Breastfeeding: How Do You Know You’re Doing It Right?

Breastfeeding a baby may sound like a simple task, but everyone’s experience is different, and expectations created by social media are often unrealistic. According to data from the Centers for Disease Control and Prevention (CDC), about 60% of moms do not achieve their initial breastfeeding goals, namely, exclusive breastfeeding.

“Mothers hear a lot of messaging about the importance of exclusive breastfeeding,” says pediatrician Dr. Melissa Glassman, a breastfeeding medicine specialist.  “Yet in so many ways, our society is not set up to help them succeed.”

As a lactation consultant who is also a doctor, Dr. Glassman has a unique lens. Along with giving guidance on the task itself, she takes into account medical and health issues that could affect breastfeeding, including diabetes and thyroid disease that impact milk production. In 2017, she launched the Outpatient Breastfeeding Support Program at the NewYork-Presbyterian Ambulatory Care Network and two years later started the Breastfeeding Medicine service at Columbia Pediatrics.

Here Dr. Glassman answers common questions about breastfeeding.

How does breastfeeding work?
Breast milk production is a supply and demand situation. The more often a baby latches and removes milk (or a breast pump is used), the more milk a breast will make. Allowing a baby to latch on demand, whenever hungry, will increase milk production to match the baby’s feeding needs.

When do you need help from a breastfeeding expert?
Breastfeeding questions, issues, and concerns can arise at any point, though most occur in the first days and weeks after a baby is born, when breastfeeding is being established and milk production is increasing. Having ongoing breastfeeding support in the early days and weeks is particularly important for moms and babies who have health issues.

Parents should see a certified lactation consultant or breastfeeding medicine specialist to address nipple and breast pain, difficulty with latching, clogged ducts, concerns about milk production, infant weight gain issues, and evaluation of the baby’s tongue. Tongue movement and mobility are important for extracting milk from the breast. But anyone who needs help, reassurance, or has a question about breastfeeding should make an appointment — the sooner the better to make sure that things are moving in the right direction and problems can be addressed early on.

Your visit could be either in-person or virtual. ”We see patients both in-person and via video visit, known as telelactation, in our Outpatient Breastfeeding Support Program,” says Dr. Glassman. “Telelactation can be a lifesaver in the early postpartum days after leaving the hospital, when breastfeeding issues often arise, and moms and newborns can have a visit from the comfort and ease of their home.”

Should you bring your baby to the appointment?
Whether in-person or virtual, bring your baby to your visit. It’s helpful for specialists to observe a latching session, measure how much milk the baby can take from the breast during a feeding session when in-person, and more.

Also, if you’re pumping, bring the pump to the visit so the specialist can observe the fit of the flange, the piece that fits over the nipple, during a pumping session.

How do you know if you’re breastfeeding right?
If the latch feels comfortable, your breasts soften with each feeding session, and your baby can feed directly from your breast and is satisfied after feeding, you’re doing it right.

From a milk production perspective, if an exclusively breastfed baby is gaining weight well and on track with their growth curve, milk production is where it needs to be. Within a few days after delivery, moms often experience very sensitive nipples and breasts can feel very heavy, full, and painful as the volume of milk increases and mature milk starts to come in. Discomfort at this stage — called engorgement — is normal.

Does breastfeeding hurt or make you tired?
In the early days, when nipples are very sensitive, moms may experience pain for the first few seconds of latching. With time and work on getting a deep latch, this should go away. Pain that lasts for an entire feeding session is a sign that a mom should seek help with latching. Breasts will get full between feeding sessions, so some parents feel breast pain if they go too long without latching or pumping. This pain should resolve as breasts are softened by a latching/pumping session.

The hormones involved in breastfeeding can make moms relaxed, but a newborn’s sleep schedule doesn’t allow for much deep sleep, so moms can feel drowsy while latching.

What should someone breastfeeding eat?
Breastfeeding parents should eat a healthy diet and drink plenty of fluids. There are no particular foods to stay away from or foods that you must eat. On average, women (and gender-nonconforming people) should consume an additional 400-500 calories per day while breastfeeding, varying by mom’s weight, baby’s age, and frequency of breastfeeding sessions. But it’s not necessary to focus on calories: eat when you are hungry.

• It’s not a good idea for you or your baby to be on a weight-loss diet during the early weeks and months of breastfeeding. Because breastfeeding and breast milk production burn calories, weight will come off with time. Moms should take the months after delivery to recuperate and eat a regular, healthy diet.
• It’s OK to have a cup of coffee (or other caffeinated drink) but limit it to once a day, ideally after a breastfeeding session.
• After the first few months, one glass of wine or other alcohol is probably OK. There is no amount of alcohol in breast milk that is considered safe for a baby to ingest, so wait at least 2 or 3 hours after drinking to breastfeed, when you have no buzz and your body has processed the alcohol.

Sushi and breastfeeding
One thing to note about breastfeeding is that it’s not the same as pregnancy, meaning the rules about what foods to avoid are not always alike. For example, while the American College of Obstetricians and Gynecologists recommends avoiding all raw or undercooked fish when you’re pregnant, the same does not apply while breastfeeding. You can eat sushi while breastfeeding.

Smoking and breastfeeding
The postpartum period is an important time for mothers who smoke tobacco or use e-cigarettes to quit. Given the health benefits of breast milk, however, breastfeeding is still encouraged even if moms smoke. In order to cut down on the baby’s exposure to smoke, do not smoke around the baby and wash hands and change clothes after smoking.
There is not enough research to say it’s safe to smoke or consume marijuana while breastfeeding. Breastfeeding mothers should not use cannabis products. This is an important topic to discuss with your doctor.

Medication and breastfeeding
Many over the counter medicines—like acetaminophen (Tylenol) and ibuprofen (Advil)—are safe while breastfeeding. Others — like the decongestant pseudoephedrine (Sudafed) — can reduce milk production.

When you start a new medicine, whether it’s prescription or over-the-counter (including DayQuil, Benadryl, Mucinex, NyQuil, Claritin, Zyrtec, and Pepto-Bismol), check with your doctor to make sure it is safe for both your baby and your milk production.

How long should you breastfeed?
The American Academy of Pediatrics and other organizations recommend:

• Exclusive breastfeeding for about the first six months after birth;
• Breastfeeding plus appropriate baby foods starting at about 6 months, and;
• Continued breastfeeding as long as mutually desired by mother and child for two years or beyond.

There is no particular time when someone should stop breastfeeding.

“Breastfeeding rules sometimes come across as very rigid, but everyone is individual,” says Dr. Glassman. “The best way to breastfeed is to do what’s best for you and your baby and seek help when needed to reach your personal breastfeeding goals.”

A version of this story first appeared in the Columbia University Irving Medical Center Newsroom.

Melissa Glassman, MD, MPH, IBCLC, is a pediatrician at the NewYork-Presbyterian Ambulatory Care Network and NewYork-Presbyterian Morgan Stanley Children’s Hospital and an associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons. She is an International Board Certified Lactation Consultant and the founder and medical director of the Newborn Clinic and Outpatient Breastfeeding Support Program at the NewYork-Presbyterian Ambulatory Care Network. Dr. Glassman founded Breastfeeding Medicine at Columbia Pediatrics to provide high-level, in-person medical care to all breastfeeding mothers and babies.