Breastfeeding: The Complete Guide to Getting Started, Common Problems and Keeping Going

Breastfeeding is natural, but it is also a skill that mother and baby learn together, and it does not always come easily. With good information and support, most problems can be solved. This guide covers the questions families ask most.

Imagine your baby is three days old. Your nipples are cracked, your breasts are rock hard, and your baby cries after every feed. A relative suggests formula “just to give you a break”. You want to keep going but do not know if you are doing it right. A midwife watches one feed, adjusts the latch, and within a day everything feels different.

Why breastfeeding matters

The World Health Organization recommends exclusive breastfeeding for the first six months of life, then continued breastfeeding alongside suitable family foods for up to two years or beyond.,Breast milk provides all the nutrients a baby needs for the first six months, along with antibodies that help protect against infections. Breastfed babies have lower risks of gastrointestinal and respiratory infections, ear infections and sudden infant death, and may have lower risks of obesity and diabetes later in life. For mothers, breastfeeding lowers the risk of breast and ovarian cancer and type 2 diabetes.

Every drop counts

Breastfeeding is not all or nothing. Any amount of breast milk benefits a baby, and many families combine breastfeeding with formula for different reasons. Some mothers cannot breastfeed, or choose not to, and their babies can still thrive with formula fed safely and responsively. Feeding decisions are personal, and every parent deserves support without judgement.

The first hour

Skin-to-skin contact straight after birth, with the baby placed on the mother’s bare chest, helps keep the baby warm, calms both mother and baby, and encourages the baby’s instinct to find the breast. Many babies will crawl towards the breast and latch on in the first hour.,If skin-to-skin is not possible straight away, for example after a caesarean birth or if the baby needs medical care, it can be started as soon as possible. Partners can also offer skin-to-skin.

Colostrum and milk coming in

In the first few days, the breasts produce colostrum, a thick, yellowish milk rich in antibodies. It comes in small amounts, which is all a newborn’s tiny stomach needs.,Between about two and four days after birth, milk “comes in” and breasts often feel fuller, warmer and heavier. Frequent feeding helps this process and prevents engorgement. Mothers who have had a caesarean, diabetes or a difficult birth may find milk comes in a little later.

How often to feed

Newborns usually feed at least 8 to 12 times in 24 hours, including at night. Feeding on demand, responding to early hunger cues such as rooting, sucking on hands or lip smacking, works best. Crying is a late hunger cue. Feeds can last from a few minutes to much longer, and babies often “cluster feed”, feeding very frequently for a few hours, especially in the evening. This is normal and helps build milk supply.

A good latch

A good latch is the key to comfortable and effective breastfeeding. Hold your baby close, with their nose level with your nipple and their head free to tilt back. Wait for a wide-open mouth, then bring the baby to the breast, chin first, so they take a large mouthful of breast, not just the nipple.,Signs of a good latch include: the baby’s chin touching the breast, cheeks full and rounded, more of the darker area around the nipple visible above the top lip than below, rhythmic sucks and swallows, and no pain after the first few seconds. If it hurts throughout the feed, gently break the suction with a clean finger and try again.

Breastfeeding positions

• Cradle hold: baby across your lap, head in the crook of your arm
• Cross-cradle: supporting the baby’s head with the opposite hand, useful in the early days
• Rugby (football) hold: baby tucked under your arm along your side, helpful after a caesarean or for twins
• Laid-back position: reclining with the baby lying on your chest, encouraging natural instincts
• Side-lying: lying on your side facing your baby, useful at night and after a caesarean
• Try different positions to find what is comfortable for you both

Is my baby getting enough milk?

• Plenty of wet nappies: by day five, usually at least six heavy wet nappies a day
• Regular dirty nappies: by day four, usually at least two yellow, soft stools a day in the early weeks
• Your baby feeds frequently and seems satisfied after most feeds
• You can hear and see swallowing during feeds
• Your baby is alert when awake and has good skin colour
• Your baby regains birth weight by around two weeks and continues to gain weight

Weight loss in the first days

It is normal for babies to lose some weight in the first few days, often up to about 7 to 10% of birth weight. Most regain their birth weight by two weeks. If weight loss is greater, or your baby is very sleepy, has few wet nappies, is jaundiced or is not feeding well, your midwife or healthcare provider will assess feeding and may suggest extra support or supplementation.

Sore and cracked nipples

Some tenderness in the first days is common, but ongoing pain, cracks or bleeding usually mean the latch needs adjusting. Ask a midwife, health visitor or lactation consultant to watch a feed.,Other causes of pain include tongue-tie, thrush and nipple vasospasm (blanching and pain, often triggered by cold). Expressing a little milk and letting it dry on the nipples, and air-drying, may help. Some mothers use nipple creams. Nipple shields can help in specific situations but should be used with support.

Engorgement

When milk comes in, breasts can become very full, hard and painful, making it hard for the baby to latch. Feeding frequently, hand expressing a little milk to soften the area around the nipple before feeds, cold compresses between feeds and gentle massage can help. Engorgement usually settles within a day or two as supply adjusts to the baby’s needs.

Blocked ducts and mastitis

A blocked duct feels like a tender lump in the breast. Mastitis is inflammation of the breast, sometimes with infection, causing a red, hot, painful area and often flu-like symptoms such as fever and aches.,Current guidance focuses on continuing to breastfeed or express from the affected breast, avoiding excessive pumping or vigorous massage, using cold compresses and anti-inflammatory pain relief if suitable, and getting rest. If symptoms do not improve within 24 hours, or you feel very unwell, see a healthcare provider, as antibiotics may be needed. Breast milk from the affected side is safe for the baby.

Tongue-tie

Tongue-tie (ankyloglossia) is when the strip of tissue connecting the tongue to the floor of the mouth is shorter or tighter than usual, restricting tongue movement. Some babies with tongue-tie feed well; others have difficulty latching, causing nipple pain and poor weight gain. If tongue-tie is suspected and causing feeding problems, an assessment by a trained practitioner can determine whether a simple procedure to release it might help.

Low milk supply

Many mothers worry about low supply, but true low supply is less common than perceived. Frequent feeding, good latch, and night feeds help maintain supply because milk production works on supply and demand.,Factors that can reduce supply include infrequent feeds, a poor latch, using formula top-ups without expressing, some medicines (such as combined hormonal contraception), certain health conditions and previous breast surgery. A lactation specialist can assess and suggest strategies, such as breast compressions, switching sides, expressing after feeds, or occasionally medicines to increase supply.

Expressing breast milk

Expressing can be useful if your baby is premature or unwell, to build supply, to relieve engorgement, or to allow others to feed the baby. You can express by hand or with a manual or electric pump.,Hand expressing is a useful skill, particularly in the first days for colostrum. Store expressed milk in clean containers: at room temperature for up to about four hours, in the fridge at 4°C or below for up to around four days, and in the freezer for up to about six months, depending on guidance. Thaw frozen milk in the fridge and use within 24 hours; never refreeze it or heat it in a microwave.

Breastfeeding and your own health

• Eat a varied diet; you do not need to follow special rules or avoid most foods
• Drink to thirst; keep water nearby during feeds
• Take a vitamin D supplement as recommended in many countries
• Limit caffeine to moderate amounts
• Avoid alcohol, or keep it occasional and limited, timing feeds carefully
• Do not smoke; if you do, smoke outside and never around the baby
• Rest whenever you can, and accept help

Medicines while breastfeeding

Most medicines are compatible with breastfeeding, but some are not, and some need extra care. Always tell your healthcare provider and pharmacist that you are breastfeeding before taking any medicine, including herbal remedies. Specialist services and databases, such as LactMed, provide information on medicine safety in breastfeeding. Do not stop breastfeeding without advice simply because you need a medicine.

Breastfeeding at night and safe sleep

Night feeds are important for milk supply, especially in the early months, because prolactin, the milk-producing hormone, is higher at night. Keeping the lights low and the room quiet helps you and your baby settle back to sleep.,Follow safe sleep advice: place your baby on their back to sleep in a clear cot or Moses basket in your room for at least the first six months. If you bring your baby into your bed to feed, be aware of the risks of falling asleep, and never sleep with your baby on a sofa or armchair, or if you have drunk alcohol, taken drugs or medicines that make you drowsy, or if you or your partner smoke.

Returning to work

Many mothers continue breastfeeding after returning to work. Options include expressing at work, feeding before and after work, and arranging for your baby to be brought to you if possible. Start building a small store of expressed milk a few weeks before you return.,In many countries, employers must provide breaks and a private, hygienic space for expressing, and a fridge to store milk. Talk to your employer before you return about what you need. Breastfeeding at work is easier with planning and support.

Breastfeeding in public

In many countries, mothers have a legal right to breastfeed in public places. Wearing loose tops, using a scarf or cover if you prefer, and finding a comfortable spot can help you feel more confident. Many cafes and public spaces now welcome breastfeeding mothers. You should never be made to feel ashamed of feeding your baby.

Introducing solid foods

Around six months, babies are usually ready to start solid foods alongside breast milk. Signs of readiness include sitting with support, good head control, and being able to pick up food and bring it to their mouth. Breastfeeding continues to provide important nutrition and comfort while your baby learns to eat. Iron-rich foods are especially important from six months.

Breastfeeding premature or unwell babies

Breast milk is particularly valuable for premature and sick babies, reducing the risk of serious gut infections and other complications. If your baby is in a neonatal unit, you will usually be supported to express milk from soon after birth, often eight or more times a day, including at night, to establish supply.,Skin-to-skin contact (kangaroo care) and expressing near your baby help. Many units have breastfeeding specialists and donor milk banks. It can take time for premature babies to learn to feed directly from the breast.

Breastfeeding and HIV

Guidance on breastfeeding for mothers living with HIV varies between countries. The World Health Organization recommends that, in many settings, mothers living with HIV who are taking effective antiretroviral therapy with a suppressed viral load should breastfeed, as the risk of transmission is very low and the benefits are significant. In some high-income countries, advice may differ. Mothers living with HIV should discuss feeding options with their HIV care team.

Getting support

• Midwives and health visitors
• Breastfeeding peer supporters and groups
• International Board Certified Lactation Consultants (IBCLCs)
• National breastfeeding helplines
• Online communities run by reputable organisations
• Family and friends who encourage you

Stopping breastfeeding

There is no right time to stop. WHO recommends continuing alongside food for two years or beyond, but every family decides what works for them. Gradual weaning, dropping one feed every few days, is gentler for you and your baby and reduces the risk of engorgement and mastitis.,Many parents keep the bedtime or early-morning feed longest. Offering comfort and closeness in other ways helps your child adjust.

Combination feeding and formula top-ups

Some families combine breast milk and formula. If supply is a concern, getting skilled help first can protect your milk. If you choose to combine, offering the breast first and expressing when a feed is missed helps keep supply going. Paced bottle-feeding lets your baby control the flow, which makes it easier to move between breast and bottle.

How partners can help

• Bring your baby to the feeding parent at night and settle them afterwards
• Take over nappy changes, bathing and burping
• Keep water and snacks within reach
• Protect rest by handling visitors and chores
• Learn the signs of a good latch and of mastitis
• Offer encouragement on hard days

Breastfeeding twins and multiples

Many parents breastfeed twins successfully, and the body can make enough milk for more than one baby because supply responds to demand. Feeding both babies at the same time saves hours each day once you are confident, and a firm twin feeding pillow makes it easier. In the early weeks, some parents feed one baby at a time to learn each baby’s latch.

If one baby is smaller or was born early, you may need to express to protect supply while they learn. Ask for help from a lactation specialist who has experience with multiples, and accept every offer of practical help at home.

Breastfeeding after a caesarean birth

You can breastfeed after a caesarean. Skin-to-skin contact in theatre or recovery is often possible and helps feeding begin. Your milk may take a little longer to come in, so frequent feeds and early expressing are useful.

Positions that keep weight off your wound, such as the side-lying hold or the rugby (football) hold, are often more comfortable. Pain relief usually given after a caesarean is generally compatible with breastfeeding; ask the team if you are unsure.

Breast surgery, implants and breastfeeding

Many people with breast implants or previous breast surgery can breastfeed, though some reductions or procedures that affect the nipple area may reduce supply. Start early, feed often, and ask for your baby’s weight to be checked closely in the first weeks. Partial breastfeeding is still valuable if a full supply is not possible.

Looking after your mental health

Feeding can feel overwhelming, especially when combined with broken sleep and recovery from birth. Feeling low, anxious or guilty about feeding is common. A small number of parents experience a sudden wave of sadness or dread just before milk lets down, called dysphoric milk ejection reflex, which usually passes within minutes.

If low mood lasts more than two weeks, or you have thoughts of harming yourself or your baby, contact your midwife, health visitor or another healthcare provider promptly. Postnatal depression is treatable, and many treatments are compatible with breastfeeding.

Red flags: when to get help quickly

• Your baby has fewer wet nappies than expected or dark urine after day five
• Your baby is very sleepy, hard to wake for feeds or floppy
• Yellow skin that is spreading or worsening, or pale stools
• A hot, red, painful area on the breast with fever or flu-like symptoms
• Cracked nipples that are not improving despite help with latch
• Your baby has not regained birth weight by two weeks

Travelling while breastfeeding

Breastfeeding makes travel simpler in many ways, because milk is always ready and at the right temperature. On flights, feeding during take-off and landing can ease ear pressure for your baby. If you will be away from your baby, expressed milk can usually be carried through airport security in reasonable quantities, though rules vary by country, so check before you fly. A small cool bag with ice packs keeps milk safe for the journey.

Frequently asked questions

How long should each feed last?

There is no set time. Some babies feed for 10 minutes, others for 40. Watch your baby, not the clock: a baby who is swallowing well and comes off the breast relaxed has usually had enough.

Can I breastfeed if I have a cold or flu?

Yes. Your milk passes on antibodies that help protect your baby. Wash your hands and rest as much as you can.

Do I need to change my diet?

A normal balanced diet is enough. You do not need to avoid most foods. Many authorities recommend a vitamin D supplement for breastfed babies.

Can I drink coffee while breastfeeding?

Moderate amounts are generally fine. Some babies are sensitive, so reduce intake if your baby seems unsettled.

Is it normal for my breasts to feel soft after a few weeks?

Yes. As supply settles to match demand, the early fullness eases. Soft breasts do not mean low supply.

Can I breastfeed if I smoke or vape?

Breastfeeding is still better for your baby than formula, even if you smoke. Try to smoke after feeds, never in the home or car, and ask for support to stop.

Can I get pregnant while breastfeeding?

Yes. Exclusive breastfeeding can delay periods, but it is not reliable contraception unless strict conditions are met. Talk to your nurse or midwife about options.

But what if breastfeeding is not working for me?

Difficulties are common and usually fixable with skilled help early on. And if you decide to stop or combine with formula, that is a valid choice. Any amount of breast milk benefits your baby, and a fed, loved baby and a well-supported parent matter most.

Related: Mastitis and engorgement · Latch problems · Expressing at work · Starting solid foods

Sources: World Health Organization, UNICEF Baby Friendly Initiative, National Institute for Health and Care Excellence, La Leche League International, Academy of Breastfeeding Medicine.