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Breastfeeding your baby is the first line of defence against infection.

Breast milk contains all the major nutrients your baby needs for his growth and development. Additionally, it often contains helpful substances such as antibodies and enzymes (which are not present in infant formula) that protects baby from diseases and enables your baby to digest major nutrients better.

Best for baby

• Breast milk contains all the nutrients your baby needs in the right proportion.
• It boosts the immune system, reduces risk of getting acute respiratory tract infections, pneumonia, diarrhoea and allergies.
• Breastfed babies are smarter
• It reduces risk of chronic illnesses such as obesity and Type 2 diabetes

Best for mum

• Breastfeeding promotes bonding between mother and baby
• It helps mums get back into shape faster as it helps to burn extra calories
• It speeds up the recovery as it reduces postpartum bleeding
• It reduces risk of post-menopausal breast and ovarian cancer
• It may reduce the risk of hip fractures and osteoporosis in the postmenopausal period

Exclusive breastfeeding means that baby is given only breast milk. No water, food or other types of drinks are necessary. Exclusively breastfed babies receive the greatest health benefits from breast milk. Other food or drinks, even water, can interfere with breastfeeding because it fills baby up so he nurses less. Babies need the nutrition and calories in breast milk to grow. Water, for instance, has none of these.

Ready … set … go!

For many women, the first signs that they are pregnant may be the changes to their breasts. They may experience tenderness, swelling and the darkening of nipples and areolas (the circle of skin around the nipples), all signs that the body is getting ready to supply milk to the coming baby.

The small bumps on the areola enlarge in readiness to produce a natural oil that will clean, lubricate and protect the nipple during pregnancy and breastfeeding. This oil contains a bacteria-killing enzyme, and makes breast creams unnecessary.

As you can see from the top diagram, the duct that holds the milk is just below the areola. Hence, it is important to latch baby on the areola to withdraw as much milk as possible, not on the nipple which is just an opening for the milk to flow out (it has 15-20 openings).

When baby suckles, the stimulation will trigger the brain to release a hormone called prolactin, which causes the milk cells in the breast to produce milk.  Hence, the earlier and the more frequent a baby suckles, the faster milk will be produced.

Prolactin levels are highest at night. Therefore, it’s also important to breastfeed your baby at night to maintain good milk supply.

Another hormone called oxytocin is also released and it causes the muscles surrounding the milk cells to squeeze the milk out and flow to the milk ducts.  This is called the letdown reflex, during which milk flows out of the nipple. It also helps the mother relax. Let down may take several minutes, especially when the mother is tired, in pain or stressed.

If the breasts are not emptied frequently, they can stop producing milk. Breast size has nothing to do with milk production. The more you nurse, the more milk is produced.

The composition of breast milk is very unique in the sense that it fulfils the babies’ needs according to their stages of development. It changes from colostrum to transition milk to mature milk.

Colostrum

This “first milk” is present before birth and up to a week after baby is born. It’s thick and sticky with a colour that varies from pale cream to orange. This easily-digested milk is rich in protein, vitamins,  minerals and antibodies for protection, thus known as “the first immunisation”. It encourages early bowel movement, which helps to minimise neonatal jaundice. No wonder colostrum is sometimes referred to as “liquid gold”.

Transitional Milk

This creamy milk is produced, following colostrum, for approximately two weeks. The quantity of milk increases, and composition changes. There is less proteins and antibodies in this milk, but more fat, lactose and water, hence it may look more watery than normal milk but rest assured, it is enough to fulfil the requirements of the newborn at this stage without overloading their immature organs. At this stage, it’s important to nurse frequently to avoid engorgement.

Mature Milk

This final milk is produced near the end of the second week after childbirth. About 90% is water, necessary to maintain the hydration of the infant; while 10% comprises carbohydrates, proteins and fats, in the right proportion, all necessary for both growth and energy, as well as antibodies, growth factors and enzymes.

Mature milk consists of foremilk and hindmilk. Foremilk flows at the start of feeding and looks like barley water. It contains water, vitamins and protein. Hindmilk flows after the initial letdown and is bluish white. It contains high levels of fat and is necessary for weight gain.

As a particular feeding progresses, the fat-content of the milk increases. The amount of time it takes to receive his fill of the higher-fat milk at the end of the feeding varies from baby to baby. Therefore, it is important NOT to switch breasts while baby is actively nursing. Allow baby to feed on one breast at a time instead of changing breast during feeding, so that he will be able to get both the fore and hind milk.

Breast milk is more easily digested than formula milk, so baby will need to be breastfed more often than if he were formula fed.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

• Doctors or nurses – speak to them if you have any concerns regarding breastfeeding.
• Postnatal care – you can request this service if you feel you need support.
• After your baby is born and you have been discharged from the hospital (government/private), inform your nearest Klinik Kesihatan.
• They will send a government-registered nurse to visit you at home to check on you and your baby.
• The nurse will help with guidance and support for breastfeeding, bathing and caring for your newborn.
• Lactation Expert/Consultant
• This is someone who can teach you proper breastfeeding techniques and talk about breastfeeding issues and concerns
• Breastfeeding NGOs
• Check out organisations such as World Alliance for Breastfeeding Action (WABA), a global community for breastfeeding information and action. It also offers advice and support to breastfeeding mums.
• Mother’s support group/counsellor groups
• Look out for breastfeeding support groups. You can enquire about it from hospitals and health care professionals. These support groups will be able to provide encouragement, information and support to breastfeeding mothers.

New mums need a lot of support in early days and weeks of breastfeeding. It has been shown that women with friends who have breastfed successfully are more likely to choose to breastfeed. On the other hand, negative attitudes of family and friends can pose a barrier to breastfeeding.

The role of dad

Research shows that fathers have a strong influence on mother’s decision to initiate and continue breastfeeding.

Mothers report feeling less anxious and isolated due to fathers acknowledging and supporting their emotional needs, and sometimes by just “being there” when needed.

What dads can do:-

• Attend antenatal or breastfeeding sessions with mum.
• Give emotional and practical support.
• Arrange paternity leave.
• Help with household chores.
• Ensure meals are ready and healthy for mum
• Get involved in baby’s care, eg bathing baby, lulling baby to sleep after each feed.

The role of family

• Help with household chores.
• Look after baby so mum can nap, or have some “me” time.
• Play and cuddle baby to promote verbal, physical and emotional interaction.

The role of friends

• Be supportive of breastfeeding efforts.
• Offer to help, for example by picking up groceries for mum or getting her lunch.
• Be considerate when going out – is your destination breastfeeding friendly?

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

Equip yourself with breastfeeding knowledge

• Learn about breastfeeding from books, reputable websites such as those with addresses ending with .org, or .gov, and websites written by a panel of experts.

Join antenatal classes/breastfeeding classes

• To gain hands-on experience and get information on breastfeeding from trained healthcare professionals during antenatal visits.
• Learn the correct breastfeeding techniques

Seek professional support

• Find a lactation counsellor/consultant. Research shows that getting professional advice helps improve confidence in breastfeeding, and increases the chance of success.

Consider joining a breastfeeding mother’s group

• To allow discussion about breastfeeding matters with experienced mothers and seek help, if needed. This helps to strengthen knowledge and motivation.

Enlist the support of family members

• Besides gaining support from husband, it is important to talk to other family members such as mother, mother in-law and other siblings about your decision to breastfeed. They all play a big role in contributing to the success of breastfeeding.

Be mentally prepared and determined

• As long as you are determined, nothing can stop you from giving your baby the best.

Choosing the most comfortable breastfeeding position for you and your baby, and mastering the correct breastfeeding technique are the keys to breastfeeding successfully.

Latching on

It’s important that baby latches on, or attaches, well to the breast as this will prevent many breastfeeding problems. Good attachment helps to prevent any nipple pain from sore, grazed or cracked nipples. It also ensures that the breasts drain well, which will help maintain the good milk supply baby needs in order to be healthy.

When a baby is not latched on properly, milk flow is lessened. This can lead to a blocked duct, or mastitis, an infection of the breast tissue that causes pain, swelling, warmth and redness.

To ensure baby latches on correctly:

	1. Hold your baby close to you with his nose level at your nipple. Brush you baby’s lips lightly across your nipple. If he is well positioned, he should already be right by your nipple.
	2. When his mouth opens wide, quickly move his head onto your breast so that he can take a good deep mouthful of breast, not just the nipple.
	3. Your nipple should point towards the roof of his mouth.

Breastfeeding positions

	1. Cross arm position Ideal for early breastfeeding Useful position if you have a small or ill baby It lets you support baby’s head and body well, making it a useful position for new mothers to adopt Take care that baby’s head is not held too tightly to prevent movement.
	2. Cradle position Similar to cross arm, but you support the baby with the arm on the same side as the nursing breast, rather than opposite arm Baby’s lower arm is tucked around your side Take care that baby’s head is not too far into the crook of your arm and that your breast is not pulled to one side
	3. Underarm / football hold position Good for C-section or if you have twins, large breasts, flat or inverted nipples This position also lets you have a good view of your baby’s attachment to your breast. Take care that baby is not bending his neck and forcing his chin down the chest
	4. Lying down on side position Good choice when you’re tired which helps you to rest especially if you’ve had a C-section Take care that baby’s nose is at the same level as your nipple and that he does not need to bend his neck to reach your breast.

There are many different types of breastfeeding accessories. Here’s a list of accessories and their uses. Bear in mind that not all of these accessories are necessary for all mothers. Mothers should always consult a lactation nurse/consultant or an experienced mother before deciding to purchase these items.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

The sooner the better
Mothers should begin breastfeeding within one hour of giving birth.

Skin-to-skin contact between baby and mother should be established immediately following birth for at least an hour. It has the following benefits:

• Keeps baby and yourself calm
• Keeps baby warm and helps keep his heart beat and breathing stable
• Allows baby to make eye contact with you which is great for early bonding between mum and baby.
• Allows baby to find your breast and self-attach, letting him learn quickly how to suckle effectively

Benefits of early breastfeeding:

• Ensures baby receives colostrum, also referred as the “first milk”, which is rich in substances that protect against infection and disease.
• Baby’s digestion and bowels are stimulated.
• Sucking difficulties may be avoided if baby feeds properly at this stage.
• The mother-baby bond is enhanced.

Breastfeeding after C-section

If you have delivered by C-section, when you can breastfeed your newborn depends on how you feel and how your baby is doing. If you’re both in good shape, you can probably start breastfeeding in the recovery room, shortly after the surgery.

If you’re groggy from anaesthesia or your baby needs immediate care in the nursery, you will need to wait for the first nursing session but start to express your colostrum and get lactation started. The expressed colostrum can be given to your newborn whilst waiting for the first nursing using a spoon or syringe.

The biggest challenge is getting through the first few days of breastfeeding. New mums who are able to overcome this critical period are more likely to continue breastfeeding for a longer period of time. The key is to be calm and determined.

What mums can expect:

During the first week after giving birth, you may experience some drastic changes to your body, physically and emotionally. Don’t worry, these problems happen to nearly all women after delivery. It’s just a transition period.

Engorged Breasts

When first milk arrives, it will leave your breast swollen, painfully tender, throbbing, hard and sometimes seriously, frighteningly gigantic. It can be avoided if you breastfeed frequently and on demand. Avoid long periods between feedings. During the day, if your baby sleeps more than two hours, try waking him up and offer him the breast. This will help to empty the breast before it becomes engorged.

The good news is that this won’t last long. Your milk supply-and-demand rhythm should be established in the matter of days, and engorgement and its effects will gradually fade.

What to do: When your breast is engorged, it becomes very hard, making it difficult for the baby to latch on. Therefore, you must first reduce the swelling by hand expressing some of the milk out. You can also apply warm compresses to the breast or take a warm shower before expressing, which helps the milk to flow. Otherwise, you can also use cold compresses after feeding or expressing, which helps to reduce the swelling.

Worries about milk delivery

The “first milk”, colostrum, which contains antibodies for your baby is present, in small amounts, after birth. Babies aren’t born with big appetite or with immediate nutritional needs. Your newborn’s stomach is the size of a cherry.

After about 3 to 4 days of nursing, your breasts will start to feel less soft and more firm as your milk changes from colostrum to transitional milk that looks like skimmed milk. While babies don’t need much more than some colostrum for the first couple days, the doctor may need to make sure the baby is getting enough to eat.

What to do: Breastfeed more frequently, putting baby to the breast every 2 to 3 hours. If your milk still hasn’t come in within 72 hours after the birth of your baby, you should talk to your doctor.

Leaking breast milk

Sometimes, breast milk may leak unexpectedly from your nipples.

What to do: Press your hand gently but firmly on your nipple when this happens. This usually helps very quickly. Wearing breast pads will stop your clothes from becoming wet with breast milk. Expressing some milk may also help.

Sore nipples

Tender nipples can make nursing a frustrating experience. The good news is that the pain will go away as you get used to breastfeeding. Your nipples will toughen up quickly and soon breastfeeding will become painless.

However, in most instances pain experienced throughout a feed is due to poor attachment. So, it’s important to learn the proper latching technique to prevent discomfort and ensure your baby is getting sufficient nutrition from you.

What to do: Apply some expressed breast milk after feeding and use comfortable bra with good ventilation to heap with the healing.

What to expect for baby:

Baby has a very small tummy and needs only a small amount of breastfeed to keep going. They will be able to get enough breast milk by feeding frequently to fill the small stomach. There is no fixed schedule for breast feeding babies. They should feed on demand, i.e whenever they are hungry or show signs of hunger.

Feeding habits

• Feeds should occur every 2 hours (8-12 times in 24 hours). This is a general guide. Different babies have different needs. During the early periods, some babies may want to feed every hour or so.
• Baby should not go longer than 4 hours at night without feeding.
• Pay attention to baby’s hunger cues and nurse him immediately whenever is needed. Don’t wait until baby cries to put him to the breast as crying is a late sign of hunger
• Early hunger cues include:-
  • Increased eye movement
  • Opening his mouth and stretching out his tongue while turning his head around to look for your breast
  • Making soft whimpering sounds
  • Sucking on hands, fingers or any nearby objects
  • Crying softly and gradually louder. (Crying is usually the last hunger sign.)

• Encourage your baby to feed as long as he is actively suckling. Detaching a suckling baby from your breast before he’s finished, or allowing him to fall asleep shortly after beginning to feed, may throw off the breastfeeding rhythm of supply-and-demand.
• Allow him to breastfeed until he seems full – at this point he will probably detach from the breast by himself.
• The longer your baby nurses, the higher the fat content of the milk he is drinking.
• Shorter, timed nursing periods may not allow him the opportunity to enjoy the full benefits of your breast milk and may leave your breasts full of unreleased milk, making you feel engorged and uncomfortable.
• Do not give pacifiers or artificial teats to breastfed babies except upon doctor’s advice.

How to know if baby is feeding well?

1. Nappy alert

Take note of baby’s nappy changes. His wet diapers and bowel movements indicate whether or not he is getting enough breast milk.

The following is what you can expect:

For the first three days, baby feeds on colostrum, thus would most probably have green-black sticky poo and about 1-3 wet nappies. As milk volume and intake increases, his poo will change to greenish-brown colour and slowly to mustard yellow after the 1^st week. The frequency of bowel movements ranges from 3 to 8 times a day and generally less frequently as baby grows older.

Urine should be clear to light yellow and expect baby to pass urine 6 to 8 times (or more) a day after the 1^st week. If you are concerned, always speak to your doctor or lactation nurse/consultant for advice.

2. Baby’s growth

It is normal if your baby drops a little weight at first. Babies should stop losing weight by the fourth day, begin gaining by the fifth day, and be back to birth weight by no later than the fourteenth day. Always speak to your doctor if you are concerned with his growth.

3. Baby looks healthy and sleeps well

Baby should be sleeping well and looking healthy and alert when awake. If baby is feeding well, he will have a good muscle tone and healthy skin. It won’t be long before he grows too big for his clothes.

4. Cry baby

Baby may be crying often. There are a lot of reasons babies cry, not just to tell you he’s hungry. It could be that he is new to this world and needs more time to get used to his new surroundings, or that he is simply feeling lonely, and seeking attention and comfort. He may also be uncomfortable i.e too cold, too warm, dirty nappy etc. Always keep yourself calm and patient when your baby cries. Try your best to identify the cause of the cry and attend to your baby’s needs accordingly. If you are stressed, your baby will feel it and be stressed too.

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.

• Breastfeeding should not be painful. For the first few days of breastfeeding, it’s natural to experience some tenderness, but this feeling should not persist, and mothers should not feel uncomfortable as to need to stop breastfeeding.
• Furthermore, anything more than mild discomfort, such as sharp nipple pain and even nipple damage, is abnormal and normally due to baby latching on poorly. If the proper positions are adopted to breastfeed, pain should not be a major issue for mothers.
• So, mastering the proper latching techniques and breastfeeding positions can help keep discomfort at bay.

• Actually, most women produce more than enough milk for their babies. Most of the time, when babies gain weight too slowly, or lose weight, it’s not because the mother isn’t producing enough milk. It’s because the milk isn’t getting to the babies.
• The usual reason is that the baby is not properly latched on to the breast. So, it’s important for all mothers planning to breastfeed to learn about proper latching techniques from the start. If unsure, always ask the nurse to help.

• That’s certainly not true. As long as there are no medical complications, a mother who has just had a C-section can still breastfeed. She will just need some assistance as she will be nursing on her back, and the movement of one or two of her arms may be limited due to the placement of intravenous lines.

• Breastfeeding does not cause sagging, and research has shown that it does not negatively affect breast shape or volume either. It is actually pregnancy that changes the shape of a woman’s breast. This will happen, whether or not she breastfeeds.
• Wearing a good, supportive bra during pregnancy and while breastfeeding will help to hold the breasts up, and keep the ligaments from stretching.
• To maintain the appearance of their breasts, women should also eat healthily, lose weight gradually after pregnancy, and exercise regularly.

• No, absolutely not! The size of breasts indicates the amount of fat they contain. It has nothing to do with their capacity to produce milk.

Insert video: “Expert: Common Breastfeeding Concerns”

For further information on infant and child nutrition, please refer to

1. MINISTRY OF HEALTH MALAYSIA (2013) Malaysian Dietary Guidelines for Children and Adolescents. Putrajaya: Technical Working Group on Nutritional Guidelines (for National Coordinating Committee on Food and Nutrition).
2. NUTRITION SOCIETY OF MALAYSIA (2011) Breastfeed with Confidence. Petaling Jaya: Mother’s Smart Choice.