Emergency Quick Start Guide to Breastfeeding

Note: I apologize for the ads. I know they’re ugly. I’m working on a budget for this thing!

How to use this guide
If you are really tired or drugged, and you want MINIMAL INFO ONLY, then you may read only the bolded sentences and section titles, and then read the rest if you need more details on the whys and hows of each item. There is a brief summary at the end.

What this guide covers
This is not a complete guide!! It assumes you’ve had, like, a class or something and know the basics, and so what I’m covering here is the stuff that hospital nurses often overlook or don’t have time for. Lots of “pro tips” and visual aids. It also includes a way of breastfeeding that is much less technical but is not usually taught in hospitals.

Why this guide exists (and who it’s for)
Often I am approached by a new mom, or someone who’s friend just gave birth, and Mom is totally blindsided by the learning curve* involved with breastfeeding and feeling a little overwhelmed! She’s just given birth, she’s elated and sore and tired, and needs simple information and quick! I often find myself giving the same information over and over, and have always thought it would be a good idea to organize all my information into a kind of “Quick Start Guide” to breastfeeding. Just like quick start guides to electronics, this guide is simple, to the point, and uses visual tools.

BUT FIRST, a disclaimer: I’m not a doctor, etc.
I’m not a lactation consultant or doctor or midwife or even a parent. I’m just a huge nerd who has accumulated some knowledge that some people, I’m told, find useful. It’s always best to talk to a professional.

Also, another disclaimer: Don’t let me tell you how to parent
The language in this guide is different from the way I normally talk to parents. Normally, I try to avoid “shoulds” and “do X” sort of language, because every family is different and I truly believe there is no one “right” way in parenting. However, this is a guide for someone who is overwhelmed, can’t take in too much info right now, and “just wants to be told what to do.” Normally, though, I encourage parents to critically analyze advice, trust your gut, and if something isn’t working for you–change it up!

That having been said, here are some tips and tricks that science and experience have shown are helpful for families who have decided breastfeeding is important to them.

First, you can do this!

Yes, that is vital information that you need to know. You are the living legacy of literally billions of women who have breastfed before you, just so that you could come into existence and create and sustain this unique individual, USING ONLY YOUR BODY OMG.

Now that you’re sufficiently in awe of yourself, let’s do this.

Do this now: Get an IBCLC (a really good lactation consultant)

If you’re still in the hospital, ask to see an IBCLC before you leave. “IBCLC” is a designation that many nurses and some pediatricians have, and it stands for International Board-Certified Lactation Consultant. That means they are board certified, which is the highest level of medical training in lactation that is possible to get—they have even more lactation-specific training than pediatricians get. You’ll want to see one whether or not you think there is a problem, because they screen for things that may become a problem in the future, and depending on where you live and your budget, it’s going to be harder to get one to come to your house later. However, keep in mind that hospital IBCLCs have a lot on their plate (and are probably overworked and underpaid) and so are often not as attentive as independent or clinic-based IBCLCs, so some problems may still be overlooked. A good IBCLC will be respectful, practice active listening, do a thorough check of you and your baby, give you some cool pro tips, and leave you feeling confident and encouraged. A great one will check in on you again later.

Watch your baby for “hunger” body language.

The key is to feed them before they start to cry! Many folks will try to draw out the time between feedings and soothe a fussy baby in other ways first. What often happens when you do this is they’re REALLY HANGRY by the time you decide to feed them, and they’re so upset they can’t focus on latching, and now you’re upset too, and it’s just stressful for everybody.

You can know when it’s time to feed by reading the universal baby body language:

  • Moving head from side-to-side (as if saying “no”)
  • Opening mouth and maybe sticking their tongue out
  • Bringing hand up to their mouth
These babies are working on their communication skills. Good job, babies!

If you see these, it’s time to feed.

Heads up! Sometimes yawning indicates hunger, not tiredness.

I’ll go into more detail on body language later.

How to latch

Hold your baby like this
I assume someone has come along and taught you all the “holds” and such. But just in case you haven’t, here’s the most popular one, the “cross-cradle.” Basically, you grab and aim your boob with the hand that is on the same side as that boob, and then use that other hand to support your baby’s back. And now all your hands are used up! It’s nature’s way.

The “Cross-Cradle” hold.

A good latch is important — A good latch is important because PAIN! Pain is caused by friction, which is caused by poor placement of the nipple in baby’s mouth. Pain can manifest instantly, or it can develop over time after days of repeated bad latches.

Latching is a skill where it’s better to just show you rather than try and describe it. Here is a great newborn latching demo, using the cross-cradle:

How do I know my baby is done feeding?

The best indicator is the baby’s whole body starts to relax and their hand goes from a clenched fist to relaxed and open.

Clenched fist. This baby is still working on it, thanks.
Open hand. This baby is full.

Also, baby will stop sucking and probably fall asleep. Some babies, however, fall asleep after just a handful of sucks. Those babies are not done, and it is something you’ll want to get help with.

Over the next few days: Build these skills.

There is a learning curve to breastfeeding, for both you and your baby, and things will get better as you get better together! Here are a few important skills you can focus on. As you are probably already overwhelmed, I recommend you keep it simple by picking one or two of these items to work on at a time.

Refine Your Latch

This cheesy video (5 min) has 2 awesome things that are awesome teaching tools. Just watch the first half of this video for now. The first half contains the best visual explanation of why latch is so crucial. The second half shows how you can use skin-to-skin to trigger feeding instincts, which I’ll talk about more in a minute.

There are 3 sub-skills to develop here:

Learn to recognize a good latch from a bad one. Looking at lots of pics and videos helps with this. Every time you latch, go through this checklist, which for your brain’s sake I’m gonna call the LAWs of latching.

  • Lips flanged. Top and bottom.
  • Asymmetry. That is, baby’s lower lip will cover your areola more or less entirely, but the top will have some sticking out. Chin is buried in the breast while nose has room to breathe. This page is a great explanation, with perfect visuals.
  • Wide gaping mouth. A newborn is tiny and has a lot of boob to fit in there, so their mouth will be open about as wide as it will go.

Here is a photo of a dope latch:

Learn “The Flipple”!!

This quick little move is a great trick for stuffing as much boob into a tiny newborn mouth as is humanly possible, while also directing the nipple towards the roof of the baby’s mouth and achieving that great asymmetrical latch we talked about earlier. It’s called the “nipple flip” or “flipple,” because you make like you’re going to have the baby latch onto a chunk of the areola instead of the nipple, and then you kinda “flip” the nipple into the baby’s mouth at the last minute. It’s so simple and effective, it should be taught to every single mom in the hospital. With this sick move, you will be taking brelfies and bragging to other people about your latch.

This is a quick demonstration:

And this is a bit of a longer explanation, with a different baby and some different angles:

Pain prevention tip: When re-latching, always “break the seal” with your finger — There will be a lot of trial and error in learning how to latch well. But did you even know there is a “correct” way to unlatch a baby so you can fix a shallow latch? Re-latching is going to help a lot more if you’re not doing it by pulling them off the nipple and creating friction every time. So, before re-latching, it is important to release the suction with your finger first. To break the suction, just stick your finger in the corner of your baby’s mouth and press down slightly against the skin of your breast. You will feel and hear the suction release, and then it’s okay to pull your breast away.

Tips for holding the baby during latching and feeding

Hold the baby’s back instead of their head. Support their back right behind their shoulderblades. This is for two reasons: First, it allows baby to pull his head away if needed to avoid gagging, if necessary. But also, some babies have a sensitive falling reflex, and if their back isn’t well-supported you may be unintentionally triggering them and causing them to involuntarily flail their arms.

Keep their arms free. Most babies are more comfortable with their arms free, sort of “hugging” your breast. Tuck one arm under your breast and the other one on top. It makes them feel safe and secure, and again can help with the falling reflex thing by pulling more of their bodyweight closer to your body.

Learn to read baby body language

It is important to understand that crying is a late indication of need. Babies communicate with whimpering noises, grunts, and subtle body language that they engage in well before they start to cry. In the case of hunger, babies will signal for 15 minutes before they actually start to cry. They only start to cry when none of those things have gotten the results they’re looking for. Once they’ve progressed to a full cry, it you will need to comfort them first, then latch them on. But catching them before they cry will help minimize stress for everyone.

This video is the best explanation of newborn cues I’ve ever seen and I show it to every new parent I meet:

I’m just gonna tell you right now, 90% of the time, the action item is going to be to stick a boob in their mouth. Even if they need a diaper change, the breast is so comforting that they’ll start to care a little less about that. And if they’re tired, well, breastfeeding helps them relax and fall asleep.

Kangaroo care (a.k.a. “skin to skin”) — Helps with breastfeeding, calms baby, helps with bonding

You’re probably at least vaguely familiar with the concept of kangaroo care, but what you probably don’t know is that it isn’t just a nice idea; it has been shown in scientific studies to assist the baby’s nervous system with homeostatic regulation, helps them build breastfeeding skills, and improves milk production. It’s amazingly, simple to do: Basically, whenever the baby isn’t fussing, just lay around with the baby on your chest. Even if they are asleep, they benefit and so do you. 

Specifically, it helps with:

  • facilitates breastfeeding in practical terms, by giving baby access to the breast
  • stimulates baby’s feeding instincts by stimulating their heightened sense of smell (milk in the open air)
  • regulating body temperature (Conserves the calories you so graciously produced for them)
  • regulating heart rate (read: stress)
  • regulating breathing (also stress)
  • Stimulates oxytocin in their brains, which helps them absorb nutrients and grow their bodies and brains
  • Parent experiences an increase in oxytocin as well, which stimulates letdown and promotes feelings of closeness and relaxation
  • Modifying the levels of other hormones, such as prolactin (present in both male and female parents) that help increase your sensitivity towards your child and strengthen attachment.

Sciencey side note (interesting but not important): It’s not very intuitive why temperature regulation is important to breastfeeding. It’s because babies lose heat quickly and temperature regulation costs a lot of calories. Those are calories you produce, and would otherwise go towards growth and weight gain. A baby that’s spending a lot of calories will have a greater appetite (that’s why you’re ravenous after a day at the pool or a day of skiing), and potentially less weight gain, and that can contribute to a feeling that you aren’t making enough milk. Studies on kangaroo care have found that the body of a lactating parent is very efficient at temperature regulation—that is, the temperature on your chest will rise and fall according to the babies needs. This is a big reason why kangaroo care is now widely practiced in neonatal intensive care units. However, because of this mechanisms by which it can help with breastfeeding in the early weeks, it is also useful for term babies as well.

The kangaroo care procedure in detail:

  1. Before you sit down, it helps to set up a chair and arrange pillows in a way that allows you to comfortably recline at about a 45-degree angle.
  2. Take off or open up the front of your shirt if it’s a button-down type.
  3. Strip your baby down to their diaper and hold the baby, “tummy-to-tummy,” on your chest, so their head is right between your boobs. A light blanket can be draped over baby’s back, and a hat if it’s chilly. Your body will help the baby regulate their temperature, though–more efficiently than an incubator, in fact!
  4. Rest there for as long as you like! If it has been more than an hour since baby ate, you can watch to see if their body language changes and hunger cues emerge. If they do, the baby may self-latch (see below).

Note that it is quite relaxing and you may find yourself getting sleepy! If you think you may doze off, switch to a safe sleep environment on a firm mattress. Chairs, sofas, and pillows are not part of a safe cosleeping environment. If you like the idea of falling asleep with your baby, make sure you memorize the Safe Sleep Seven.

If you decide you’re a fan of kangaroo care, it’s a good idea to get yourself some button-down shirts! Pyjama tops work great for this.

When to do kangaroo care: When you try it for the first time, do it when the baby has recently fed and changed and happy. This is the rule for trying basically any new thing for the first time (like babywearing). The reason for this is because you don’t want to go through all the work of getting comfortable only to have a sleeping baby wake up HANGRY and not know what to do.

However, once you are comfortable with it, you’ll be ready to level up…

Self-latching — (aka. baby-led latching)

Kangaroo care lays the foundation for self- or baby-led latching. It’s really cool.

Newborns are highly attuned to the smell of mother’s milk, so being placed on the mother’s chest with an open shirt is an intensely stimulating sensory experience for a newborn, and stimulates their instinctual feeding behavior. If given the time and opportunity, newborns (right after birth, and the weeks after) will, in fact, do a little “army crawl” to the breast and latch on, entirely by themselves. Don’t believe me? Watch this squish do this super dope baby trick:

You will find loads more videos on YouTube (Search “breast crawl”), mostly of just-born babies doing it. I chose this one in part because these instincts persist long after you leave the hospital, and most people don’t realize it’s something you can try at home.

When to do the self-latch
It’s best to try it when it’s been an hour or so since baby has fed, and they’re awake and alert (but not yet crying) or just coming out of sleep and starting to stir. If they’re starting to open their mouth and turning their head side to side in their sleep, that is a good sign that they’re primed to feed.

If you had a c-section, you may not like the kicking the baby will do to get to the breast. You can try positioning the baby more across your body rather than straight up-and-down. But it might also not be for you and that’s okay.

The self-latch procedure
It’s almost exactly like the skin-to-skin procedure above, except here you want a slightly more active baby who is going to be hungry soon.

You want to recline at about a 25-45 degree angle. Too high and the baby will slide down, and too low and the baby will have to work harder to lift their head. But experiment with what works for you.

When placed on mother’s chest, right between your breasts (top of head about level with nipples), you’ll notice the baby’s movements become more coordinated, as opposed to the flailing they often do while lying on their back. Be patient, and let the baby wiggle and squirm. They may fuss a little, and if they do, you don’t need to help them unless you feel you need to. Just speak soothingly and encouragingly to them and pat them on the back. They’ll get there within 10-30 minutes, and it will be really cool.

Why do self-/baby-led latching?

On a deeper level, giving your baby the chance to self-latch is a great lesson in trusting your baby and your body. While you wait for them to work their way towards the nipple, you get a lesson in patience and giving your child a chance to fail and try again. When they finally self latch, you will be filled with pride at what they’re capable of—and what you can achieve together. It’s just a really great early parenting lesson overall.

But in practical terms, self-latching is about capitalizing on your baby’s instinctual—and very useful!—feeding behaviors to make the baby do more of the work. Your baby has been living here for 12 hours, it’s about time they start pulling their own weight around here!

But also, with many of the breastfeeding positions that are taught in hospitals (cradle, cross-cradle, football, devil’s trapezoid) gravity is working against you. They are basically just bottle-feeding positions, developed without much thought to the normal evolved physiology of breastfeeding, or basic physics. These positions require all of your hands to keep your baby from falling, and trigger the baby’s falling reflex. By reclining and placing the baby, face down, on your body, it takes care of the falling reflex problem and allows the baby to orient themselves. You’ll even notice their movements become more coordinated and deliberate. And since you are reclined, you can relax and milk flows more readily. And you just might get half of your hands back, too.

Later on: 

Get help

Family, friends–this is the time, if ever in your life, you get to call in all of the favors. Even if there is nothing in particular wrong, you job right now is to recover from birth and get to know your baby. Here are some very practical suggestions:

  • Stagger visitors — Don’t have too many people over in one day, because it can get intense, especially with relatives.
  • Meal trains — Many churches have them, but families and neighbors can do it too. This feels like a big thing to straight up ask for, but I’m here to tell you that it’s okay to ask for help. People are very empathetic about having babies, because we’ve all been there.
  • Assign a friend or family member to help organize the above two things.
  • Have a rule for all visitors: If you want to hold the baby, you need to do a chore first. Put in a load of laundry, load the dishwasher, wipe down the counters, take out the trash.
  • Get a postpartum doula, who will do many of the above things for you. A privileged but very, very worthwhile expense.

Know who you want to call for help if something doesn’t feel right with breastfeeding. Research lactation consultants in your area, and their rates. If you can afford it, it’s immensely helpful to have one come to your home. Again, the IBCLC certification is the best way to go.

If you can’t afford a lactation consultant, investigate volunteer organizations in your area such as Le Leche League. Even a trusted friend is better than going it alone. It takes a village.

If you are separated from your baby in an emergency, you need a plan for that too. You have options:

  • Build up a freezer stash
  • Peer-to-peer milk donations (have a number on hand and make sure others know where it is)
  • Formula — Research what kind you’d like to be used, as there are many kinds, and talk to caregivers about how to safely prepare it, and never to water it down
  • Cross-nursing (a.k.a. allonursing) — Do you have a close friend or family member who you would like to feed your baby? In most cases, this is a safe option as long as you ask a few pointed health questions of the allonurser.

Request a follow-up with your OB sooner rather than later. The ACOG guidelines on postpartum follow-up care recently changed. Most notably, they’ve cut the time until your first follow-up appointment in half. It used to be 6 weeks and now it is 3. Make sure your doc or midwife follows this guideline.

A word on calling the doctor. I say this over and over to parents — You’re not inconveniencing your pediatrician when you call with questions. It’s always, always better to be annoying and safe than low maintenance and sorry. If something doesn’t seem right with your baby or your body after birth, or if you’re just not sure about something, do not hesitate to call your pediatrician, OB, or midwife. They’re literally paid to take your calls.

Breastfeeding in a reclined position

If you like the idea of breastfeeding in a reclined position as described above with self-latching, but you don’t want to take your shirt off every time, here is what that looks like:

For more about this “laid back” breastfeeding approach, Nancy Mohrbacher’s YouTube videos are awesome. This one explains how to get comfortable in the reclined position.

Nancy Mohrbacher calls this the “natural” breastfeeding position. I’ve seen other people call this the “laid back” breastfeeding position or “physiological breastfeeding.”

Shirtless Babywearing Around the House
Just as an aside, babywearing without a shirt (or using an open-front or very low-cut shirt) is a great way to get some skin-to-skin while up and about the house. For newborns I recommend Moby-style wraps or ring slings, because they’re made of fabric and are more comfortable for both baby and you. When using a wrap, it covers a lot of your torso and it will hardly be evident that you’re shirtless under there. But for a bit more coverage, you can just wear an open button-down shirt.

Ring slings are less familiar to most folks, but they’re really great for around the house due to the easy in and out, and they’re relatively easy to breastfeed in. They also grow with baby for longer than stretchy wraps do. Maya Wrap is a decent brand for the price, and you can get them on Amazon.

In summary

Do Now:

Get checked by an IBCLC before you leave the hospital, even if you think things are going okay. If you are already home, have one come to your home if you can afford it. 

Do After discharge:

Request a follow-up with your OB or midwife in 3 weeks at the latest.

Do over the next few weeks:

  • Work on your latch:
    • Recognizing a good latch from a bad one
    • Achieving a good latch
    • Unlatching by breaking the seal
  • Learn to read baby body language
  • Do lots of kangaroo care
  • Enjoy your new baby!

Okay, that’s all I’ve got! For everything else, let me refer you to kellymom.com. It’s run by a Ph.D. in nursing, and I’ve literally never seen anything scientifically unsound there.

Good luck and congratulations!

* Of course, it goes without saying, breastfeeding shouldn’t be as difficult as it is, or something you need to “study up” for. One of my goals is that someday, it won’t be. But the reason it is that way right now is that society isn’t doing it’s part, so the mental, practical, and emotional labor falls on moms alone. As you spend more time on this blog (and as I get my butt in the seat to write more!), you’ll come to have a deeper understanding of why that is–and why it’s not actually moms’ fault when breastfeeding doesn’t go as planned.






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