If breastfeeding is so natural, why do so many women run into problems?

I think there are two main reasons. One is that we don't get enough chance to "learn by observing" and the other is that we tend to interfere with the birth process.

Little girls in many parts of the world have the opportunity to watch mothers breastfeed every day of their lives. By the time they have their own babies, they already know how breastfeeding is supposed to look, how to hold a baby for feeding in many different positions, how to breastfeed with the baby in a sling or lying beside you at night. If they do have any problems, they are surrounded by experienced breastfeeding women who can help.

That's not true for many of us. Most women today have seen more babies being fed from bottles than from the breast. That's one reason you often see new mothers trying to insert their breasts into the baby's mouth as if they were using a bottle. And if problems crop up, the first solution they are offered is usually a bottle of formula.

One step towards counteracting this is to join a group for breastfeeding mothers during your pregnancy. If one isn't available where you live, consider renting or buying some videos. Read books on breastfeeding - especially those with photos and illustrations. You want to have a clear picture in your mind of how babies and mothers look when they are breastfeeding well.

Secondly, it is important to plan for your birth. Getting off to a good start will make the whole process of breastfeeding easier.

Many birth interventions can affect breastfeeding. For example, IV fluids (commonly given when labour is induced or an epidural is used) tend to significantly increase the risk of engorgement - causing your breasts to be very full and hard. Engorged breasts can be difficult for the baby to latch onto and can lead to further problems of plugged ducts or mastitis. The ideal way to begin breastfeeding is to allow the baby to self-attach. If you simply place your newborn on your belly, he or she will naturally crawl and wiggle up to your breasts and latch on to the nipple. You will need to be in a warm room or have some kind of overhead heat source to keep both of you comfortable. It's important not to wash either the baby's hands or your breasts beforehand, as the baby apparently relies at least partly on smell to find the nipple. This can take a long time - on average, close to an hour - and your baby may just nuzzle or lick at the nipple at first - but when babies self-attach this way, latching and breastfeeding problems are extremely rare.

Medication you have been given during labour can affect the baby's ability to find the nipple on his own. You may have to wait until later, when the effects of the medication have worn off.

If your baby was unable to self-attach at birth because of medication or other interventions, you might find it helps to "re-create" the birth later in a warm bath. Get into the tub with your baby, and let the baby relax in the water with you. Then gently lay the baby on your abdomen (out of the water) and allow him to find your nipples and attach on his own. You mayhave to do this more than once.

During the early hours and days after your baby is born, you will begin to learn your baby's hunger cues. He may make sucking movements with his lips, turn his head restlessly back and forth as though searching for something, move his hands up to his mouth, tip is head forward like a little bird pecking, try to suck on his blanket, or many other cues. You will soon learn your baby's signals. Try not to wait until the baby is actually crying, as by that point your baby may be too upset to latch easily.

It helps to have some "breastfeeding corners" set up at home, where you can sit comfortably during these early feedings. A firm support for your back, something to rest your feet on, and perhaps a couple of pillows to raise the baby up to breast-height will help. Many women find the "cross-cradle" hold an easy one to start with. To use this hold, lie your baby across your right arm, with your forearm supporting the baby's weight and your hand supporting his head. His feet will tuck in between your elbow and your body. His tummy should be against your tummy. Your hand is at the base of his head, with your fingers on the bottom and thumb on top, but behind his ears (if you touch his cheek, he will naturally turn towards your touch). Tuck his bottom arm around your waist, and use your other hand to support your breast. With your thumb on top and fingers underneath, but well back from the nipple, brush your nipple against baby's mouth. His head should be slightly tipped back. When he opens his mouth very wide (like a yawn), use your hand and arm to bring him in close. Be willing to wait as long as necessary for that wide-open mouth. Use the hand supporting your breast to aim the nipple at the roof of the baby's mouth.

When baby comes onto the breast, his lower jaw should hit first and should cover more of the breast than the upper jaw. His nose may not be touching the breast (although if you have large breasts, it probably will be) but his lower jaw should definitely be pressed into your breast. Your baby may suck quickly at first, to stimulate your milk to let down, but then you should see a slower suckling pattern, with a distinct pause each time the baby opens his mouth to its widest point. That tells you baby just had a mouthful of milk.

If your baby has latched on well, breastfeeding should not be painful. Some women do experience some tenderness during the early days, and even one or two bad latches may cause bruising to the nipple which will take time to heal. If the tenderness is so much that you are dreading feeding the baby, or if it is getting worse, not better, seek out some help from an experience breastfeeding counsellor.

Expect your baby to feed frequently, and know the signs that baby is getting enough to eat. After the fourth day after birth, you should see at least six soaking wet diapers and at least one or two bowel movements every 24 hours. Let your baby nurse as long as he wants to on the first breast, then offer the second one, again for as long as he wants. But don't be surprised if your baby prefers short frequent feedings.

With a good start, many breastfeeding problems can be avoided. If you do run into challenges, though, or if you have a special situation (such as previous breast surgery or a medical condition, or a premature baby or multiple birth) be assured that there are solutions to most of these challenges and you will be able to give your baby the benefits of breastfeeding. It is well worth the
effort to find a knowledgeable breastfeeding counsellor or lactation consultant.