Many people expect a breastfeeding mother to lose her milk. They believe milk supply can dry up suddenly. It is a case of when, not if, that a mother will need to begin supplementing with formula. In fact, some family, friends or even health professionals have so little faith in breastfeeding being successful, they suggest parents keep formula on hand at home, just in case.

Humans and other mammals have relied on breastfeeding to keep infants alive for thousands of years. Breastfeeding is designed to sustain a baby completely until they start to eat family foods after six months and is then part of the natural diet for at least two to four years of age! Surely it can’t suddenly have become unreliable?

If you give birth without intervention and have uninterrupted skin-to-skin contact with your baby for at least one hour after birth and your baby attached and breastfed, you can expect changes to begin around 30-40 hours after the placenta is expelled.

You might begin to see signs of your milk “coming in” over the following days however what you will definitely experience is signs of your baby taking it out!

It is normal for babies around the second to fourth days to be fussy, unsettled and feeding constantly around the clock. This is one of the most demanding stages of breastfeeding.

It is typical for babies to bring up some milk after feeds. The immature digestive system might not be quite up to the task of keeping milk in the stomach and sometimes it comes back out again! Babies might look surprised, relieved or not react at all. If they just fed, the milk might look much like it did on the way in but the longer it sits in the stomach, the more digested it will look when it reappears. Some babies will just spit up a little while others might projectile vomit an impressive volume of milk. Babies whose mothers have a strong let-down reflex of fast flow of milk might regularly vomit early in the feed to release the pressure before going back on to continue the feed.

“Happy Chuckers” is a nickname for babies who bring up milk without signs of pain or discomfort. Milk which has sat in the stomach a while might have them screw up their face at the sour taste but they are otherwise unbothered.

You probably have a lovely General Practitioner (GP), Paediatrician, Child Health Nurse, Midwife or other postnatal nurse. And if you have concerns about breastfeeding its natural these would be the professionals you would turn to for advice. So it will come as a shock to discover some of these practitioners have less education hours about breastfeeding management than you would expect. And depending on how long it is since they trained, you might be better informed about current best practice in lactation support!

When a baby can feed at the breast but is not able to fully meet their needs, supplemental expressed breastmilk, donor milk or infant formula might be added as a short or long-term strategy. A Supplemental Nursing System (SNS) is a way of doing so without separating feeding from the breast.

Some babies have a temporary or permanent barrier to effectively removing milk from the breast to fully satisfy their hunger. This can be due to pre-term birth, oral variations like tongue ties or clefts of lip or palate, or injury during birth affecting the nerves associated with sucking.

For mothers whose breast development is atypical (Insufficient Glandular Tissue or IGT, for example), surgery or injury has damaged the breast or nipple function or rare medical conditions prevent optimal lactation, fully meeting their babies needs with their own breastmilk might not be possible. However, breastfeeding is much more than breastmilk.

Like any other part of our body, breasts and nipples can experience injury, inflammation and infection. Nipples are particularly at risk in the early days of breastfeeding as mother and baby learn to breastfeed together. The highly sensitive skin of the nipple and areola helps the baby find the breast and signal milk release. But just as our heels and toes are vulnerable to damage from new or ill-fitting shoes our nipples are vulnerable to new or ill-fitted babies!

Most mothers will experience an element of discomfort or short-term pain when their baby is learning to attach well. Like anything, it takes practice to get it right every time. When a baby is consistently attaching incorrectly though, the delicate skin can be grazed or even split due to pressure, leading to sore or cracked nipples. With skilled help to help your baby take a good mouthful of breast tissue, the nipple is positioned further back and damage will not occur.

Relactation is the process of stimulating milk production after a period of not removing milk regularly by direct feeding or expressing. This is usually weeks or months down the track. The human breast is a complex system and its flexibility is surprising. Even if you have only small signs of lactation, like being able to squeeze a trace of milk from the breast, you can boost production to once again meet some or all of your baby’s daily needs! In fact, women who have never been pregnant or breastfed can establish a breastfeeding relationship with adopted babies!

Can birthweight have any impact on breastfeeding?

When we consider than the recommended minimum for breastfeeding is two years and the average weight of a two year old is around 10.6 - 13.9kg (23.3 – 30.7 lbs) for girls and 11.1 - 14.6 kgs (24.4 – 32.2 lbs) for boys, clearly breasts can produce enough milk for even the largest newborn baby!

What do we know about breastfeeding and PND?

Women who are breastfeeding and experiencing symptoms of PND might wonder if breastfeeding is having an impact on their mental health.

Women who have symptoms of PND and are breastfeeding might wonder if their mental health is having an impact on the breastfeeding.

Researchers in recent years have explored both these scenarios and results show some interesting data.

Never again does the human develop at the rate it does in the first three months of life. Newborns typically sleep around 16 hours out of 24, conserving energy and allowing for the Active Sleep state, which wires the enormous human brain in advance of each stage of physical and intellectual development. Humans produce a unique milk which supports this rapid brain growth, unlike many mammals who need to produce young with strong muscles and bones to allow them to keep up with a moving herd.

During pregnancy, a woman finds herself the centre of attention. Even total strangers care about her comfort and well-being. She is urged to eat well, get enough rest and take care of herself.

Labour and birth change everything - most significantly, the new mother must share the limelight with the new kid in town.

The word trauma has only recently been used to describe some women's experiences of birth and breastfeeding, yet childbirth and the postnatal period have long been the most risky stages of female life and - in the past and sadly in some parts of the world today - a matter of life and death. 

While some populations in the modern world no longer fear death as an outcome of birthing or lactation, they face a new threat to their mental health.

Breastfeeding is a relationship between a baby and their mother. But it is also a relationship between a baby and the breasts. A complex system of hormones guides your baby in many ways which might surprise you.

Evolution of Man as hunter-gather meant our males needed to become swift as they hunted prey large enough to meet the needs of their tribe. Running while covered in thick hair in hot climates such as that we now call Africa was not efficient, so over time, hair became shorter and finer: it aided evaporation of sweat, keeping the runner cool as he covered long distances. But the female also became increasingly hairless, posing quite a problem for mothers.

One of the biggest barriers to successfully establishing breastfeeding is the use of routines or schedules.

From the innocent-sounding “feed, play, sleep” to the extreme regimes favoured by some sleep training advocates, using the clock to structure babies feeding patterns is not compatible with the natural relationship between baby and breasts.