Understanding the early days of breastfeeding
The beginning of breastfeeding can be both a wonderful and unsettling time for a new mother. Between milk coming in, engorged breasts, pain or cracked nipples, it is common to feel overwhelmed. However, these phenomena are normal during the establishment of breastfeeding, and understanding them better helps to anticipate them, relieve them, and experience them more calmly.
This article guides you step by step through the first stages of breastfeeding, based on the most recent scientific knowledge.
1. What is milk coming in?
Milk coming in, or lactogenesis II, refers to the transition from colostrum production to mature milk production. It usually occurs between 48 and 72 hours after childbirth.
From a hormonal perspective:
- After the placenta is delivered, progesterone levels drop sharply.
- This releases the action of prolactin, the key hormone for milk production.
- Oxytocin, on the other hand, is responsible for milk ejection (let-down reflex).
Associated sensations:
- Heavier, warmer breasts, sometimes tight.
- Tingling or shooting sensations during breastfeeding.
- Milk that begins to flow more abundantly.
A delayed milk coming in (beyond 4–5 days) can occur in cases of difficult delivery, cesarean section, stress, or if feedings are infrequent at the beginning.
2. Engorgement: when breasts become painful
Breast engorgement is a common temporary phenomenon during milk coming in.
Why it happens:
- Too much milk produced compared to what is consumed.
- Ineffective or infrequent feedings.
- Incorrect baby positioning.
Symptoms:
- Hard, shiny, very tight breasts.
- Diffuse or localized pain.
- Slight fever sometimes (but if >38.5°C and redness: consider mastitis).
Solutions:
- Frequent and effective feedings: every 2–3 hours.
- Gentle massage and hand expression to soften the breast before feeding.
- Cold after feeding (cold compresses, cabbage leaves).
- Proper positioning: baby tummy to tummy, mouth wide open.
Be careful not to use a breast pump excessively during engorgement: this can further stimulate milk production.
3. Cracked nipples: when breastfeeding hurts
Cracked nipples are lesions of the nipple, often caused by improper latch.
Signs:
- Cracks, redness, scabs, sometimes bleeding.
- Sharp pain as soon as the baby latches, persisting during feeding.
- Baby frequently releasing the breast or crying during feeding.
Common causes:
- Poor baby positioning
- Suboptimal sucking (tongue-tie?).
- Nipples that are too moist or not dried properly.
- Excessive use of pacifiers or breast pumps at the beginning of lactation.
What to do?
- Review breastfeeding position with a lactation consultant.
- Check for the absence of a restrictive tongue-tie.
- Let the nipple air-dry after feeding.
- Apply colostrum or pure lanolin.
- Limit aggressive or frequent washing.
- Change positions from time to time.
Avoid creams containing antibiotics or antifungals without medical advice.
4. How to prevent these difficulties?
At the maternity ward:
- Put the baby to the breast as early as possible after birth.
- Do not limit the duration of feedings.
- Observe whether the baby is swallowing well.
- Seek the support of an IBCLC lactation consultant if needed.
At home:
- Follow the baby’s rhythm, even at night.
- Avoid supplements without medical indication.
- Get help in order to rest.
- Do not trivialize pain: it is never normal.
5. What if breastfeeding is really difficult?
Sometimes, despite all efforts, breastfeeding remains painful or discouraging.
- Consult a certified lactation consultant (IBCLC).
- Seek psychological support if needed.
- Adjust your choices without guilt: every journey is unique.
6. Conclusion: a sometimes chaotic beginning… but often temporary
The first weeks of breastfeeding are often the most intense. Milk coming in, tight breasts, nipple pain can be disorienting. But with help, rest, and reliable information, most mothers find their rhythm and breastfeed with pleasure.
The most important thing is to remain kind to yourself, surround yourself with the right people, and remember that you are doing your best.
Sources
- World Health Organization (WHO). Guidelines on optimal feeding of low birth-weight infants. 2011.
- Lawrence RA & Lawrence RM. Breastfeeding: A Guide for the Medical Profession. 8th edition.
- UNICEF & Baby Friendly Hospital Initiative (BFHI). Official materials and guidelines.
- Academy of Breastfeeding Medicine. ABM Clinical Protocol #20: Engorgement.
- Walker M. Conquering Common Breastfeeding Problems. Journal of Midwifery & Women’s Health, 2008.
- Wambach K. Breastfeeding and Human Lactation.
- McClellan HL et al. Breastfeeding problems and solutions. International Breastfeeding Journal, 2012.
- Douglas PS. The management of unsettled infant behaviour and feeding problems. Early Human Development, 2019.
- Amir LH. Managing common breastfeeding problems in the community. BMJ, 2014.
- Kent JC et al. Breastfeeding initiation and success. Pediatrics, 2016.