Prenatal Breastfeeding Education 101

Studies show that women who receive comprehensive prenatal education breastfeed longer and more successfully. But for new moms, knowing how to prepare for breastfeeding—and what questions to ask—can be hard to figure out. We sat down with lactation consultant and educator Kate Zachary to discuss tips based on evidence-based information and her own practical guidance gleaned from years of witnessing hundreds of births in hospital, home, and birth center settings.

By Kate Zachary, IBCLC

Feeding your baby is a personal and special experience. For many of us, food is our love language and comes with all sorts of ties and messages we aren’t even conscious of. Having supported hundreds of families in many different birth and postpartum settings, I have made it my work to hold families tenderly as they navigate the tricky waters of parenting and finding a feeding plan that works best for them. Most people I work with want to give breast milk in some form to their baby, but the “how” is often way harder than they imagined. So why would anyone want to do this if it’s so challenging?

Benefits of breastfeeding to mother, baby, and society

There are lots of breastfeeding benefits to both parent and baby, and you may be familiar with many of them from posters in your care provider’s office or unsolicited comments from your neighbor’s sister who breastfed. But in case you haven’t already been bombarded, here is a small sample. 

For the breastfeeding parent, these benefits include: 

• Decreased risk of breast and ovarian cancer
• Decreased postpartum bleeding 
• Decreased risk for hypertension, heart disease, type 2 diabetes

Benefits for baby include: 

• Decreased incidence of respiratory tract infections, diarrhea, and a rage of infectious diseases
• Decreased rates of SIDS
• Decreased rate of Type 1 and Type 2 diabetes
• Decreased rate of asthma

But did you also know there are benefits to society? That’s not usually on a poster, so let me tell you a few: 

• Decreased costs for public health programs such as WIC
• Decrease in waste from formula containers
• Decrease in annual health care costs
• Decrease in lost wages due to parent staying home due to child sickness

Downsides of breastfeeding

All that said, we can’t talk about the benefits without talking about some of the downsides, otherwise I’d be misleading you into thinking this was going to be butterflies and roses. And that’s just not true. For anyone. Don’t let anyone make you think that it’s an easy task to feed a human with your body, because that isn’t the case—even for this highly trained International Board Certified Lactation Consultant! You may be more familiar with the downsides that come with this territory: feelings of overwhelm, isolation, and of course, pain!  

Is breastfeeding painful? Yes, for most of us in the beginning it is painful. Is that normal? After supporting hundreds of parents in all birth settings and breastfeeding my own daughter for three years, I think it is normal. 

However, it is not normal for there to be injury to the nipple or such excruciating pain that you don’t want to do it anymore. Is that a common experience for many breastfeeding parents? Yes, it is common due to a variety of reasons that are resolvable with good support and time. Pain with initial latch on: normal. Pain that lasts for the entire feeding: not normal. Pain is also a really personal experience. What I think is painful now after breastfeeding a baby with a severe lip and posterior tongue tie is not the same as what I thought was painful before! It’s all relative. 

The breastfeeding truth for new mothers 

So what should you expect when breastfeeding a newborn? It is very demanding, you will feel exhausted, your nipples will feel sore, you will wonder 100 times an hour if you are doing it “right” and if the baby is getting enough. You will get lots of advice from well-meaning friends and family who are all coming from their own personal journey—not yours—and who want the best for you, but will not fully understand your experience. You will have moments of pure joy and elation over things you can’t even imagine caring about (ie: burps and poops)! You will be so very, very tired and so very, very confused.  

What to expect during the first week of breastfeeding

So, let me be very clear about how to know if baby is getting enough and if feeding is on track in the first week:

• The first 24 hours: In the first 24 hours, baby is likely to be very sleepy. Birth is crazy, no matter how it goes, and the baby will be overwhelmed and exhausted just like you! Baby may also be busy spitting up clear, thick fluid, which is very common for babies who are born very quickly or through cesarean birth. All of this may lead to a baby who doesn’t want to do a lot of eating, but you still have to encourage baby to try. Keep your baby skin to skin on your chest as much as you can in that time!
• Frequency of feeds: Baby should breastfeed on demand (aka: anytime they smack their lips, try to eat their hands, or root around on your chest like they are looking for something!), and at least every three hours. Aim to have baby feed for 15-20 minutes on each breast, but don’t worry if they don’t do that every time! Your baby is building up the muscles in their jaw that they need to be a strong feeder, and that is tiring at first. 
• Bowel movements: Baby should have at least one poop and one pee in the first 24 hours of life, two poops and two pees on day two, three poops and three pees on day three, and around day four or five, their poop should change from dark, sticky poop (called meconium) to a watery, seedy Dijon mustard color. You should be keeping track of all the stuff that comes out of your baby and all the times they feed! Get an app or a nice sharp pencil and sheet of paper.
• Colostrum: Days one, two, and three, you are producing a kind of milk we call colostrum. It is thick and sticky because it’s mainly made up of a sugar that helps the baby poop and pee.  You’ll hear people call it “liquid gold” because of its health benefits and also because it is sometimes a golden color. But it may start out looking clear or white or, for some women, it is green or red! It’s still “liquid gold” even if it doesn’t come out looking golden! It doesn’t have any fat in it, so your baby will lose weight in the first four to five days until your milk increases and baby can take in higher volume.  
• Engorgement: Day four to five is when you should feel your breasts getting full. This can hurt and feel sudden! For a few days you may experience engorgement. Your milk may rush in so fast and furious that your breasts become hard—as hard as your forehead (crazy, I know!)—and make it difficult for the milk to flow. Gentle breast massage while your baby is latched on can help. This video on hand expression is a great one to bookmark. By day seven, the engorgement should settle down, and you and your baby start finding a rhythm.  
• Feeding schedule: Once your baby has Dijon mustard poops and you have felt your milk increase, you can switch from waking baby every three hours to just feeding on baby’s demand. They will still demand it every two to three hours, and sometimes more frequently, but you can follow their lead more than pushing them. You can also tune into the feeling of your breasts more and feed on one side until baby seems done (comes off seeming satisfied).  

So, basically, what I am trying to tell you is that the first week is bonkers! There is so much you are learning and doing on top of all the healing and processing. I wish mother nature had built in three days where the baby doesn’t need anything, and we can all just sleep. But she hasn’t taken my feedback yet. So here we are with a lot to learn and do...but remember, you aren’t alone in this time!

Resources to help new moms with breastfeeding problems

Obviously, I wish everyone could have access to a skilled IBCLC (International Board Certified Lactation Consultant), but that may not be easy depending on where you live or your budget. On that note, you should check with your insurance provider to see if they have consultants that are covered. If they do not, they may still cover an IBCLC—you just have to find them and ask them to provide a superbill for you to submit and get reimbursed for their fee, which you will pay at time of service. You may also be able to get remote support via telehealth if you can’t find anyone in your area.

Breastfeeding support groups are also available, but not the best setting if you are having major issues like cracked nipples, low milk supply, concerns for tongue or lip tie, or poor weight gain for baby. Those are bigger issues that should be worked out with a practitioner one-on-one because they are very personal, and a group setting won’t be able to tune into your very specific history or needs.  

There is a lot of information on the interwebs, and it’s easy to get very confused. The world of lactation support is very wide and the credentials varied. Make sure you know the background of the person you are getting support from to ensure it’s the support you need. You want to know where to get the best nursing top? Another nursing person at a support group or the park will have a great answer for you! If you want to work on some new breastfeeding positions because now your kid is giant and doesn’t fit on your breastfeeding pillow, call a Certified Lactation Counselor (CLC). If you are concerned that your baby is not gaining enough weight and you want to evaluate your milk supply, call an IBCLC.  

Here are some of my favorite online resources:

• Kelly Mom website for parenting and breastfeeding
• The Instagram page for Legendairy Milk
• Dr. Jack Newman’s website
• Nancy Mohrbacher’s website, especially the videos on the laid back breastfeeding position.

Conclusion

I’m a little worried that I may have scared you out of wanting to breastfeed! I hope I haven’t because despite what it may sound like, I really love and believe in this experience. Getting to breastfeeding my daughter for so long despite our many, many challenges in the beginning has been a dream come true. We have walked through some serious fire together, and it has made us stronger. 

I firmly believe that there is no wrong way to feed your baby. But there is a wrong way to go into this process, and that is to be told by an educator that it’s a simple process and to think you have to do it one specific way. 

After supporting hundreds of families, it breaks my heart to hear them say, “no one told me it was going to be this hard—I had no idea.” So I walk the line as an educator to tell the truth, but not scare anyone away. It’s a tight one, so I want you to know that you are not alone no matter what kind of experience you have. We were never meant to do this in isolation, and I hope you will reach out for support when you need it, even if it’s just to sit in a circle with other parents and say, “Does your baby’s poop smell like buttered popcorn like my baby’s poop does?”

Learn more about how to prepare for breastfeeding while pregnant here.

Kate Zachary is a Lactation Consultant and Educator, Doula (both birth and postpartum), and a Midwife's Assistant. You can follow Kate on Instagram @katydiddidit or learn more about Kate here.