Ask a Doc: Breastfeeding: What Do I Need to Do to be Successful?

April 07, 2015


Dear Doc,

I am about to have my second child. I did not breastfeed my first child because I had to go right back to work. Since then I have learned a lot more about the benefits of breastfeeding. With this baby, I really want to breastfeed. I know I can use a breast pump once I go back to work but what else can I do to make sure I have a good supply of breast milk?


Mayo Angelo said, “I did then what I knew how to do. Now that I know better, I do better.” It is wonderful that you are planning to breastfeed your second child. Breast milk is the best source of nutrition for infants. In order to answer your question about your milk supply, I have asked Rebecca Surgoine, a certified lactation consultant at Newark-Wayne for her expert advice.

“It is excellent that you have decided to breast feed! Your question about making milk might be the most common question among mothers who plan to breastfeed,” said Rebecca Surgoine, RN, IBCLC. “While some women may have risk factors that can impact milk production, most women can, and do, make more than enough milk for their babies.”

The first few days that you are breastfeeding require a little bit of faith. Your first milk, colostrum, is very concentrated, and you likely won’t notice it being present in your breasts just yet. Most babies only need to eat about ½ -1 teaspoon of colostrum each time they feed during the first few days, so that is approximately the amount of colostrum your breasts will make. Since you have just the right amount of colostrum, and your baby will be emptying your breasts often, you may not be able to tell that your milk is starting to “come in.”

It takes most women’s bodies 3-5 days to have their milk “come in.” While you are waiting, your baby will want to feed very often: at least 8-12 times each 24 hours. While you may be tired, the good news is that the more your baby breastfeeds in the first 3-5 days, the more milk you will make, and the faster your milk will “come in.”

During this time, if your baby is not able to breast feed or is fed formula, your milk supply may be quite limited and may take longer to come in. The most important way to ensure that you will make enough milk, is to make sure your baby breastfeeds often enough in the first 3-5 days. Make sure you are getting enough rest, proper nutrition and staying hydrated. You should also continue to take your prenatal vitamin while breast feeding.

It is important to avoid giving formula to breast fed babies, unless medically needed; this is to ensure a mother’s milk “comes in” as it should. In the event that your baby cannot breast feed, a hospital-grade electric pump, like the ones we use on the Labor and Delivery floor, is the best tool to continue to maintain your milk supply. A lactation consultant is available in the hospital and can explain more about pumps and help you develop a pumping schedule that will work for you and your situation.

The World Health Organization recommends exclusively breastfeeding infants for the first six months. While this may not be possible for every Mom and baby, research has proven there are many immediate and long term benefits to breastfeeding.

Benefits to your baby include:

  • Reduction in acute illnesses (ear infections, colds, GI viruses) even after breastfeeding is stopped
  • Improved gastrointestinal function
  • Decreased obesity
  • Reduced risk of childhood cancers such as leukemia and lymphoma
  • Reduced risk of developing cardiovascular disease as an adult
  • Decreased risk of developing diabetes
  • Improved visual and cognitive function but it is unclear if this is a significant difference
  • Improved maternal bonding which may reduce stress

Benefits to you include:

  • Faster recovery from childbirth
  • Decrease stress – improved maternal child bonding
  • Enhanced weight loss after pregnancy
  • Reduced risk of breast and ovarian cancer
  • Decreased risk of developing cardiovascular disease
  • Cost savings of ~$1000 per year for formula with further cost savings due to decreased medical cost from reduced illnesses

Additionally there are some risks associated with bottle feeding. The most significant immediate risk is contaminated formula or bottles. This can lead to possible infections or exposure to environmental toxins. While this risk is small, in 2008 six infants died and 54,000 were hospitalized in China due to a chemical added to formula. In a separate incident in China, several infants died of malnutrition when formula was watered down. Here in the U.S., it is estimated that if 80-90% of infants were breastfed, over 900 infant deaths could be avoided annually and over $13 billion could be saved in health care costs from preventable illnesses.

We are very fortunate that here in Wayne County our health department and our hospital have recognized the importance of breastfeeding and supporting families with this effort. Unfortunately data from 2008-2010 shows that Wayne County was well below the state average for breastfeeding infants for at least six months. The NYS average during that time was 39.7% and in Wayne County this was 16.2%. In an effort to combat this, Newark-Wayne Community Hospital overhauled its policies and procedures around infant feeling. In January 2015, Newark-Wayne was awarded Baby Friendly status by the World Health Organization in a partnership with UNICEF. This award recognizes that Newark-Wayne is following best practices to support maternal child bonding and infant nutrition. Back in 2011, as few as 41% of Moms delivering at NWCH began breastfeeding. That rate has risen to an astounding high of 82% in 2015.

If you have more questions about making enough milk, breastfeeding, or returning to work and pumping, contact a lactation counselor through your OB or pediatric office.

Tara Gellasch, MD, is the Associate Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email Dr. Tara Gellasch’ s assistant, Monica Decory with questions for Dr. Gellasch at and write “Ask a Doc” in the subject line. The Women’s Center at NWCH is located at 1250 Driving Park Avenue, Newark. Call (315) 332-2427 to schedule an appointment.