Breastfeeding. It’s more complicated than you think.
Where should we start?
With the definition. Breastfeeding is the act of feeding a baby milk from a mom’s breast. You can also give your baby milk pumped into a bottle. And give them a combo of formula and breastmilk. Other words for breastfeeding: nursing and lactation.
How long do babies drink milk exclusively?
It varies. Newborns typically need breastmilk and/or formula until they’re at least six months old — that’s when they can usually start eating solid food. But you can technically breastfeed a child until age one or older, as long as it’s working for both of you.
How common is breastfeeding?
About 84% of US children born in 2017 were breastfed in some capacity. More stats: 47% were exclusively breastfed for the first three months and nearly 26% were exclusively breastfed in the first six months, according to the most recent CDC data available. Thing to know: Compared to white moms, Black moms are 2.5 times less likely to breastfeed their babies.
Why is that?
Because of systemic racism and cultural factors. For example, studies show that Black women might get less lactation support compared to other new moms, and are more likely to have to return to a job with inflexible hours shortly after birth. That could make breastfeeding inaccessible (not that it was easy to begin with). But organizations like BMBFA are working to break down these barriers by creating supportive communities, providing training, and raising awareness around the benefits of nursing with summits, conferences, and events like Black Breastfeeding Week (the last week in August).
What’s with all the hype around breastmilk?
For one, the consistency changes over time, and even during feedings, to help with a baby’s development. Plus, it contains nutrients that protect babies against infection and illness. Studies show vaccinated moms can provide protective COVID-19 antibodies from their breastmilk to their babies. And according to the CDC, breastfed infants can have a lower risk of asthma, obesity, Type 1 diabetes, certain respiratory diseases, ear infections, and SIDS. There are benefits for breastfeeding moms too: they can have a lower risk of ovarian cancer, breast cancer, Type 2 diabetes, and high blood pressure. But breastfeeding might not be a fit for everyone — like moms with certain viruses including HIV, those on specific medications, or ones dealing with a condition like PCOS.
And what if breastfeeding just isn’t for me?
That's OK. Every breastfeeder has their own challenges, and every child is different. Some moms simply opt not to do it. Enter: formula. Formula is a drink made for infants that’s either ready to use, or comes from water mixed with concentrated liquid or powder. Formula’s been a thing since 1865, when chemist Justus von Liebig patented the OG formula in a liquid and powder. Then in 1980, the Infant Formula Act was passed to ensure that commercial formulas were regulated and subjected to quality control by the FDA, meaning a certain number of nutrients are required for them to be deemed safe for infants. Formula's typically made from cow’s milk protein, but can also come from soy, protein hydrolysate, or other specialized ingredients.
OK, now give me the breastfeeding basics.
What happens to your boobs…They might feel heavy. By the second trimester, hormones (prolactin, estrogen and progesterone) expand your milk ducts. And your breasts can get more than a cup size bigger. You might also notice more prominent veins (as you form more red blood cells and platelets in your blood), bumps around your nipples (those are oil-producing glands meant to lubricate your breasts and help with feeding), or nipple discharge (because your milk’s coming in and that’s totally normal). Other common changes: stretch marks and darker nipples. Once you’ve stopped breastfeeding, your breasts might go back to the way they were, stay larger, or even shrink. Because you don’t have enough unknowns already.
When milk kicks in…Early. It starts as a protein-packed substance called colostrum ahead of your delivery date (timing’s different for everyone). Once the baby arrives, moms can often breastfeed right away. And if you’re not the gestational mother, it’s also possible (but challenging) to induce lactation. Remember: Your milk supply depends on demand, so the more milk you express, the more milk you’ll produce. Note: If you ever get lumps on your breasts that don’t go away with a gentle massage or compress, you could have a blocked milk duct or infection that could lead to mastitis — which about 10% of breastfeeding moms get. If your breasts become red or swollen, you have a fever, or it burns to feed, contact your doctor.
How it feels...Different. Having someone suck on your breast every few hours is probably a new thing, and your nipples will be sensitive when you first start (pro tip: putting some of your own milk on your nipples might help relieve minor soreness or try coconut oil). Know that breastfeeding should not lead to ‘the three Bs’: bleeding, breakdown, and blisters. If nursing is continually painful, seek help (more on that below).
How you might feel…Bonded. That’s because of the 'love hormone' oxytocin that fires when you’re skin to skin with your baby. But if you’re not feeling that way, you’re not alone: About one in eight women experience symptoms of postpartum depression, which might have something to do with your oxytocin levels. (See one Skimm’r’s story about recovering from PPD here.) Worth noting that oxytocin is the same hormone that can help your uterus contract and return to its pre-pregnancy size (heads up: it can feel a lot like menstrual cramps). Also, oxytocin might cause your nipples to leak when you’re not breastfeeding...specifically, when a baby (doesn’t have to be your own) cries...or, while you’re turned on. So that's new. But you might not feel like getting it on in the first place, thanks to the hormone prolactin (which revs up breastmilk production and can decrease libido).
How often to do it…Your call. As with anything, a lot of this depends on you and your baby. Experts typically recommend breastfeeding every two to three hours, for about 10-15 minutes per breast to start (which could mean waking up a sleeping baby). After the first few weeks, you’ll learn your baby’s 'feed me already' hints (sucking on fingers, smacking lips) and figure out times that work best for both of you. If you get to a place where your newborn has gained weight back after losing some after birth (which is normal), you can stop feeding when your baby pulls away or falls asleep. In most cases, you probably don’t need to stick to a strict feeding schedule. Two more tips: Make sure your baby has regular dirty diapers, and try not to compare your feeding amount and routine to someone else’s (because every pair does it differently).
I’m worried that my breasts can’t handle this.
If you’ve had surgery...You may still be able to breastfeed. Women with breast implants typically can nurse. However, if you have incisions around or across the areola (the ring around your nipple), you might have challenges. Try talking to a lactation consultant about your specific situation.
If you have inverted nipples…You still have a good shot at being able to breastfeed. After all, it’s not called 'nipplefeeding' — babies need to latch onto the areola and not just a nipple. Try gently tugging your nipples with your fingers or using a pump before feeding. Another thing to check out: a nipple shield.
If latching is a problem...Know it can take some practice for everyone involved. Latching on is how your baby attaches its mouth to the breast in order to suck. Signs of a ‘good’ latch: you see or hear your baby swallow (though there are a bunch of quiet milk drinkers out there), your baby’s mouth covers all or much of the nipple and areola, and your baby has their lips out, like a classic selfie ‘duckface.’ Some tips for establishing a comfortable latch position: hold your baby directly on your bare skin, try to stay relaxed, and use gravity to your advantage by leaning back. But there are some infants who can’t easily latch for a number of reasons. They might have tongue-tie, or could have low muscle tone (sometimes the case for babies with Down syndrome and other special needs) that prevents them from sucking properly. They could even just need a little time to get used to it. If you’re not making progress, get professional help.
If you have preemies and/or multiple babies...you can still make enough milk, in many cases (and if not, you can look into donor milk here). And if your baby has a low birth weight, they still might be able to take milk straight from your breast right away. More options: pumping or a feeding tube could work, especially if your baby is unable to suck or swallow or is in the NICU.
Pumping — tell me more.
Whether you have to return to work, want to share the feeding responsibility with a partner, or any other number of reasons, pumping could be for you. It’s a method of expressing breastmilk – through a sucking device or by hand – for bottle feeding. You can think of pumping sessions as having similar timing to breastfeeding ones: about 15 minutes a pop, every couple of hours, both breasts. A number of parents do a combo of pumping and feeding from the breast, and there are some moms who exclusively pump and bottle feed. See here for guidelines on safely storing pumped breastmilk (hint: it needs to be refrigerated). And know your rights: Employers are required to give you “reasonable break time” to express breastmilk for up to one year after birth. And they must provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public.” To be clear, breastfeeding in public is legal in all 50 states.
Can I get help?
As that commercial for Frida Mom showed, lactation and feeding can be unglamorous and exhausting. And it’s just one of the many major changes that moms must navigate as part of their so-called fourth trimester. But help is out there. La Leche League International is a reliable database for breastfeeding questions and support groups. Lactation consultants with IBCLC certification (like Brianne Taggart, who we talked to for this guide) can work with you in person (your hospital may have an IBCLC on staff) or virtually. And Ovia Health has a suite of apps for whatever parenting stage you're in. Good news if you’re insured: The cost of breast pumps and lactation consultants are mostly covered under the Affordable Care Act.
And what if I’m a breastfeeding Olympian heading to Tokyo?
OK, so this is a narrow question. But FYI: Breastfeeding athletes Kimberley Gaucher, a Canadian basketball player, and Aliphine Tuliamuk, a U.S. marathoner, pleaded publicly for an exception to the COVID-19 ‘no foreign spectator’ rule at Olympics. Less than a month from the start of the Games, the International Olympic Committee finally decided that, yes, they could bring their infants to Japan. However, there are at least two nursing athletes who’ve said the requirements are too restrictive, and decided to leave their babies at home.
When it comes to breastfeeding, every mom and baby have their own style. Talk to your doctor about the best way to feed your newborn. And here’s a reminder to prioritize your own physical and mental health, because your body – not just your routine – will experience plenty of changes along the way, too.
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