The 12 steps of frequent flexible breastfeeding (which make life easier, not harder!)

1. Enjoy abundant skin-to-skin contact with your baby in the first hours and days after the birth

Generous opportunities for skin-to-skin contact in the first hours and days after birth makes it more likely that your baby will be interested in frequent and flexible breastfeeds (though feeds may not last for long).

When frequent and flexible breastfeeds occur in the early days of your baby's life, you

• Have less risk of mastitis and engorgement in those first days, and

• More chance of producing enough milk to meet your baby's needs in the weeks to come.

2. Around 12 offers each breast in a 24-hour period is biologically normal and works best for most mothers and babies

Many or most women need to offer each breast about 12 times in 24-hour period (without counting or watching clock) to maintain milk supply and baby weight gain. This is much more often than you might have heard.

3. You don't need to ‘drain’ the breast

About sixty percent of milk is transferred in the first two letdowns of a feed, though most women don't feel milk ejections. Subsequent letdowns in the same feed transfer less and less milk.

This explains why frequent shorter episodes of milk removal are more effective than spaced, longer episodes of milk removal for making milk and maintaining your supply.

Fat content over a 24-hour period is same between women regardless of feeding frequency and there's no need to try to make baby receive cream by extending breastfeeds.

Your breasts are never 'empty'. Trying to keep your baby on the one breast as a pattern over time may decrease your milk supply.

4. You don't need to make sure your baby fills up with a meal of milk each breastfeed

The research shows that in happily and successfully breastfeeding mother-baby pairs, some breastfeeds don't transfer much milk at all. This is normal. It's building up the pattern of frequent, flexible, relaxed offers over time that matters.

There is no need to count sucks and swallows. The ratio of sucks to swallows in breastfeeding is highly variable, and it's not helpful to track this.

What matters is that your baby has unrestricted access to your breast. Then (as long as any underlying problems like nipple pain or difficulty bringing baby on have been sorted out) we can trust your baby will take the milk that he needs over a 24 hour period. It's important you don't feel under any pressure to make sure baby is taking milk in with any particular breastfeed.

5. The length of time taken to breastfeed and the use of one or both breasts at a time are highly variable

Some breastfeeds will be short or very short, depending on the age of your baby. Others will be much longer. Often, you might just take baby off just because you've had enough, especially after the first few weeks! Then you get into your day and see what happens.

You don't have to offer both breasts in the one feed but you might also find your baby wants to go between breasts.

• You can offer the breast again even if only a very short period of time (for example, five or ten minutes) has passed since the previous feed.

• Breastfeeds are best occuring ‘on the go’ in the midst of a day which meets your baby's needs for rich sensory motor nourishment and your own needs for a rich social life, or to get tasks done, or to exercise your body. You can find out about your baby's sensory motor needs starting here.

• Breastfeeding dials babies down during the night, which makes night-waking much more manageable. Excessive night-waking is not caused by the 'habit' of frequent flexible feeds, but by disruptions to the biological sleep regulators. You can find out about this in The Possums Sleep Program.

6. Babies suckle to meet both nutritional and sensory motor nourishment needs

There is no need to try to determine if your baby is hungry or not. You can offer the breast whenever you feel like it, or when you think the breast might

• Dial your baby down, or

• Prevent baby from dialling up.

You might worry that you are supposed to wait for specific cues from your baby before you offer the breast, but this is not the case. You can find out why we don't give parents lists of possible breastfeeding cues in the Possums programs here.

Non-nutritive sucking is an unhelpful term, because it makes people think that the times when baby isn't vigorously swallowing aren't an important part of the breastfeed. But periods of 'suck-suck-suck-suck-suck-suck-suck-swallow' can still be accompanied by the transfer of small amounts of milk. And anyway, milk transfer is about patterns over a 24-hour period, not about what happens in any one particular breastfeed. Suckling even when not much milk is being transferred meets your baby's powerfully soothing biological need to suck and be close to you for a time.

7. Breastfed babies can’t be overfed

It's not possible to overfeed your baby from your breast. However, any pressure with breastfeeding can result in baby developing a conditioned dialling up at the breast, which is distressing and important to avoid. You can find out about conditioned dialling up at the breast here.

A baby can also be returned to the breast after a puke, or if she has just fed, or whenever you want to.

8. Your baby can be trusted to communicate when he's not interested in the breast

You can trust your baby to self-regulate her needs at the breast, in the context of frequent and flexible offers (as long as any underlying problems like nipple pain or difficulty coming onto the breast or the sleepy newborn with jaundice have been addressed).

Babies can be trusted to communicate when they're not interested in breastfeeding, which they'll do by dialling up and other physical signs - including not wanting to take the breast.

9. Avoid placing any pressure on your baby to breastfeed or stay on the breast

Accidentally placing pressure on your baby to feed can result in conditioned dialling up at breast, which you can find out about here.

10. There's no need to burp or hold your baby upright after feeds

Babies don't swallow significant amounts of air, even when encountering breastfeeding problems. Burping or holding upright after feeds unnecessarily rouses infants. You can find out about this here.

11. Baby is your best breast pump

Some babies don't suckle well because they

• Have underlying diagnosed neurological condition

• Are prematurely born, or

• Are in the newborn period, when sleepiness and jaundice can be problems.

But mostly, baby suck problems are not due to an intrinsic weakness of suck, but relate to the way baby is fitted into your body.

Once these problems are sorted out, baby is your best breast pump, better than any machine!

12. Experimentation is the key to resilience

You, as a breastfeeding woman, are the one who has expert knowledge about your own baby! You'll experiment with frequency of offers and responses to your baby's cues or communications to see what works.

You can find out about experimentation here.

Selected references

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Douglas PS. Re-thinking benign inflammation of the lactating breast: a mechanobiological model. Women's Health. 2022;18:https://doi.org/10.1177/17455065221075907.

Douglas PS, Hill PS. A neurobiological model for cry-fuss problems in the first three to four months of life. Med Hypotheses. 2013;81:816-822.

Kent JC, Gardner H, Geddes DT. Breastmilk production in the first 4 weeks after birth of term infants. Nutrients. 2016;8(756):doi:10.3390/nu8120756.

Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatics. 2006;117(3):e387-395.

Moore ER, Berman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2016(Issue 11. Art. No.: CD003519):DOI: 10.1002/14651858.CD14003519.pub14651854.

Prentice, A., Paul, A., Prentice, A., Black, A., Cole, T., Whitehead, R. (1986). Cross-Cultural Differences in Lactational Performance. In: Hamosh, M., Goldman, A.S. (eds) Human Lactation 2. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-7207-7_2

Schafer R, Watson Genna C. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery and Women's Health. 2015;60:546-553.