My Baby Wasn’t Born With a Breastfeeding Manual—Now What?

As a mom who breastfed two babies and trusted my instincts, I assumed breastfeeding would come naturally. It didn’t. 

After an emergency C-section with my first baby, I could barely keep my eyes open long enough to attempt a latch. Within hours, he was admitted to the NICU, given formula, and I didn’t have another opportunity to breastfeed him for six days.

Instead, I sat in my hospital room—exhausted, arms empty—listening to the steady hum of a breast pump I didn’t know how to use. It felt frustrating and unfamiliar, nothing like the bonding experience I had imagined. I felt helpless, but I also knew I had to keep trying. 

With guidance from a nurse and a lactation consultant, I slowly learned how to use the pump, and it became my first step in providing milk for my baby.

Now, as a pediatrician caring for newborns, I see how common these breastfeeding struggles are. While most mothers in the U.S. start breastfeeding, far fewer continue exclusively through the first six months.¹ The reality is that babies aren’t born with instruction manuals—and neither are parents.

The good news? You don’t have to figure it out alone. With support from your pediatrician, a lactation consultant and your community, you can find a plan that works for you and your baby.

Why isn’t breastfeeding my baby working automatically?

During pregnancy, your body spends pregnancy preparing to make milk, but breastfeeding itself is a learned skill. Once your baby arrives, both of you are trying to figure it out together. 

Many parents expect breastfeeding to feel instinctive right away. When it doesn’t, frustration and self-doubt can creep in. But struggling in the beginning doesn’t mean you’re doing anything wrong—it means you’re learning something new. 

Why does breastfeeding hurt?

Achieving a good latch is one of the core skills of breastfeeding. 

Some tenderness in the first days can be expected early on, but persistent pain is not something you should simply endure. A proper latch makes all the difference—both for your comfort and for your baby’s ability to remove milk effectively. It’s called breastfeeding, not nipple feeding, for a reason.

Start when your baby shows early hunger cues. Position them belly-to-belly with you and wait for a wide-open mouth before bringing them to the breast. If your baby pulls away or seems frustrated, it may be a positioning issue. Support your baby’s neck and shoulders and bring them to the breast, rather than pushing the breast toward them.²

A shallow latch can cause pain and limit how well your baby removes milk. Think of biting down on a straw while barely sealing your lips around it—you won’t get much fluid. Signs of a poor latch include cracked nipples or a flattened, “lipstick-shaped” nipple after feeding. 

As you and baby learn together, add nipple cream/balm to your routine after each breastfeeding session for relief.³ Most importantly, seek help if feeding remains painful. Be patient, give yourself grace and reach out for help early—lactation support is part of the process, not a last resort.

Am I making enough breastmilk for my baby?

A good latch also helps build your milk supply. Because you can’t see how much your baby is drinking, it’s normal to worry about milk supply.

In the early days, your baby’s stomach is very small, about the size of a cherry at birth, growing to an apricot by the end of the first week and an egg by one month. The small amounts of colostrum you produce are exactly what they need.^4,5 

Frequent feeding is normal and does not necessarily mean your baby isn’t getting enough milk. Breast milk production works on a supply-and-demand system—the more milk your baby feeds on, the more your body is signaled to produce.⁶

This is especially true overnight. Milk-producing hormones are higher at night, and the demand of those middle-of-the-night feeds help build supply in the early weeks.⁴

Instead of focusing on the amount of breastmilk, watch your baby. Signs that feeding is going well include swallowing sounds, a relaxed body after feeding and regular wet diapers. Over time, weight gain at pediatric visits becomes the most reliable sign your baby is getting enough breastmilk.¹

Should I supplement my breastmilk?

Breastfeeding and breastmilk offer many benefits and are worth prioritizing when possible. In the early days, offering the breast or expressed milk first can help support supply and build a breastfeeding relationship.

At the same time, some babies may need supplementation.

Some babies may need additional nutrition because of medical concerns, like low blood sugar, separation from their parent, or are not yet feeding effectively at the breast⁵. In these situations, temporary supplementation of small amounts of formula can help support your baby while their strength and coordination needed to breastfeed continue to develop.

When used thoughtfully, supplementation doesn’t have to derail breastfeeding—it can be a bridge. 

The key is to continue stimulating the breast. When your baby receives a bottle, try to pump around the same time, and when possible, offer the breast before offering the bottle to signal your body to keep making milk.⁵

Every family and every baby are different. Your pediatrician or a lactation consultant can help you create a plan that supports both your baby’s needs and your breastfeeding goals.

You don’t have to go through breastfeeding alone

Breastfeeding doesn’t come with a manual, and it’s not something you’re meant to figure out without support.

Support doesn’t end when you leave the hospital—your pediatrician, lactation consultants, community organizations and breastfeeding support groups play an important role along the way.

Research shows that mothers with strong support systems are more likely to continue breastfeeding at six months.^7,8

And while social media can offer encouragement, not everything you see on social media is accurate or right for your situation. If you’re unsure about the breastfeeding advice you are seeing, check in with your pediatrician or a lactation consultant to make sure it’s safe for you and your baby.

Breastfeeding lessons learned

My first breastfeeding experience looked nothing like I imagined. It involved a NICU stay, a breast pump, tears and a lot of learning. But it also taught me something I now share with new parents every day:

Breastfeeding isn't a test of your instinctive abilities, rather it's a skill that takes time, practice and support. You and your baby are learning this skill together.

References

1          Meek, J. Y., Noble, L. & Section on, B. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 150 (2022). https://doi.org/10.1542/peds.2022-057988

2          Pediatrics, A. A. o. Ensuring Proper Latch On While Breastfeeding, <https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/ensuring-proper-latch-on.aspx> (2022).

3          Berens, P., Eglash, A., Malloy, M. & Steube, A. M. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeed Med 11, 46-53 (2016). https://doi.org/10.1089/bfm.2016.29002.pjb

4          Organization, W. H. The physiological basis of breastfeeding., <https://www.ncbi.nlm.nih.gov/books/NBK148970/> (2009).

5          Kellams, A., Harrel, C., Omage, S., Gregory, C. & Rosen-Carole, C. ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeed Med 12, 188-198 (2017). https://doi.org/10.1089/bfm.2017.29038.ajk

6          Alex, A., Bhandary, E. & McGuire, K. P. Anatomy and Physiology of the Breast during Pregnancy and Lactation. Adv Exp Med Biol 1252, 3-7 (2020). https://doi.org/10.1007/978-3-030-41596-9_1

7          Massare, B. A., Hackman, N. M., Sznajder, K. K. & Kjerulff, K. H. Helping first-time mothers establish and maintain breastfeeding: Access to someone who can provide breastfeeding advice is an important factor. PLoS One 18, e0287023 (2023). https://doi.org/10.1371/journal.pone.0287023

8          McFadden, A. et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2, CD001141 (2017). https://doi.org/10.1002/14651858.CD001141.pub5