The ultimate guide to breastfeeding: Expert answers to every new mother's question
A correct latch should feel comfortable. It shouldn't be painful. You can see that the baby's lips are flanged out and wide open, with their mouth far apart.
What you need to know:
- WHO encourages mothers to breastfeed exclusively for six months and up to two years and beyond.
- "Beyond" is dependent on the mother and the baby as long as they're happy to continue the breastfeeding relationship, they can continue for as long as they wish.
Before I started working on this explainer, I asked a question to many mothers via WhatsApp: How was your breastfeeding journey? The responses came in immediately. Voice notes, long paragraphs, others terse.
Reading the replies, I realised that breastfeeding isn’t simply an instinct that falls into place. In fact, it is one of the steepest learning curves of parenthood. For many parents, every feed brings moments of uncertainty, sometimes pain, and countless questions that they type into search engines at 2am.
So, I gathered the questions and posed them to two experts: Mili Wanjiru Karina, a nurse midwife and international board-certified lactation consultant, and Janet Ntwiga, a nutrition specialist with UNICEF Kenya.
1. What should a mother do in the first hour after birth, and why does it matter?
Wanjiru: Immediately after birth, the mother should initiate breastfeeding or start skin-to-skin contact with her baby. That means placing her baby on her chest, skin to skin, so that the baby has the ability to latch onto the breast if they wish, or simply be close to their mum. This keeps the baby calm, warms their body temperature, and regulates their blood sugar and breathing.
For the mother, latching the baby to the breast helps initiate lactation. The body gets the message that it’s time to start producing milk. Even though breast milk has been present in the mother's breasts since around 16 weeks of pregnancy, this begins the active process of lactation.
What's amazing is that the baby can actually do this on their own. Iit’s called the breast crawl. They just need to be placed on the mother's abdomen, and they will use their legs and knees to crawl up to the breast.
2. What is colostrum?
Wanjiru: Colostrum is referred to as liquid gold. It is the first milk a mother produces, full of good enzymes, proteins, human milk oligosaccharides (a short chain of carbohydrates), and packed with immunity-boosting properties. It’s the “fast food” the baby should get and is usually present from birth to about three days.
Colostrum also has a mild laxative effect, helping the baby pass meconium; the black, tarry stool, during the first few hours after birth. The mother's milk will then change to transitional milk, and eventually to the mature milk we tend to identify with its white colour.
One important thing mothers need to know about colostrum is that it has a protective factor: it actually lines the infant's gut, preventing allergens or micro-bacteria from passing through. This gut lining helps protect the baby from allergies and illnesses.
Mothers are encouraged to latch their babies immediately after birth so that they can get this colostrum. We do not want to give newborns anything other than the mother's milk. Many mothers may think, "Oh, it's just a clear fluid coming from my breasts," but that is the start of colostrum. It looks very little and is quite thick and viscous. In fact, it is said that one drop of colostrum is equivalent to about 30 drops of mature milk.
Janet: It is sometimes called a baby's "first vaccine" because it contains antibodies, immune cells, and protective substances. It helps protect against infections, supports gut development, and assists in the passage of meconium. Mothers should never discard colostrum, as every drop is valuable.
4. What does a correct latch look and feel like?
Wanjiru: A correct latch should feel comfortable. It shouldn't be painful. You can see that the baby's lips are flanged out and wide open, with their mouth far apart. The baby's chin is touching the lower part of the breast, their lips look full, and there is no smacking or clicking sound.
Janet: A good latch means the baby takes a large portion of the areola into the mouth, not just the nipple. The baby's mouth should be wide open, lips turned outward, chin touching the breast, and more of the areola visible above the baby's mouth than below. A good latch is essential for effective milk transfer and maternal comfort.
5. What is the difference between normal early discomfort and pain that needs attention?
Wanjiru: It's normal for a mother to experience a bit of pain when she's breastfeeding initially, especially during the first 10 days or two weeks. She may feel some sensitivity within the first 30 seconds or so as soon as the baby has latched on. Usually, I tell mothers to wait and give it a minute as the pain tends to dissipate. If it doesn't, then the latch is incorrect because breastfeeding should not be painful.
Janet: Persistent pain, cracked or bleeding nipples, severe breast engorgement, fever, or pain throughout the entire feed are not normal and require assessment by a healthcare worker. Persistent pain often indicates poor positioning and attachment, or breast complications, and should be assessed promptly.
6. How often should a newborn feed, and what is normal?
Janet: Newborns should breastfeed on demand, day and night, usually 8–12 times in 24 hours. Some babies feed more frequently, especially during growth spurts.
7. How does a mother know her baby is getting enough?
Janet: The baby appears satisfied after feeding, has adequate urine output, and shows steady weight gain. The baby is also alert and active when awake.
8. What do mothers most commonly get wrong in the first weeks?
Janet: Delaying initiation of breastfeeding, giving other liquids and/or foods, poor positioning and attachment, stopping breastfeeding too quickly when difficulties arise, and introducing bottles and pacifiers prematurely.
9. What is the guidance for HIV-positive mothers?
Janet: Mothers living with HIV should exclusively breastfeed for the first six months, introduce complementary foods at six months, and continue breastfeeding for two years or beyond while receiving and adhering to effective antiretroviral therapy (ART). The benefits of breastfeeding, combined with
ART, reduce the risks of transmission. Mothers should remain in HIV care and maintain treatment adherence. Consistent ART greatly reduces the risk of HIV transmission and improves maternal health.
10. When should a mother stop breastfeeding, and when should she not?
Janet: The World Health Organization recommends continued breastfeeding for two years or beyond, while introducing appropriate complementary foods from six months. Mothers should not stop breastfeeding because of common childhood illnesses, teething, return to work, maternal stress, or mild maternal illness.
These and other situations can be managed with appropriate support.
11. What is the guidance on breastfeeding during the baby's illness?
Janet: Breastfeeding should continue during illness and, if possible, be offered more frequently. Breastmilk provides fluids, energy, nutrients, and antibodies that help babies recover. Sick babies may feed more frequently but for shorter periods. If the baby cannot feed directly, expressed breast milk may be necessary.
12. What is the guidance on medication and breastfeeding?
Janet: Most medications are compatible with breastfeeding. However, mothers should always consult a qualified health professional before taking any medicine.
13. When is the right time to wean, and how should it be done?
Wanjiru: We actually do not talk about weaning; we talk about complementary feeding. Weaning means stopping milk and starting foods. We don't wean our babies, we complement their diets. You start complementing their diet from six months. The main reason is that at six months, the iron and vitamin A in breast milk are depleted, and the energy sources in breast milk no longer meet the baby's needs, as they are now more active and require more energy.
Introduce foods that are rich in protein, iron, vitamin A, and energy. They should be thick and dense, not foods you pass through a sieve, to meet the baby's needs. Notably, we do not start with fruits. We start with bland foods, just like breast milk is bland. You don't start with sugary fruits because the baby may then reject other foods. Start with foods like bananas, butternut, pumpkin, potatoes, and avocados. Ideally, start with a tablespoon and add a second tablespoon day by day.
What happens sometimes is that mothers tend to overfeed their babies. Some babies just want to keep eating, and unfortunately, mothers keep giving food. The baby then gets constipated, and the mother panics. You need to follow a routine. At the same time, you need to be sure the baby is really ready for food.
The baby should be able to sit upright, have good head and neck control, have reduced their tongue thrust, and start showing interest in your food, even chewing movements in their mouth. But they should be above six months of age. From the day of birth, 180 days later, you start to complement your baby's milk.
14. What are the risks of weaning too early?
Wanjiru: WHO encourages mothers to breastfeed exclusively for six months and up to two years and beyond. "Beyond" is dependent on the mother and the baby as long as they're happy to continue the breastfeeding relationship, they can continue for as long as they wish.
Now, "exclusively" means no water, no artificial milks, no powdered milks, no foods, and no fruit given to the baby. Babies do not need water because 87 per cent of breast milk is water. There's no need for the mother to give any extra water; all she needs to do is exclusively breastfeed her baby for up to six months. After six months, of course, she can introduce water and other foods to complement breastfeeding. But breastfeeding continues to be the baby's main source of nutrition until they are one year old.
Some risks of complementary feeding or starting to give your baby too much food include constipation, which is quite common. There are also allergies and choking risks if your baby doesn't have good head and neck control.
Regarding allergens, there's no need to prevent giving your baby allergen-causing foods such as peanuts. If you give your baby peanuts at six months or at one year, if they were to get an allergic reaction, they would still get it. Postponing it doesn't prevent it. Eggs can be given from six months, and peanuts or peanut butter are also fine after six months.
Lnjeru@ke. nationmedia.com
