Breastfeeding

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A mother's breasts make as much milk as the baby wants. If the baby suckles more, more milk is produced. Almost every mother can successfully breastfeed and produce enough milk when:

• she breastfeeds exclusively
• the baby is in a good position and is well attached to the breast, with the breast well in the baby's mouth
• the baby feeds as often and for as long as she or he wants, including during the night, and is kept on the breast until she or he has finished suckling. The baby should finish feeding from one breast before being fed from the other breast.

Holding the baby in a good position makes it easier for the baby to take the breast well into the mouth and suckle.

Signs that the baby is in a good position for breastfeeding are:

• the baby's head and body are in line
• the baby is close to the mother's body
• the baby's whole body is turned towards the mother
• the baby is relaxed, happy and suckling.

Holding the baby in a poor position can cause difficulties such as:

• sore and cracked nipples
• the baby does not receive enough milk
• the baby refuses to feed.

Signs that the baby is well attached:

• more of the dark skin around the mother's nipple (areola) can be seen above the baby's mouth than below it
• the baby's mouth is wide open
• the baby's lower lip is turned outward
• the baby's chin is touching the mother's breast.

Signs that the baby is suckling well:

• the baby takes long, deep sucks
• the cheeks are round when suckling
• the baby releases the breast when finished.

Generally, the mother does not feel any pain in her breast when breastfeeding.

From birth, the baby should breastfeed whenever she or he wants. A baby should be fed on demand at least eight times in a 24-hour period, during both the day and the night. If a newborn sleeps more than three hours after breastfeeding, she or he may be gently awakened and offered the breast.

Crying is not a sign that the baby needs other foods or drinks. It normally means the baby wants to be held and cuddled more, the baby's diaper or nappy needs changing, or the baby is too hot or cold. Some babies need to suckle the breast for comfort. More suckling produces more breastmilk, which helps satisfy the baby's feeding needs. If the baby cries a lot and does not settle after feeding and being cuddled, the mother may need additional breastfeeding support or the baby might not be well. A trained health worker should be consulted.

Using pacifiers, dummies or bottles can interfere with establishing breastfeeding in the baby's first months of life, as the sucking action for these is different from suckling at the breast. The baby may become used to the bottle teat or pacifier and refuse the breast. This may cause less suckling time at the breast, which reduces milk production. Pacifiers and bottle teats may become contaminated, increasing a baby's risk of illness.

Mothers who fear they do not have enough breastmilk often give their babies other food or drink in the first few months of life. This causes the baby to suckle less often, so less breastmilk is produced. The mother will produce more milk if she does not give the child other food or liquids and if she breastfeeds often.

Mothers need to be reassured that they can feed their babies under 6 months of age properly with breastmilk alone, and they need to be shown how to do it. All mothers, especially those lacking the confidence to breastfeed, need encouragement and support from the child's father and their families, neighbours, friends, health workers, employers and women's organizations. A mother who has undergone a Caesarean birth may require extra help to begin breastfeeding her baby.

Skilled birth attendants can raise awareness and understanding about the benefits of breastfeeding. They should support mothers to initiate and continue breastfeeding and help fathers and other family members accept breastfeeding as a natural and nutritious practice that protects the life of the baby.