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The information provided on this site is not meant to replace the recommendation of your physician or primary care provider.

How breastfeeding works

Breastfeeding works by a principle of supply-and-demand. The more the breast is emptied, the faster it produces milk. The less it is emptied, the slower the milk production is. If there is no stimulation (no pumping or breastfeeding), milk production itself will slow down until eventually no new milk is produced at all. This happens even if the breasts are full with milk (as they would be post-partum if they weren’t emptied). It is important to understand how milk production works so that women who intend to breastfeed can learn to manage their milk supplies and provide enough milk for their infants.

It should be noted that the breast is never “empty”. It is always producing milk (as long as it is stimulated), and the amount of milk in the breast falls under a continuum. This continuum ranges from its full capacity (varies from woman to woman and depends on the amount of milk-producing glands in the breast and functioning, intact milk ducts, among other factors) to an amount that is so small as to not be appreciable from outside the breast (when it is considered “empty,” though it actually never is absolutely empty).

To help understand this concept of a continuum and the fact that a breast is never truly empty, picture a sink filled with water and the tap running slowly. This is like the full breast; the milk being produced is represented by the tap, very slow when the breast is full. If you pull the plug, the water will run down the drain, but as you do so, picture the water coming out of the tap faster. This is analogous to feeding the baby; the water running down the drain is the milk being fed to the baby, while the tap increasing its flow is a lot like the milk being produced in the breast as it empties — it increases also. Understanding this is key to understanding how lactation is established and maintained.

Generally it is recommended that when establishing a milk supply (starting as soon as the baby is born), a woman should offer the breast to her newborn every 1.5-2 hours. Waiting longer than two hours between offering the breast may result in diminished milk production. In order to adequately maximize lactation, it is important to follow the recommendation of not letting more than two hours elapse between the beginning of each feeding. If a woman cannot breastfeed to establish her supply for whatever reason, it is crucial that she pump in lieu of breastfeeding so that she does not dry up.

To learn more about how breastfeeding works, please see the links page.

To learn about pumping, see the pumping page.

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Benefits of breastfeeding

There are numerous benefits to breastfeeding, both to the mother and infant. The mother who chooses to breastfeed experiences a faster contraction and shrinkage of her uterus after birth than if she doesn’t breastfeed. Apart from the closeness and bonding that occurs during every feeding session, mothers who breastfeed also never have to worry about washing and sterilizing bottles, measuring formula, boiling water, or any of the other tedious activities that must take place when formula feeding. Breastfeeding also burns about 500 calories daily, so it helps the post-partum mother to get rid of the weight she may have gained during pregnancy. As if that weren’t enough, breastfeeding may also provide other health benefits, including possible breast, ovarian, and uterine cancer prevention. More maternal benefits

Breastfed babies also experience many benefits. Breast milk is the food babies were intended to eat; it is therefore perfectly formulated for their immature digestive systems to process. It has just the right balance of vitamins, minerals, fat, carbohydrates, immunoglobulins, and other beneficial properties not yet fully understood by science which enable the human infant to maximize his or her potential. It is a hardy substance, its immunological properties remaining strong even after freezing and thawing. Even when pasteurized (heat treated to kill bacteria, which consequently also may denature or “deactivate” some of its immunological properties), human milk is beneficial enough to pre-term infants that it prevents and may even cure necrotizing entercolitis (a serious and life-threatening disease unfortunately common to preemies) more than feeding with formula. Often for these infants what they are fed could mean the difference between life and death.

Some studies suggest reduced rates of childhood leukemia, obesity, diabetes, asthma, and acute otitis media (ear infections) among breastfed infants. Other studies found that among premature infants, those who were fed breast milk scored higher on IQ tests when tested as children than those who were not.

This is not intended to be a comprehensive overview of all the benefits of breastfeeding. There are countless others. Please see our links page for resources where you can find out more about the benefits of breastfeeding.

Despite breastfeeding’s numerous benefits, there are some challenges to breastfeeding. Following are a few of those.

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Challenges to breastfeeding

There are very few disadvantages to breastfeeding once it’s going well. It is, however, worth noting what the challenges facing breastfeeding mothers are, in order to understand why not everyone breastfeeds.

The truth is, at the beginning, breastfeeding can be very difficult for some mothers. Like any new skill, it takes practice. Unlike many learned skills which require interaction with inanimate objects (bicycle riding, painting, computer programming, etc.), breastfeeding is particularly challenging because the mother learning to breastfeed must interact with a living, breathing, arm-flailing, opinionated individual. She needs to learn not only how to hold the baby to obtain a good latch-on (crucial for avoiding nipple pain — another challenge!), but how to position the infant to his or her liking. It sometimes takes several tries in the beginning to achieve the all-important latch.

Add to this that all of this new learning has to start as soon as the baby is born — the post-partum period can be an exhausting one even without having to learn a new skill — and you can begin to understand why so few women opt to breastfeed. (Interestingly, this is precisely the time when hospitals give out free formula — when the post-partum mother is exhausted and vulnerable and may not have the energy to fight it.) Thankfully, women were biologically pre-programmed to breastfeed immediately after giving birth and to endure the challenges of learning this new skill.

Mothers who give birth through cesarean, who give birth to preemies or infants requiring time in the NICU, or who have been separated from their babies immediately after birth face additional challenges. After birth, for about an hour, a baby is primed and receptive to learning to breastfeed, as is the mother. If this moment is short-circuited by a prolonged separation (as is the typical protocol in many hospitals throughout the world, though thankfully there are exceptions), when they are reunited again, the mother and infant may have to work harder to achieve the same results. If the infant is fed orally with a bottle in the nursery during the separation (also pretty typical), the infant may “bond” with the bottle. This is known as nipple confusion or nipple preference. The baby may learn how to suck from a bottle but not how to latch onto a breast. It takes a greater effort and a different set of muscles to suckle from a breast than it does to drink from a bottle, so if the nipple confusion is severe, the baby may never learn to latch on. This can make breastfeeding extremely challenging, and in some cases causes irreparable damage to the breastfeeding relationship.

Given that the typical protocol in many hospitals is to separate the baby from its mother immediately after birth and feed it with a bottle, and given that most babies in western countries are born in hospitals, it’s important to keep these things in mind before passing judgment on a mother for bottlefeeding her baby.

There are other things to consider as well. Many women have surgeries or piercings on their breasts which can sever some breast milk-making ducts and substantially reduce the amount of milk produced and delivered to the breastfeeding infant. Some of these surgeries/alterations are cosmetic and some are medically recommended. Doctors do not always advise their patients before surgery of the possible risks to future lactational capacity, nor do piercing parlors. On top of the aforementioned challenges regarding hospital policies and general breastfeeding difficulties, the additional challenges of reduced lactation make breastfeeding next to impossible for women in these situations. Amazingly, there are an elite few women who soldier on anyway, despite the enormous challenges they face.

Other challenges many women face (these are not meant to represent all of the possible challenges):

  • Breast deformities or differences. Hypoplastic breast deformity/tuberous breasts can cause a woman to have diminished lactational capacity. In severe cases, women with this condition don’t produce more than a few drops of milk. Other breast differences that could cause complications with breastfeeding are: flat nipples, inverted nipples, scarring caused by injury or surgery (particularly when it is on or around the nipple), absent nipples, and large nipples.
  • Unsupportive spouse/partner. Oftentimes this factor alone is what leads to breastfeeding failure. The support (or lack thereof) given by a spouse/partner can make or break breastfeeding success.
  • Unsupportive family. Sometimes well-meaning but ignorant family members can interfere with a fledgling breastfeeding relationship by offering the baby a bottle (which could lead to nipple confusion) or by separating the baby from the mother to “help” her “rest”. An exhausted post-partum mother may not fight it for fear of being “rude,” but in the long-term, it could ruin the breastfeeding relationship by interrupting crucial early bonding between mother and baby.
  • Developmental problems/deformities in the infant which make it impossible to breastfeed. Sometimes this can be resolved by pumping, though the added stress and worry of having a sick baby can make pumping quite burdensome. It should be noted, though, that most sick babies need breast milk more than their healthy counterparts do, so pumping should be encouraged. One noteworthy exception of this is in the case of galactosemia, a rare (1 in 60,000 births) metabolic disorder in which the baby cannot digest galactose (found in all milk products, including breast milk). If fed milk products, babies with galactosemia do not process it; it builds up in their cells causing cell toxicity and death. Babies with galactosemia are recommended to drink soy formula not containing any galactose. Galactosemia can and should be tested for to rule it out as early as possible.
  • Working. This depends on the type of job a woman has and how supportive her workplace is toward breastfeeding. She may have a job that requires her to be exposed to toxic chemicals which would preclude her from breastfeeding. Or her job may not involve anything toxic, but if it does not provide a room in which she can safely pump, she may not be able to maintain a milk supply adequate enough to sustain her infant.
  • Previous sexual abuse. Although breastfeeding is not a sexual act, it is an intimate one. Some women who have been sexually assaulted or molested may feel very uncomfortable with the act of breastfeeding because of the prolonged closeness to another person that it requires. Sometimes, though, breastfeeding can bring healing with regard to this matter. Each individual woman knows her own situation, her own mind and her own body best to know what decision is best for her circumstances.

It has been mentioned before, but it’s worth noting again: it’s important to keep these challenges in mind whenever starting to judge a woman for bottlefeeding her baby. It’s never known what a given woman’s circumstances are or what what she has experienced in the scope of her life that has influenced her decision (or made it virtually impossible to have another choice) regarding breastfeeding. The purpose of this site is to educate and make people aware of breastfeeding and its new symbol in order to help make the world more breastfeeding-friendly, not to alienate mothers who formula-feed their infants. The hope by the authors of this site is that societal impediments to breastfeeding (ignorance, work, non-supportive attitudes, bad hospital policies, etc.) are reduced so that more women who choose to breastfeed are successful at it, not to demonize women who for whatever reason(s) do not breastfeed.

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Educate Others

In order to educate others, you must first educate yourself. Make sure you are thoroughly and accurately informed about breastfeeding before sharing your information with others. Check out the links page and learn more from many different sources so that you have a clear picture of what lactation is all about. Once you’ve done that, there are a few other ways in which you can help:

  • Teach by example: Breastfeed. Whenever possible, breastfeed in public in a manner that makes you comfortable.
  • If you cannot breastfeed but you are lactating, express your milk into a clean container and bottle-feed your pumped milk. This takes time and dedication and can sometimes feel like a chore, but the outstanding benefits (compared to even the best formula) are worth the effort. Check out our pumping page for more information.
  • Be a silent advocate. Wear clothing bearing the International Breastfeeding Symbol. Let others see you wearing it and if they ask you about it, tell them what it is and what it represents. This might open up a dialogue about the subject. Answer their questions if they ask you about it. Above all, though…
  • Try not to judge anyone who is already bottle feeding her baby. Nobody likes to be preached to, and certainly nobody likes to be judged. You never know what challenges a mother feeding her child formula has had to face, nor what her infant’s specific needs are. Yes, typically breastfeeding is best, but chances are the woman who chooses to bottlefeed has a good reason for doing so (or several). Also, keep in mind that what’s in the bottle could very well be breast milk. Though bottlefeeding breast milk is not exactly breastfeeding, it’s very nearly as good for both the mother and baby, and often in situations like this, the mother has had very little choice about the matter. Do try to remain sensitive to this.

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Other ways to help

In addition to following the above tips, you can help promote breastfeeding awareness and education by supporting a nonprofit breastfeeding organization close to where you live. Consider joining a chapter of La Leche League near you, or train to become a leader. Help hand out flyers for your local milk bank or for the one closest to where you live (not all states have milk banks). Donate breast milk (to a HMBANA milk bank) or monetary funds (to a non-profit breastfeeding organization like La Leche League) to help. Or shop in our store; we make a donation with every purchase to a non-profit breastfeeding organization. Every time you shop here you’re helping to make a difference in the lives of many babies and their mothers by helping to finance the organizations that support them.

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Breastfeeding and the law

Inform yourself about your rights regarding breastfeeding laws in your state to protect yourself and become a better advocate for breastfeeding:

If you have information about laws in other countries, please write so that this section can be updated. (In order to assure accuracy of information, if you would like additional information added to this site, please provide a link so that the information may be verified.)

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Breastfeeding recommendations by different health organizations

There isn’t a single reputable health organization that doesn’t recognize the benefits of exclusive breastfeeding for most babies in the first six months of life. The World Health Organization states:

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed (1) for the first six months of life to achieve optimal growth, development and health (2) . Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.

The American Academy of Pediatrics recommends (among other things):

Exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.

The American Medical Association recognizes that breastfeeding is “the optimal form of nutrition for most infants” and supports the AAP’s recommendation.

Health Canada, Canada’s federal department in charge of health recommendations for the country, states:

Exclusive breastfeeding is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth.

Many other health organizations around the world have similar recommendations regarding breastfeeding. Breastfeeding is universally recognized as the biological norm for most babies. It is their ideal nourishment, far superior to any substitute. The only thing left now is for societal norms, attitudes, and expectations to catch up with this reality and help new mothers achieve these recommended goals.

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