Breastfeeding: The Answers You Need in the First Weeks

What Makes Breastfeeding Work From the Start?

Breastfeeding is a skill that mother and baby learn together, which means difficulties in the first days are normal and not a sign that breastfeeding will fail. The single most important factor in breastfeeding success is correct attachment, meaning the way the baby takes the breast. A shallow latch, where the baby holds only the nipple, causes pain for the mother and does not drain the breast efficiently, which signals the body to reduce production.

A good latch means the baby's mouth is open wide, taking in the areola (the dark tissue around the nipple) not just the nipple itself, the cheek looks full and rounded rather than hollow, and you can see or feel swallowing rather than just sucking. Breastfeeding should not cause significant pain after the first minute of each feed. If pain continues, the latch needs adjusting.

In the first three days, the breast produces colostrum, a thick yellow fluid concentrated with immune factors and growth elements. The volume is small but it precisely matches the capacity of the newborn stomach. Low colostrum volume is not a supply problem. It is exactly what the newborn needs in those first days.

The Most Common Reason Women Stop: Worry About Low Supply

Concern about milk supply is the most frequently cited reason for introducing formula or stopping breastfeeding early. A 2021 study published in Maternal and Child Nutrition confirmed that perceived insufficient milk is extremely common in first-time, fully breastfeeding mothers even when supply is adequate, and that infant crying amplifies this concern significantly.

The breast works on a supply-and-demand basis. The more it is drained, the more it produces. Adding formula without a genuine medical reason in the first weeks sends the body a signal that demand has fallen, so production decreases and the fear of low supply becomes self-fulfilling. A 2013 review in Pediatric Clinics of North America identified this cycle as one of the key barriers to achieving exclusive breastfeeding at six months.

Signs that the baby is getting enough milk: six or more wet nappies per day after day five of life, return to birth weight by two weeks, and periods of alert activity between feeds. If these signs are present, milk is sufficient even if the breast feels less firm than expected. Breast firmness is not a reliable measure of supply.

Night Feeds and Growth Spurts

Babies go through growth spurts at approximately two weeks, six weeks and three months of age. During these periods they feed very frequently, sometimes hourly, which leads many mothers to conclude that supply has dropped. In reality the baby is feeding more to stimulate the body to produce more milk, because requirements have increased. This is a normal and temporary phase that resolves within a few days if feeding on demand is maintained.

Night feeds are a normal and important part of the process. Prolactin, the hormone responsible for milk production, is produced in higher quantities at night. A night feed carries more production-stimulating value than a daytime feed. Mothers who stop night feeds too early without a replacement stimulus often notice a decline in overall supply.

Severe fatigue and high stress affect breastfeeding. A mother who is acutely sleep-deprived or under extreme psychological pressure sometimes produces less milk because elevated adrenaline impairs the release of oxytocin, the hormone that triggers milk let-down. This is a cycle that needs support and rest, not blame or formula as a first response.

Mastitis: What It Is and How to Manage It

Mastitis affects around ten percent of breastfeeding women, according to a study of 946 women published in the American Journal of Epidemiology. It occurs when a milk duct becomes blocked or infected. You feel a hard, painful area in the breast with redness and warmth, often accompanied by fever and flu-like symptoms.

The most common mistake is stopping feeding from the affected breast. Research is clear that continuing to feed from the affected side, or expressing milk from it, is part of the treatment. It drains the breast and prevents the formation of an abscess. Stopping increases engorgement and accelerates the progression to abscess, which then requires surgical drainage. Milk from an inflamed breast is safe for the baby.

Treatment includes rest, warm compresses and regular breast emptying. Antibiotics are prescribed if fever is present or if there is no improvement within 24 hours. A breast abscess is diagnosed by ultrasound and requires drainage. It is a complication that is almost always preventable with early treatment. Seeing a doctor promptly when mastitis begins is the most important step.

Sore and Cracked Nipples

Nipple pain in the first days of breastfeeding is common but should not persist beyond the first week if the latch is correct. If pain continues beyond the first minute of each feed, or if there is cracking, bleeding or a visible wound on the nipple, the cause is almost always poor latch. Correcting the latch resolves this in the majority of cases without any other intervention. Applying a drop of expressed breast milk to the nipple after each feed and allowing it to air-dry supports natural healing.

Tongue-tie (ankyloglossia), a short or tight lingual frenulum, is another common and commonly missed cause of persistent pain. It limits how wide the baby can open the mouth and how deeply they can latch onto the areola. The result is a shallow, inefficient latch that hurts the mother and does not drain the breast well. A paediatrician or lactation consultant can assess for this and the treatment is usually a simple and quick procedure.

A Candida infection of the nipples, sometimes called thrush, causes a burning or shooting pain that continues between feeds rather than being limited to the feeding itself. It often follows a course of antibiotics in the mother. The baby may show white patches inside the mouth that cannot be wiped off. Both mother and baby need to be treated simultaneously or the infection will pass back and forth between them indefinitely. Your doctor prescribes the appropriate antifungal for each.

Breastfeeding While Fasting in Ramadan

This is a question that preoccupies many breastfeeding mothers across the Arab world and is rarely addressed in standard breastfeeding guides. The short answer is that most breastfeeding women can fast safely during Ramadan with adequate hydration and nutrition during the hours between iftar and suhoor. Studies examining the effect of fasting on milk composition and infant weight have not shown significant adverse effects in mothers who compensate adequately.

Hydration is the most important factor. Milk is primarily water, and dehydration reduces milk volume more than caloric restriction does. Drink generous amounts of water between iftar and suhoor, and eat a late suhoor meal that includes fluid-rich foods such as soups, yoghurt and fruit. Avoid caffeinated drinks in the evening as caffeine has a mild diuretic effect.

A woman breastfeeding an infant under six months who notices a reduction in wet nappies, decreased infant activity or weight loss during fasting days should break her fast and consult her doctor. Islamic scholarship explicitly provides for the option to break the fast for a nursing mother when it affects her or her baby's health. The religious concession exists precisely for this situation.

Weaning: When and How

WHO recommends exclusive breastfeeding for six full months with no other food or water, then continued breastfeeding alongside complementary foods to two years or beyond. This guidance is based on strong evidence of benefits to the infant's immune development, cognitive development and protection against diarrhoeal and respiratory illness. A 2023 scoping review in Maternal and Child Health Journal, examining breastfeeding programmes across Arabic-speaking countries, underlined the gap between high initiation rates and low exclusive breastfeeding rates at six months, identifying support gaps in the early postpartum period as the key driver.

Gradual weaning is much easier for both mother and baby than stopping abruptly. Sudden weaning causes painful engorgement, significantly raises the risk of mastitis and may distress the baby emotionally. The recommended approach is dropping one feed every one to two weeks, allowing both supply and the baby's emotional adjustment to proceed progressively rather than as a sudden rupture.

Emergency weaning due to maternal illness or a medication that is not compatible with breastfeeding needs a discussion with the treating doctor before any decision is made. Many more medications are safe during breastfeeding than most people assume. Lactation databases that doctors use list safety data for thousands of medications. Do not stop breastfeeding because of a medication without first checking, because the instruction to stop may have been given out of caution rather than evidence of actual risk.

Breastfeeding in Difficult Circumstances

A 2025 study of breastfeeding practices among long-standing refugees in Jordan found that breastfeeding was maintained across a wide range of difficult living conditions. In environments where water safety is unreliable and cold chains for formula storage are absent, breastfeeding provides protection against diarrhoeal disease and infection that formula cannot match. In these contexts breastfeeding is not one option among several but a critical health protection.

A mother hospitalised after surgery or for a medical condition needs clear guidance from her clinical team about resuming feeding. Most types of anaesthesia do not prevent resuming breastfeeding after a short recovery period. The clinical team should state clearly when feeding can resume rather than suggesting stopping as the convenient default.

If you are separated from your baby for medical reasons, regular expression of milk with a breast pump maintains supply and allows you to resume direct breastfeeding when reunited. Separation does not have to mean permanent cessation. Milk storage guidance from the nurse or lactation consultant will help you plan this.

Sources

• Aboul-Enein BH, Dodge E, Benajiba N et al: Interventions and Programs to Promote Breastfeeding in Arabic-Speaking Countries: A Scoping Review, Maternal and child health journal, 2023
• Crepinsek MA, Taylor EA, Michener K et al: Interventions for preventing mastitis after childbirth, The Cochrane database of systematic reviews, 2020
• Foxman B, D'Arcy H, Gillespie B et al: Lactation mastitis: occurrence and medical management among 946 breastfeeding women in the United States, American journal of epidemiology, 2002
• Mohebati LM, Hilpert P, Bath S et al: Perceived insufficient milk among primiparous, fully breastfeeding women: Is infant crying important?, Maternal and child nutrition, 2021
• Neifert M, Bunik M: Overcoming clinical barriers to exclusive breastfeeding, Pediatric clinics of North America, 2013
• Qasem N, Al-Shdaifat A, Abu-Khader D et al: Breastfeeding practices among long-standing refugees in Jordan: insights from a cross-sectional study, Frontiers in public health, 2025