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The Breastfeeding Process

Breastfeeding is a natural way to feed a baby. Babies are born with reflexes that help them find the breast and begin nursing. But for mother and baby both, breastfeeding is a learned art. Without assistance, learning how to position and latch the baby can seem difficult (see Websites section). The first few weeks can be challenging but, with support, mothers can enjoy the special intimacy and vital health benefits provided by breastfeeding.

Breastfeed Thoroughly

Putting your baby to breast frequently is very important. However, the baby must actually be transferring milk. Occasionally a mother will complain that her infant is not gaining well in spite of nearly constant nursing. These babies are often just sleeping with the nipple in their mouths. When a baby is breastfeeding well, mothers will observe signs of effective feeding:

  • The baby’s eyes are open and the baby seems actively engaged in feeding 
  • The baby’s jaw moves in wide, slow, rhythmic sweeps
  • Mother can hear sounds of swallowing
  • The breast feels full before and softer after feeding
  • As the breasts soften, baby becomes drowsy and appears content
  • The baby makes many soaking wet diapers each day
  • During the first 2 months of life or so, the baby makes 3-4 yellow bowel movements each day

If the baby is not latched to the breast, or if there is a problem transferring milk, these signs of ineffective feeding may occur:

  • The baby’s eyes close almost immediately
  • Jaw movements are shallow, choppy, and are not rhythmic
  • Swallowing sounds occur only during the “let-down,” or milk ejection reflex (MER)
  • The breasts remain uncomfortably full (over time losing any sense of fullness as supply decreases; chronic poor breast emptying leads to low supply problems)
  • The mother may complain that her nipples are sore or feeding is painful
  • The baby gains weight slowly and always seems fussy or discontent
  • The baby makes few wet diapers, and the urine is concentrated and has a strong odor
  • The baby passes few bowel movements, and many are smaller than a quarter or are very watery

The milk must be emptied from the breasts on a regular basis or the mother’s brain gets a chemical message to slow down production. If a mother observes signs of ineffective feeding, she should report them to her doctor, nurse, midwife or health clinic, and to a lactation consultant. The baby should be weighed and breastfeeding help provided. If help is sought early, it generally is not difficult to identify and fix the problem, allowing breastfeeding to progress much more happily for everyone.

Some problems have been identified in research studies as red flags for early feeding problems. If these occur, parents should arrange for an early follow-up weight check and extra breastfeeding help:

  • The baby loses more than 10% of birth weight at hospital discharge
  • The baby has not regained birth weight by Day 10-14
  • The baby’s urine is dark or contains red crystals after Day 4
  • The newborn baby (under 4 weeks of age) has not passed any bowel movements in 24 hours
  • The baby has trouble latching and swallowing milk at breast

Family and neighbors used to teach new mothers how to feed and care for their infants. Today, in our more mobile society, breastfeeding assistance is more likely to come from individuals or organizations dedicated to helping parents get off to a good start. La Leche League International, founded in the 1950s by a group of mothers, is now a worldwide organization that provides mother-to-mother support for breastfeeding. Trained volunteers called Leaders, conduct monthly gatherings where mothers come with their babies to talk about their challenges and successes. The Nursing Mothers Council is another such organization. Many countries around the world also have lay breastfeeding support organizations. These groups typically provide printed materials on various breastfeeding related topics and free phone counseling services.

The new profession of lactation consulting arose out of the recognition that some mothers need specialized breastfeeding assistance. The gold standard for individuals practicing in the field is to complete the process to become an International Board Certified Lactation Consultant. Lactation Consultants work in hospitals assisting mothers and babies in special care nurseries and postpartum wards. Some Lactation Consultants work in outpatient clinics where moms can return with their babies for help, or answer questions on phone hotlines sponsored by departments of health or WIC agencies. Other Lactation Consultants work privately in the community, making home visits to clients. Medela provides help locating a lactation consultant though the Breastfeeding National Network (see Websites section).

The key message to remember is that help is available. Please reach out to someone if breastfeeding is painful or difficult or if you are concerned that your baby is not feeding well.


Content provided with permission from Medela, Inc.



For more information or to discuss lactation support concerns please contact Partners Employee Assistance Program at 1-866-724-4EAP.

In case of emergency, please call 911 or your local hospital emergency service.

This content was last modified on: 08/21/2008

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In case of emergency, please call 911 or your local hospital emergency service.

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