Preparing for Breastfeeding: A Practical Guide for New Parents

Breastfeeding is a natural way to nourish your baby, and success often depends on preparation, understanding, and support. Julia Selezneva, MD, a pediatrician and International Board Certified Lactation Consultant (IBCLC) at Stanford Medicine Children’s Health – Pediatrics (formerly Altos Pediatric Associates) in Los Altos, shares her insights to help you navigate your breastfeeding journey with confidence.

It’s important to note that the positive health effects of breastfeeding are well documented and widely recognized by health authorities throughout the world. At Lucile Packard Children’s Hospital Stanford we adhere to the highest standards of care for breastfeeding mothers and their babies, and we’re proud to be a Baby-Friendly designated Hospital.

How lactation starts

Before your baby is even born, your body has already started preparing to produce milk (also called lactogenesis). “Your breast milk glands start proliferating during pregnancy, driven by hormones,” Dr. Selezneva said. “Some can even start expressing a little colostrum (the first form of breast milk) toward the end of their pregnancy.”  

Dr. Selezneva explained that after your baby is born, there is a dramatic shift in hormones that prompts your milk to come in. However, it’s important to note that it can take up to three to five days for the colostrum to fully transition to milk.

“After the baby is born and the placenta is removed, there’s a big drop in progesterone. That’s really what triggers the milk to come in in the beginning,” she said.

Milk production demand and supply

According to Dr. Selezneva, lactation is based on the concept of demand and supply. The more the baby demands (often in the form of frequent cluster feeds), the more milk your body will supply, until you are producing just the right amount your baby needs.

“The more the baby feeds and removes milk, or if mom chooses to pump, the more milk is removed from pumping, the more milk production is increased,” she said. “It takes about six weeks on average to establish a full milk supply, which can be anywhere from 24 to 32 ounces, give or take. That just depends on what the baby establishes they need to grow adequately on their own growth curve. Then it more or less stays the same until they start solid foods and then slowly decreases as the demand decreases.”

In the first two weeks, pediatricians often say to feed the baby at least every three hours on both sides until they are back to their birth weight. It is normal for babies to lose up to 10% of their body weight in the first week, then regain it by the end of two weeks. If babies lose more or are very slow to gain weight by two weeks, consult your pediatrician.

Dr. Selezneva shared that nothing can replace frequent emptying of the breasts, either by the baby or from pumping. While it may be tempting to turn to supplements or snacks marketed to boost lactation, Dr. Seleneva suggests focusing on a nutrient-dense diet and plenty of hydration instead.

Causes of delayed supply

Sometimes there are complications during pregnancy or birth that cause milk production to be delayed. Dr. Selezneva outlined some factors that can delay lactogenesis:

• If there’s a piece of placenta still left inside (“retained placenta”)
• A difficult or stressful birth
• A cesarean, or C-section, birth
• Diabetes, thyroid disease, or metabolic syndrome

If you experience a delay, Dr. Selezneva encourages partnering with a lactation consultant or talking to your pediatrician.

Breastfeeding supply essentials

The first few months of breastfeeding can be challenging as you and your baby establish a rhythm. Dr. Selezneva suggests setting up a comfortable breastfeeding area with everything mom needs close at hand.

“You want to make the mom as comfortable as possible,” she said. “It can be setting up a little area where she’s going to be breastfeeding the most, with a comfortable chair, breastfeeding pillow, a little table or nightstand nearby to put water or some kind of hydration for mom, as well as snacks and baby supplies, because you’re going to spend a lot of time there, especially when baby is cluster feeding and you are stuck in the same spot for a while.”

The importance of preparation

Many parents spend months researching and preparing for the arrival of their baby, from choosing the best crib to finding the perfect stroller. However, Dr. Selezneva explained, it’s just as important to prepare for feeding.

“The first months are the hardest months for breastfeeding,” she said. “I always recommend prenatal breastfeeding classes to help prepare new parents or doing prenatal breastfeeding consultation with a lactation consultant. There are a lot of lactation consultants in the area eager to help.” Stanford Medicine Children’s Health offers both in-person lactation consultations, a lactation Advice Line, and lactation support groups, through our breastfeeding support program.

For more information about breastfeeding or caring for your newborn, check out our Pregnancy and Newborn Classes, and our Guidelines for Storing and Preparing Breast Milk at Home. Also see A Boost for Breastfeeding or Creating a Safe Sleep Environment for Your Baby.