Breastfeeding ABC

When should I start breastfeeding?
 Ideally within one hour from birth - WHO (World Health Organization) recommends.                                
    
 How long should I continue breastfeeding?
The WHO recommends minimum six months of exclusive breastfeeding (i.e. nothing else than breastmilk, not even water or pacifiers) and minimum two years of breastfeeding accompanied by appropriate complementary foods. 
This is a minimum: no upper limits - A mother can continue breastfeeding until she and her child desire to do so. Breastmilk properties  do not diminish with time. Milk composition varies with the child's age but the nutritional and immunological value does not decrease! Breastmilk is taylored to meet the specific needs of your child in each stage of his/her development.

How many times a day should I breastfeed and how long should a breastfeed last?
Breastfeed on clue (i.e. whenever your baby asks for it), untill your baby is satiated and leaves your breast spontaneously(at this point you may offer him/her the other breast - the next feed will start with the last breast offered or with the one that was not given).
This will ensure appropriate emptying of your breasts and adequate milk supply. To understand the mechanism of milk production we can make an easy comparison with a sponge: it can be filled back only once the water has been squeezed out. The hormones involved in the production of milk send a message to the brain asking to 'order' new milk only when the breasts are emptied. It is the law of demand and offer. Reducing the demand artificially (by time-feeding or limiting the duration of a breastfeed) can needlesslly compromise the offer and the overall success of your breastfeeding experience.
Also note that the creamier portion of the milk (called hindmilk) is released at the end of a feed, when the breast is almost empty. Reducing the duration of a feed might deprive your child of important calories.
A newborn baby's stomach is very small and breastmilk is very easily digested. This is a perfect match. Human cubs require small and frequent feeds, especially in their first months of life: at this age, they need a medium of 10-12 feeds per day. Such feeds might not be uniformly distributed along the 24 hours. There might be moments of the day/night when your baby seems to need to feed continuously - followed by longer pauses. This is a very common and normal pattern, called 'cluster feeding'. 
Infants periodically go through phases of intense growth (growth sprints or growth spurts ). During these periods, which normally last few days, your baby will ask to breastfeeding more frequently - sometimes almost continuously. It is normal and the feeding pattern will become more regular once the milk offer adjusts to meet the demand. It is very important to acknowlegde such periods of inense growth by not restraining the baby from feeding: your baby actually needs more milk to meet his growth demands and unrestricted access to your breast ensures and adequate milk supply.
If it is true that some children might have a strong suction at a very early age and empty a breast in 5-10 minutes, most children will need longer time, especially during the first weeks. These variations are normal.
Nevertheless, if seems that your child falls asleep too soon or breastfeeds for excessivelly long intervals without swallowing or really feeling satiated, it is adviced to hear the opinion of a breastfeeding expert (lactation consultant).
 
This is my second child and I have not been able to breastfeed my first one. Does this mean that this time I'd better not even try?
NOT AT ALL! Most breastfeeding problems are simply created by mismanagement and they can be solved with patience and competent help. Women who are really incapable to produce milk are extremely rare (only 3% of the world women population) and in most cases they do not conceive either. A first insuccess does not predict the success of a second experience. Prepare yourself during pregnancy, read good books on the topic and surround yourself with helpful professionals and supportive friends and family members.
 
My baby prefers one breast/one breastfeeding position over the other. ..
This is very common and normal. Anatomic differences in the breasts or in the baby, position in uterus, small - and maybe invisible - birth traumas can make the baby feel more confortable in a specific position or at one of the breasts. Such preferences may remain but normally babies gradually learn to accept both breasts or to breastfeed in different positions. It is important to keep encouraging the child without forcing him/her. Both breasts must be emptied regularly (by the child or by extracting the milk) in order to keep the milk supply up and avoid painful engorgements. Being creative and experimenting different positions can help the baby to accept the same breast 'from a different angle'.
 
My baby refuses my breast - immediately after birth
This can happen due to a variety of reasons -eg. birth traumas, aggressive suctioning after birth, delayed initiation of breastfeeding and interference of bottlefeeding...
It is a condition that can be solved with patience and with the help of an experienced lactation consultant and normally breastfeeding can start and continue succesfully.
In such situations it is very helpful to give the baby a lot of skin-to-skin touch with the mother: in most cases this helps the child accept the breast and stimulates in the mother the production of breastfeeding hormones which will keep her milk supply up.
While the child is not breastfeeding it is very important to empty the breasts regularly and fully in order to keep an adequate milk supply. Expressed breast milk can be used to feed the child through a variety of methods - other than bottles.
A lactation consultant helps the mother build up a sufficient milk supply and bring the child back to the breast.
 
My baby suddenly refuses to breastfeed - after a period of successful breastfeeding
This is a relatively common problem, called 'nursing strike'. It normally happens when the child is not yet ready for solid foods and resolves pretty fast.
The cause of such refusals can be found in various circumstances in the family life: a stress, a fear, a flu, shifting house, a refusal from the mother to breastfeed when the baby asked to...
Patience, sweet attention to the child, skin to skin touch with the mother normally bring the child back to the breast fast.