
• Delay ovulation if your baby is exclusively breastfed.

Research shows not breastfeeding increases the chances of the baby having:

• Medical problems such as diabetes, obesity, ear infections, gastrointestinal problems and allergies.

Research shows not breastfeeding increases the chance of the mother having:

• Breast and ovarian cancer, heart disease and osteoporosis.

Holding your baby skin-to-skin helps you to bond closely with your baby. This is linked to better breastfeeding success and longer breastfeeding duration. We will help you recognise the signs that your baby is ready to feed such as licking, sucking, putting his/her hand to her mouth, making soft noises. Immediate skin-to-skin contact helps populate your baby’s microbiome with the micro-organisms of the mothers’ skin, leading to better gastrointestinal health in baby. Baby’s temperature, heart rate, breathing rate, blood pressure and blood sugar levels are more stable, reducing stress levels in baby. After a caesarean birth, it is usual practice to have your baby with you in recovery whenever possible; please talk to your midwife about this.

During pregnancy, in response to changing hormones, a woman’s breasts begin to prepare for breastfeeding. Glandular tissue develops and the breasts increase in size. The first milk – which may appear clear to bright yellow in colour – is called colostrum. This may start to leak from the nipples as early as 20 weeks into your pregnancy.

Following birth, colostrum provides all the fluid and nutrition a healthy term baby requires. It also aids in the prevention of infection and disease in newborn babies.

Over the next few days colostrum gradually changes to mature milk and the volume increases. This is when we often say the milk is ‘coming in.’ During this time, there is often more milk produced than required and the breasts become full and may be uncomfortable. This is common and will settle.

Good feeding practices will help the milk supply adjust to meet your baby’s needs. By about two weeks the milk has become whiter and thinner in appearance and continues to increase in volume to meet the needs of your growing baby. Continued milk production depends on frequent stimulation and drainage of your breasts, either by breastfeeding or expressing.

During breastfeeding or expressing, a hormone called ‘oxytocin’ is released that pushes the milk through the ducts to the nipple openings. This action is called the ‘let-down’ reflex. It takes approximately 60 seconds and is felt by some women as a tingling sensation or fullness in the breasts; some women do not feel any sensation but may notice milk leaking from the other breast or that the baby has changed to a regular suck and swallow action.

Breastfeeding is a learned skill that takes time, patience and practice. In the first few days, your breasts are producing colostrum which is all the nutrition a healthy baby needs. Your breasts will feel soft at this stage before the mature milk ‘comes in.’ This time allows you and your baby an opportunity to learn and practice good positioning and attachment. This will help avoid nipple pain and ensure your baby receives enough milk.

When breastfeeding:

• Make sure you are sitting comfortably and you are well supported.
• Hold your baby close to you, facing your chest.
• Position your baby on their side with their nose opposite your nipple.
• Remove your bra and support your breast from underneath.
• Position your fingers well back from the areola/nipple so your baby is able to take a big mouthful of breast tissue.
• Touch your baby’s lips with your nipple to encourage your baby to open their mouth wide.
• Make sure your baby’s mouth is very wide (like yawning); bring your baby quickly to the breast, chin first.
• Attach so your baby’s bottom lip is well down over the areola, ‘off centre’.
• Continue to support your breast until your baby is sucking and swallowing in a deep rhythmic pattern.
• If you experience pain once your baby has commenced swallowing, take your baby off and re-attach.
• Remember to insert a clean finger between the baby’s gums to break the seal when taking your baby off the breast.

Optimal attachment

Source: UNICEF UK 2020

Poor attachment 

Source: UNICEF UK 2020

Around the third or fourth day after you give birth, your breasts start to produce lots of milk. For some women this can take up to six or seven days. This is known as the milk ‘coming in.’

During this time, your breasts may produce much more milk than your baby needs and they may feel full and uncomfortable. This will only last for a few days. Most women feel their breasts softening from around 10 days to two weeks.

When your milk first comes in:

• Your nipple and the dark area around it (the areola) may become full and firm and it may be difficult for your baby to attach properly to your breasts.
• Your baby may not take all your milk from your breasts during feeds. After feeds, your breasts may still feel quite full and uncomfortable.
• Some babies can be unsettled during this time and want to feed very frequently.
• Your baby might have lots of loose, greenish bowel motions.

All of this is normal. If your breasts feel uncomfortable the following are a few things which can help to relieve your discomfort:

• Feed your baby while your breasts are full.
• Good positioning and attachment are important; ask your midwife for help with this if you need it.
• Hand express some milk before you attach your baby to your breasts. This will soften the areola and make it easier for your baby to attach. Ask your midwife to teach you how to hand express.
• If your baby only feeds from one breast at a feed and the other breast is uncomfortably full, express a small amount of milk for comfort.
• Change sides each time you begin a new feed.

Between feeds:

• If your breasts are very uncomfortable between feeds, you may need to express a small amount of milk to relieve the fullness.
• You can also stimulate some milk to flow by:
  • Placing a warm pack on the breast for a few minutes.
  • Having a warm shower or bath.
• Let some milk drip from one side into a towel or container while feeding from the other breast.
• Wear a supportive bra but make sure it doesn’t dig in. Some women feel more comfortable without a bra at this time.
• Cold packs after feeds for a few minutes may help to relieve swelling and discomfort. A covered cold pack can be used for this.
• Paracetamol may be taken for pain relief if required. Follow instructions on the packet.

Things to remember if your breasts are full or uncomfortable:

First feed:

• Feed from one breast.
• Top-up from the same breast if needed.
• Let the other breast drip during the feed or express a small amount for comfort.

Next feed:

• Feed from the other breast.
• Top-up from the same breast.
• Let the other breast drip during the feed or express a small amount for comfort.
• Go back to offering both breasts at each feed when the fullness settles down.

Once your milk supply has settled down:

• Offer both breasts at each feed again, but continue to let the baby finish the first side before offering the second. Time taken to ‘finish’ the first side is very variable but is usually around 15–20 minutes.

Healthy breastfed babies need no other food or drink until around six months of age.

Your baby needs a minimum of eight to 10 feeds in 24 hours, especially in the early weeks after birth.

You can be confident that your baby is receiving enough breast milk when:

• Your baby is settled after most feeds.
• Your baby is alert, active and content when awake.
• Your baby has at least six soaked cloth nappies in 24 hours after your milk ‘comes in’. If using disposable nappies, there should be 6–8 per day and they should be heavy and spongy.
• Your baby has at least one yellow, loose bowel action every day after initial meconium (first bowel action) is passed.

Your baby should be back to birth weight by two weeks of age. Normal weight gain is between 20 and 30 grams per day, or between 150 and 210 grams per week.

You may develop problems breastfeeding if you:

• Restrict suckling time at the breast.
• Give infant formula to your baby without medical advice.
• Use dummies in the early weeks.

Good feeding practices

The following points are a guide to initiating and establishing breastfeeding:

When your baby is newly born:

• He/she will instinctively seek around the breast for a feed.
• Feed your baby soon after birth, preferably within the first hour.
• Place undressed baby directly onto your chest (skin-to-skin).
• Ensure your baby is well attached to the breast.
• Before the milk ‘comes in’ many babies may feed up to 12 times in 24 hours.
• Ideally, you and your baby should remain together so baby can breastfeed according to need throughout the day and night.
• If your baby is having difficulty attaching to the breast, hand express and give colostrum to your baby by finger feeding.
• Avoid using strong deodorants, perfumes, soap or body wash on your breasts in the early days. These can create a confusing scent trail for your baby.
• Breastfeeding is a learned skill and assistance is often required. Be patient with yourself and don’t be afraid to ask for help.
• Avoid the use of dummies, teats and infant formula unless you are advised to do so by a medical professional.

At the Lyell McEwin, we will be supporting you to keep your baby in your room with you all the time. Keeping baby with you helps you to recognise the signs that your baby is ready for a feed or if your baby is tired or needs a cuddle. Rooming–in also enhances mothers’ confidence, milk supply, mother-baby bonding, and reduces the risk of cross infection.

Babies in the early days after birth can be very sleepy and need encouragement to feed. On the other hand, they can seem to feed very frequently. Feed your baby whenever they are ‘asking’ for a feed. Also, feed your baby when you feel like it, not just for food, but when you feel it might help, for comfort and love. If you are unsure, always follow your instincts and don’t ever be afraid to ask for help.

Your baby will usually feed a minimum of eight times and up to 12 times in 24 hours while breastfeeding is being established – this is normal and will settle with time. Night time feeds are common and a normal part of breastfeeding. Remember every mother-baby pair is unique; other mothers may have a completely different experience to you. It is important to get to know your baby and recognise feeding cues.

Your young baby is learning to breastfeed and can become confused if offered a teat or dummy before they have learnt to breastfeed well.

Offering fluids other than breast milk will decrease the time your baby breastfeeds, which can reduce your breast milk supply and your confidence. Frequent, unrestricted suckling at the breast will satisfy your baby.

Early cues — "I'm Hungry"

Cues can include (1) Stirring, (2) Mouth Opening, (3) Turning Head, Seeking Rooting.

Mid cues — "I'm really hungry"

Cues can include (4) Stretching, (5) Increasing physical movement, (6) Hand to mouth.

Late cues — "Calm me, then feed me"

Cues can include (7) Crying, (8) Agitated body movements, (9) Colour turning red.

Time to calm your crying baby

If you baby is showing late feeding cues, you can calm baby by:

• Cuddling
• Skin to skin on chest
• Talking
• Stroking

Source: Baby Feeding Cues (signs) — https://www.qld.gov.au/health/children/pregnancy/antenatal-information/breastfeeding-101/signs-of-hunger

Expressing breast milk is when you use your hands or a breast pump to get the milk from your breasts. Whether you use your hands or a pump is dependent on how long you have been breastfeeding, the reason you are expressing and how often you are going to express. Some women have no need to express; however, it is helpful to know how to as there may be a need in the future.

The first milk you produce after your baby is born is called colostrum. If you need to express milk at this stage, it is best done by hand or an electric pump on a low setting.

During the first week, as your breasts feel fuller, you may choose whether you wish to continue expressing by hand or to use a pump. The number of times you will need to express per day will depend on your circumstances. For example, if your newborn baby is not feeding from the breast at all, then you need to express frequently to establish and maintain your supply (eight to ten times a day). Once your supply is established, you may be able to reduce the number of times you express. Your midwife or a lactation consultant can advise you on what you need to do.

Important points to remember

• Expressing should be done gently to avoid pain and discomfort.
• The use of gentle breast massage and nipple stimulation will help to encourage the milk flow let-down reflex.
• Using relaxation techniques or thinking about your baby while expressing may also be helpful.
• Expressing frequently throughout a 24-hour period (including overnight) is more effective in stimulating your milk supply than expressing for a long period of time at one sitting.

Reasons for expressing

There are a number of reasons why you may need to express breast milk, such as:

• Your baby is not sucking effectively.
• You are separated from your baby, for example your baby is premature or sick, or you are unwell.
• To soften full breasts to make it easier for your baby to attach.
• To allow healing after nipple damage (this may not be necessary if attachment is improved).
• If your milk supply is low.
• To clear blocked areas and prevent mastitis.
• To maintain milk flow during mastitis.
• You are returning to work or you are going out and will miss a feed.
• You have chosen not to breastfeed but want to give your baby expressed milk.

It is important to learn how to express by hand before you go home from hospital. The midwives will help you with this.

Some general points to remember

• Hand expressing should be used for the first few days (before the milk comes in), but after this a pump can be used at any time.
• If your baby is not able to breastfeed, expressing should begin as soon as possible after the birth, ideally within the first two hours.
• In the first few days after birth the amount of colostrum expressed may vary from a few drops to a few mls. As colostrum changes to more mature milk, the volume will gradually increase.
• Expressing frequently (eight to ten times in 24 hours, including overnight) will help establish and maintain your milk supply.
• If your breasts become very full, hand express a little milk just before the feed to help your baby to latch on well.
• If your nipples are damaged and sore, then hand expression is the gentlest way of expressing breast milk. Electric pumps can also be used if they can be set on a low suction level.

A general guide for hand expressing

1. Always wash your hands before you start to express. With your hand under your breast, place your thumb and index finger on either side of your areola, well back from the nipple.
2. Gently press your thumb and forefinger back into your breast and, as you do this, press them towards each other behind the nipple. Press for about two seconds, then release.
3. Continue to compress and release and your milk will begin to appear. When the flow stops, move your fingers to another position around the edge of the areola and start again.
4. When the flow slows to drops of milk, change to the other breast, massage both breasts again and repeat steps 1 to 4.

It is important not to cause pain or friction while expressing.

How long does expressing take?

Breast milk expression will probably take between 20 and 30 minutes in total. The important thing is to express one breast until the flow slows to drips and then to switch to the other breast. Once that breast slows, if you are expressing because your supply is low, switch back to the first breast again. By switching back and forth, expressing each side two or three times, you will increase your supply over time.

Using ‘breast compression’ will help to drain your breasts and therefore speed up the process as well as increasing the amount you obtain. Breast compression means squeezing your breast gently (i.e. where the breasts meet the ribs with your fingers on one side and thumb on the other).

How much milk should you get?

The amount of milk you obtain depends on individual circumstances and the stage of breastfeeding. In the first few days after birth between a few drops and a few mls of colostrum may be expressed each time. As colostrum changes to more mature milk, the amount increases.

At day four or five this may be around 50–70mls at each feed or expression, increasing to 80–120mls by the end of the first week (these amounts are very variable from mother to mother). By about 6 weeks, you may produce around 600–800mls (sometimes more) over a 24-hour period.

If you feel your milk supply is not enough for your baby please seek expert assistance.

Reference: https://www.cafhs.sa.gov.au/topics/feeding

The following table outlines what to do with stored breast milk.

Reference: National Health & Medical Research Council (NHMRC), 2012, Infant Feeding Guidelines, Canberra, p59.

Recommended viewing

We recommend watching a collection of breastfeeding videos online produced by the Raising Children Network. They provide guidelines and breastfeeding solutions. 

Recommended reading

Breastfeeding with confidence

Sue Cox is an Australian IBCLC (International Board Certified Lactation Consultant) and midwife. She is widely respected as one of Australia’s leading educators and practitioners in the field, having been a breastfeeding specialist and lactation consultant for over 25 years.

Sue’s work was recognised in the 2004 Australia Day Honour’s List for service to community health.

Breastfeeding made simple: seven natural laws for nursing mothers

Breastfeeding Made Simple teaches mothers and mothers-to-be seven natural laws for successful breastfeeding.

The ultimate breastfeeding book of answers: the most comprehensive problem-solving guide to breastfeeding

In this comprehensive guide, Dr Jack Newman, a leading authority on infant care, and Teresa Pitman, a La Leche League leader for more than twenty years, give you the facts about breastfeeding and provide solutions for the common problems that arise:

• The Womanly Art of Breastfeeding: From preparing for breastfeeding during pregnancy to feeding cues, from nursing positions to expressing and storing breast milk, this book has it all.
• Breastfeeding: How to Breastfeed Your Baby: This book is the culmination of 40-plus years of hands-on experience from three dedicated and internationally respected authors.
• Ina May’s Guide to Breastfeeding: From leading midwife and the author of Ina May’s Guide to Childbirth comes this deeply compassionate and comprehensive guide to making breastfeeding a joyful experience for both mother and child.
• The Nursing Mother’s Companion: Easy-reference survival guides help identify and resolve problems at each stage.
• Breastfeeding: A Practical Guide: From the Australian Breastfeeding Association, which is free with an annual subscription.

• Australian Breastfeeding Association (ABA) – ABA is an organisation for people interested in the promotion and protection of breastfeeding. The ABA site includes a discussion board, helpline information, media releases and a wide range of breastfeeding information. 
  https://www.breastfeeding.asn.au/
• Australian College of Midwives (ACM) – Baby Friendly Health Initiative (BFHI) Standards for Maternity Facilities. 
  https://www.midwives.org.au/news/announcing-new-baby-friendly-health-initiative-bfhi-standards-maternity-facilities
• Australian Dietary Guidelines – The NHMRC Dietary Guidelines provide information about healthy food choices based on scientific evidence for infants, children, teenagers and adults. 
  https://www.nhmrc.gov.au/about-us/publications/australian-dietary-guidelines
• The Australian Breastfeeding Strategy – 2019 and Beyond – Launched by the Australian Government to support, encourage and promote breastfeeding. 
  https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/national-strategy-to-increase-breastfeeding