I didn't bother buying bottles before I had my daughter, Stella. Believe it or not, I'd been dreaming of breastfeeding since I was a little girl, and I was sure I'd be able to nurse. But my new baby and I had a surprisingly tough time. Before I even left the hospital, my nipples were chapped and sore, and I faced the hard truth familiar to so many new moms: Nursing may be natural, but it's also downright difficult. So difficult, in fact, that many moms just give up. While 79 percent of mothers breastfeed soon after birth, only 49 percent are still nursing six months later, according to the Centers for Disease Control and Prevention. That's a surprisingly low number considering that the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about six months. What's more, evidence shows that nursing lowers your baby's risk of ear infections, stomach viruses, asthma, the flu, and diabetes.
I eventually got much-needed help from a wonderful lactation consultant, Jan Ellen Brown, and I breastfed Stella until just after her first birthday. To help other struggling moms, I persuaded Brown and nine other experts to share their most effective techniques for mastering nursing.
Line up help. "Consider meeting with a lactation consultant or another nursing expert before you have the baby. She can share tips that will help in the beginning, and you'll know whom to call if you have a problem. International Board Certified Lactation Consultants, or IBCLCs, have had the most intensive training." --Dee Kassing, IBCLC, a lactation consultant in the St. Louis, Missouri, area
See the real thing. "If you have a friend who's nursing, ask if you can watch. If not, attend a La Leche League meeting or another breastfeeding support group where you can see moms feeding their babies." --Jessica Claire, IBCLC, a lactation consultant in Los Angeles
Tell the hospital what you want. "Ask whether you can keep your baby in the room with you at all times if possible. Rooming in will help you bond with your baby, learn feeding cues, and better establish breastfeeding." --Laurie Jones, M.D., IBCLC, a pediatrician in Phoenix and founder of DrMilk.org
What to Do in the Hospital
Don't wait to get help. "If the nurse in the hospital says your latch 'looks great' but it still hurts, call a lactation expert (IBCLC). If your doctor says your baby is not gaining enough weight, call. If your nipple is injured, call. If your gut says something isn't right, speak up. You can save yourself weeks and weeks of pain and trouble." --Jaye Simpson, IBCLC, lactation consultant in Sacramento, California
Try to nurse within the first hour after delivery. "Two hours later, many babies will be hard to rouse. It may seem like you're producing very little at first -- maybe just a few drops of colostrum -- but a 1- or 2-day-old baby's stomach is only the size of a marble." --Jenny Thomas, M.D., IBCLC, a pediatrician in Franklin, Wisconsin, and author of Dr. Jen's Guide to Breastfeeding
Enlist Dad. "If possible, your partner should be there when you meet with the lactation consultant, both in the hospital and afterward. Dads can be good problem-solvers, and you may find yourself feeling so overwhelmed and sleep-deprived that it will be hard for you to process information." --Jan Ellen Brown, IBCLC, lactation consultant in Charlotte, North Carolina, and coauthor of 25 Things Every Nursing Mother Needs to Know
Focus on those little feet. "Babies always seem to nurse better when their feet are touching something, like your leg, the arm of the chair, or a pillow tucked next to you. It makes them feel more secure." --Veronica Jacobsen, a doula and lactation counselor in Richfield, Minnesota
How to Get a Deep Latch
Position yourselves nose to nipple, belly to belly. "Make sure that your baby's stomach is touching yours, so she doesn't have to turn her head to latch. And point your nipple at her nose, not at her mouth, so she'll lift her head up, open her mouth wide, and latch on deeply." --Jacobsen
Encourage a mouthful. "If you're breastfeeding sitting upright, bring your baby to your breast once his mouth is completely open. Press between his shoulders firmly to bring him to you, while you support your breast. Your nipple will fill the roof of his mouth. If it still hurts after the first few sucks, de-latch and reposition." --Brown
Don't push the back of your baby's head. "That triggers his instinct to resist and chomp down. Instead, put your hands at the nape of your baby's neck, and bring him swiftly to your breast." --Leigh Anne O'Connor, IBCLC, lactation consultant in New York City
Make It Through the First Few Weeks
Don't count minutes. "You can leave your baby on the first breast until she comes off on her own and then offer the second breast. It's typical for some babies to take one breast at some feedings and both breasts at some." --Nancy Mohrbacher, IBCLC, lactation consultant in the Chicago area and author of Breastfeeding Answers Made Simple
Avoid pacifiers at first. "The AAP recommends delaying the pacifier for the first month because it can suppress hunger cues and steal time from the breast during a critical period. After that, offering a pacifier shouldn't hurt." --Dr. Jones
Lie on your side. "It lets you rest your shoulders and lower back if you tend to hunch over, and it's good for moms who've had a C-section, who have carpal tunnel syndrome, or who are just exhausted. Put a pillow between your knees and your arm under your head, and bring the baby in facing you. Have someone help you at first." --Brown
Try a nursing stool. "It can help give you more of a lap, especially if you're short, and it takes the pressure off if you've had an episiotomy. When I watch a mother use one, I can see right away on her face how much more comfortable she is." --Brown
Offer the first bottle at 4 to 6 weeks. "If you wait until 8 weeks, you risk bottle refusal. Have someone other than you give the first one -- and get out of the house so you're not tempted to help out." --Dr. Jones
Don't buy a whole nursing wardrobe. "It can be easier to just lift up your shirt. If you wear a blouse over a camisole, you'll have a lot of coverage." --Brown
Lose the snooze. "If your infant keeps falling asleep on your breast, try tickling the bottom of his feet, stroking him under the chin, or touching him with a wet washcloth." --O'Connor
Step Up Your Milk Supply
Look at your baby, not at the scale. "I've seen so many moms whose baby looks healthy, nurses well, and meets milestones, but they've lost confidence in breastfeeding because their doctor told them that their baby's weight was not on the charts. If you received a lot of IV fluids during labor, your baby could be artificially 'heavier' at birth. If he has low weight gain, but he's smiling, his linear growth and head circumference and neurological development are notably okay, I'd get a second opinion before giving formula." --Jay Gordon, M.D., pediatrician in Santa Monica, California
Try a stronger pump. "Some hands-free pumps and the ones covered through insurance aren't as powerful as you need when you're establishing your milk supply, so you may want to rent a hospital-grade one, at least at first." --O'Connor
Don't get a used pump. "A good electric pump has a limited number of hours of motor life before the suction starts to die." --Simpson
Returning to Work
Ease in. "Consider starting back on a Thursday rather than a Monday, so you have only two days away from your baby at first." --Claire
Understand how much milk babies actually drink. "Unlike those on formula, breast milk-fed babies need the same amount of milk per day when they're 6 months old as they did when they were 1 month old. Really! By about 1 month, a baby has established how much breast milk she'll need and you don't have to keep increasing how much she eats as she grows. But a lot of moms (and docs) are still applying formula rules to breast milk-fed babies. So remember: If you'll be pumping for the next day's feedings when you go back to work, all you really have to do is maintain your current supply." --Dr. Jones
Feed the baby, not the freezer. "You don't need to pump like a maniac on your maternity leave. You may end up with clogged ducts, mastitis, letdown that's too fast, and exhaustion. You need only a small reserve." --Dr. Jones
Pump Up Your Pumping
Get the right fit. "A lot of mothers don't realize that pump flanges come in different sizes. If the standard shields that come with your pump are too tight or too big, you won't pump as much milk and you could even cause damage. A lactation consultant can help you choose the right ones." --Claire
Make your own DIY hands-free bra. "You don't have to spend a fortune on a fancy bra designed for pumping. Instead, buy a sports bra that's snug, cut little slits in it, and stick the breast shields in there." --Claire
Get in the mood. "To help encourage letdown, download a galactogogue, a relaxation recording designed to stimulate milk production. Search 'podcasts for breastfeeding' on iTunes for a free one." --Dr. Jones
Make cleaning a breeze. "Mothers may be glad to know that as long as your baby is healthy, you really don't have to clean your pump parts every time you've finished pumping. You can simply put all the parts in a plastic bag, store them in a fridge or a cooler, and pull them out to use again a few hours later." --Dr. Jones
Fixing Common Problems
Heal damaged nipples. "Use water-based hydrogel pads or apply enough purified lanolin to keep nipples moist between feedings. --Mohrbacher
Resolve tongue-tie. "If you're having pain even though your latch looks great, ask a lactation consultant whether your baby may have tongue-tie. A specialist can treat the problem." --Jacobsen
Prevent blocked ducts. "Avoid anything that puts pressure on part of your breasts. That includes baby carriers, diaper-bag straps, even sleeping on the same side every night." --Dr. Jones
The Tools Every Breastfeeding Mom Needs
Nursing pillow Unlike other pillows, it wraps around your body and helps with positioning. It can also relieve stress on your back, neck, and shoulders.
Sore-nipple soother Lanolin-based creams are a proven remedy, but some consultants prefer organic coconut oil or Motherlove nipple cream, which are not animal products. (Lanolin comes from sheep. Either can occasionally cause an allergic reaction in a sensitive mom.) All are considered safe for babies. Water-based hydrogels can also promote healing. But your nipples won't heal unless you first solve any underlying latch problems.
Tracking system Download an app such as Baby Nursing (free, iTunes) to record feedings and diaper counts and track doctor's visits during those foggy first weeks.
Expert access Have the number of someone you can call for help (a local lactation consultant or a La Leche League leader) programmed into your phone.
Double electric pump It's a must-have if you're going back to work; look for one with graduated suction- level settings (rather than just high, medium, and low) and several sizes of flanges (breast shields) available.
What's "Laid-Back Breastfeeding"?
Some lactation consultants are embracing a different technique called laid-back breastfeeding, or "biological nurturing." A few early studies have found it can make breastfeeding easier. To try it, lean back or recline slightly, and then bring your naked baby skin-to-skin and facedown on your chest. Use your hands to gently guide your baby's mouth to your nipple, then let gravity and his instincts take over. "Most babies will bob over and self-attach with a great deep latch," says lactation consultant Jessica Claire. "It's a little more relaxing for you and can really help if you've been having pain."