Your breastfeeding questions, answered 

Breastfeeding is a natural process for new babies and their mothers, but so many families have questions about what’s normal.

To help educate families and address any questions, concerns, or struggles they may encounter with breastfeeding, University of Michigan Health created the Breastfeeding and Lactation Program.

Maria Skoczylas, M.D., the medical director, and Kelly McCarley, M.S.N., R.N., the clinical nursing director, along with a team of International Board Certified Lactation Consultants, lead the program to ensure families receive the breastfeeding support they need to reach their individual breastfeeding goals.

Here, Skoczylas answers some of the most common questions their team receives from new breastfeeding families.

What changes can you expect during pregnancy and after your baby is born?

Skoczylas: During pregnancy, your breasts will start to get bigger.

This is your body getting ready to produce milk for your baby.

You might see colostrum, milk your body makes in the first few days of your baby’s life, but not everyone does.

After your baby is born, you’ll notice changes in your breasts.

Your breasts will feel full or heavy with milk. This is called engorgement and it happens even if you do not breastfeed your baby.

Engorgement occurs approximately three to five days after birth and may last one to two days.

Engorgement can be uncomfortable, even painful, and it can extend through to the armpit.

Cool cloths and ice packs can help. Avoid applying heat or getting a deep massage, which can make symptoms worse.

Feed your baby frequently to help to relieve engorgement, and if you’re pumping instead of feeding your baby at the breast, pump just enough to feed them, but not extra.

How do you know if your baby is getting enough milk?

Skoczylas: Many parents worry that their baby isn’t getting enough to eat.

It can be difficult to trust that your body is making enough milk, especially in the early days when it’s producing colostrum.

At first, you’ll make very small amounts of colostrum because your baby’s tummy is very small.

Colostrum is often thick, sticky and gold in color. It has a lot of essential antibodies to protect your baby from infection.

In most cases, babies born right around their due date don’t need extra milk; your colostrum is all they need.

But babies who are born before their due date, or babies born very small, usually need extra care.

For those born earlier, or for smaller babies, they might require some extra feedings of milk by spoon or by bottle.

Then your colostrum should start to transition to milk around three to five days after birth.

You’ll notice your breasts feeling fuller as your milk “comes in” and the color will change from gold to white.

As your body starts to make more milk, you should hear your baby swallowing during their feedings. This is a sign that your baby is removing milk adequately from your breast.

To make sure your baby is getting enough to eat, watch for wet and poopy diapers.

By day six, your baby should have at least six wet and four poopy diapers a day.

As your baby gets older, they’ll have fewer poops but for now, in the early days, poopy diapers are a good sign that your baby is getting enough food.

After feeding your baby, your breasts will feel softer, and your baby should appear happy and relaxed after feeding if they got enough to eat.

It’s important to also follow closely with your baby’s doctor during this time so that you can make sure your baby’s weight is on track.

If you breastfeed, do you have to pump?

Skoczylas: Most people don’t have to pump.

Instead, it’s helpful to think of pumping as a substitute for your baby.

Your body produces breast milk based on the demand for that milk. In other words, an empty breast tells the body to make more milk.

Extra (unnecessary) pumping can lead to an oversupply, which can lead to complications like mastitis.

For instance, you shouldn’t do a lot of extra pumping just to stock up on milk in the freezer.

If your baby is born early and has trouble feeding at the breast, use a breast pump to help protect your milk supply.

The expressed breast milk can be used to provide supplemental nutrition for your baby until their breastfeeding skills improve.

If your baby isn’t effectively removing milk from your breast, you should pump eight times per day, and you shouldn’t go more than six hours without pumping to protect your supply.

If you and your baby are separated for any reason, you’ll need to use a breast pump to mimic your baby’s typical feeding pattern. Try to pump for each time your baby would normally feed at the breast.

If your baby is gaining weight well from breastfeeding and you can be together for feedings, you don’t need to pump at all.

How do you know if you have mastitis?

Skoczylas: If you notice hard areas or red streaks on your breast, call a lactation helpline or your health care provider.

These could be signs that you have extra swelling in a certain area of your breast, and extra swelling in the breast can lead to inflammation called mastitis.

Some cases of mastitis require antibiotics. If you develop a fever or flu-like symptoms in addition to the breast symptoms, it’s important to talk to your provider right away.

Thankfully, most cases of mastitis don’t require antibiotics and can often be managed at home with rest, ice, and anti-inflammatory medications like ibuprofen and acetaminophen.

If you develop mastitis, continue to feed your baby normally; there’s no need to avoid breastfeeding when you have mastitis, and you shouldn’t need to do any additional pumping either.

Know that producing too much milk (creating an oversupply) can increase your risk of developing mastitis.

If you feel like your body produces more milk than your baby needs, contact a lactation consultant to learn how to best manage this.

When should you introduce a bottle while breastfeeding?

Skoczylas: In the early days, you and your baby will be working as a team to develop your breastfeeding skills.

Once breastfeeding is well established, you can introduce a bottle to practice and prepare for an eventual separation (returning to work, school or travel).

A good time to introduce a bottle is when your baby is around 3–4 weeks old, which will be another learning opportunity for your baby.

Just like breastfeeding, some babies will learn to take a bottle very easily while others may need more practice.

Offer the bottle regularly, at least a couple of times each week, so that your baby learns to comfortably switch between breast and bottle feeding.

When your baby’s caregiver feeds your baby by bottle, make sure they pace the feeding for them.

They can do this by holding the bottle horizontally (instead of vertically) and using a slow flow nipple. That way the feeding experience will require effort from your baby that is similar to breastfeeding. 

Breastfeeding is a unique journey for every family.

There can be bumps in the road at any time but, at University of Michigan Health, members from the Breastfeeding and Lactation Program are here to support you throughout your journey.

Contact your provider or your baby’s provider for specific medical concerns.

For general breastfeeding information, call the Lactation Help Line at (844) 200-8894 to speak with a specialist.

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