Your Breastfeeding Questions, Answered by an Expert

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New parenthood is a lot — and breastfeeding can feel like its own full-time job, especially when you’re running on minimal sleep and up in the middle of the night for a feeding. Jessica Tucker, DO, NABBLM-C, a women’s health and lactation medicine specialist at OhioHealth, answers the questions new and expecting parents ask most about breastfeeding.

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Getting started

What is breastfeeding and how does it work?

Breastfeeding is a natural feeding process for a parent a baby, but it’s about more than feeding your baby. It’s a full-body experience for both of you, and it starts the moment your baby latches for the first time.

“With the initial latch, it actually causes a flood of hormones to be released,” Dr. Tucker explains. One of the things these hormones help with is causing the uterus muscles to contract after giving birth. That’s a good thing, as it clamps down on the blood vessels inside of the uterus that could cause postpartum hemorrhage and suppresses one of the leading causes of maternal mortality.

And here’s something worth knowing: your baby already has instincts for breastfeeding. “We put a lot of pressure on parents to know exactly what they’re doing,” Dr. Tucker says. “But a lot of times, infants have a rooting reflex and instinct, and breast crawl is real.”

How do you get a good latch, and what might get in the way?

A deep, asymmetric latch is what you’re going for. “With an asymmetric latch, you really want to kind of position your nipple towards the baby’s nose,” Dr. Tucker says. “Then wait for a wide-open mouth so that the breast can go to the chin, the nipple can kind of flip in and they get a really deep latch.”

Positioning matters a lot here. The cradle, cross-cradle and football hold are all great options. Support your baby’s neck and shoulders rather than pressing on the back of the head, which can make latching harder. Find out how to achieve an asymmetric latch and other tips on positioning while breastfeeding from the Institute for the Advancement of Breastfeeding and Lactation Education (IABLE).

Some things can make latching more of a challenge, including a Neonatal Intensive Care Unit (NICU) stay, a cesarean birth, having a baby that is tongue tied or inverted nipples. The good news? Many babies in these situations go on to breastfeed successfully with a little extra support from an international board-certified lactation consultant (IBCLC) or other lactation specialist.

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Breast milk supply

How often should a newborn feed, and how long do feeding sessions take?

Watch your baby, not the clock. Early hunger cues like rooting, hands to the mouth and stirring are your signals. Feeding on demand helps your supply keep up with your baby’s needs.

“In the first 24 hours after they’re born, the baby’s stomach is the size of a marble. So, they really don’t need that much volume,” says Dr. Tucker. For example, newborns will likely intake one ounce or less of breast milk on their first day. By six months, they may be drinking 8-18 oz. in a day. Feeding sessions vary in length from baby to baby, so let yours lead the way.

How do I know if baby is getting enough milk?

Diapers are your best early guide. “In the first week of life, every 24 hours, we want to be sure that baby has the number of wet diapers as days old that they are,” Dr. Tucker says. Three wet diapers on day three? That’s a reassuring sign that you’re making enough milk and baby’s getting enough milk.

If you’re worried about weight, ask your care team about the Newborn Weight Tool (NEWT). It compares your baby’s numbers to a large sample of newborns and can help flag concerns early. There are also a lot of other ways that care teams can assess if baby is getting enough milk such as transfer feeds.

What things might affect breast milk supply?

A few things can nudge supply up or down. Some medications, herbs and conditions such as PCOS or insulin resistance can lower production. “A class of medications called anticholinergics are medicines that dry us up. They include things like overactive bladder medication, cold medication and those that help with runny noses,” explains Dr. Tucker.

Another thing to watch out for is the herb, sage. “We historically see a dip in milk production around the beginning of December, says Dr. Tucker. That’s because Thanksgiving recipes have a lot of sage in them, which can drop your milk production.

On the encouraging side, your body builds on past experiences. For each child and lactation journey a person has, they build more glandular tissue when they deliver. This can help with milk production in subsequent births.

What’s the one thing you wish every parent knew about milk supply?

A hard stretch doesn’t mean breastfeeding is over. “It’s a very, very small percentage of parents who have low milk supply and can’t do anything about it,” Dr. Tucker says. Her advice for the hard days: “Don’t quit on your hard days, and make sure you’ve gotten all of the information before you make the decision to stop breastfeeding.” Seek support from an IBCLC or other lactation specialist to help work through any breastfeeding concerns.

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Common challenges

What are clogs?

Clogs aren’t what most people think they are. “A clog is actually nothing to do with the inside of the duct and everything to do with the outside of the duct,” Dr. Tucker explains. “A clog is an area where there’s some swelling on the outside of your duct, and there’s so much swelling that it occludes the duct and prevents milk from flowing through.” When milk can’t flow through, it backs up and causes pain.

Swelling of this tissue can occur due to engorgement, overproduction, latch problems or a force, like if one of your children accidentally hit your chest.

The goal is to reduce the swelling, not fight the duct. The management of a clog is just like when you are recovering from a swollen ankle. First, engage in breast rest and resist the urge to pump aggressively. As Dr. Tucker puts it, “If you pump like crazy, you make more milk. If you make more milk, the problem gets worse.” Second, take an anti-inflammatory, like ibuprofen. Lastly, you’ll want to ice to help with the swelling. Try a gentle cooling method instead of applying ice directly to the skin.

Avoid using a breast massager or massaging the tissue as a method to try and fix the clog. This can make the swelling worse.

What is mastitis and how do you handle it?

Mastitis is a painful inflammation of the breast that presents as redness, swelling and sometimes includes flu-like symptoms such as fever and chills. Mastitis often begins as an untreated clog or can occur after frequent clogs. When swelling around the milk duct goes untreated, milk flow stalls and the tissue becomes inflamed. Most cases of mastitis are inflammatory, but they can be bacterial as well.

For inflammatory mastitis, you can follow a similar protocol to treating a clog:

• Maintain your normal feeding routine and avoid excess pumping, which can worsen inflammation.
• Rest the breast and avoid aggressive massage.
• Apply cold therapy, like an icepack wrapped in a cloth.
• Manage pain and swelling using ibuprofen and acetaminophen.

With these steps, breast swelling should begin to ease within 24 hours. If symptoms worsen rapidly or do not improve after one or two days, contact your healthcare team immediately. Bacterial mastitis requires a professional evaluation and may need antibiotics to resolve.

What is engorgement, and how do you handle it?

“Engorgement is just swelling,” Dr. Tucker says. It usually peaks in the first week as your milk comes in. Gentle care is your best move: feed on demand, use ice and try reverse pressure softening to make latching easier on a full breast. A supportive bra can also help fluid drain more naturally. Whatever you do, avoid panic-pumping to “empty” things out — that tends to make the swelling worse.

Does breastfeeding hurt, and when is pain a real problem?

Some soreness in the early days is normal. “It’s common to have some mild to moderate sensitivity in the first couple of days as you’re getting used to things,” Dr. Tucker says.

But intense or lasting pain is a different story. “Nipple pain that persists or is intense, really warrants a full evaluation,” cautions Dr. Tucker. And sometimes a pump is the culprit. People can get nipple pain because of pump trauma. If something hurts a lot, ask for help sooner rather than later.

What are the benefits of direct feeding? If I use formula too, does breast milk still help?

Milk ducts in your body are bidirectional, so when baby latches, saliva from their mouth presents to maternal tissue and the parent’s body will make antibodies tailored to whatever exposures their baby has at that time. “It’s the most bioactive and unique body substance we have. One mom’s breast milk is not the same as another’s,” explains Dr. Tucker. The antibodies delivered through direct feeding can help reduce illnesses, ear infections and hospitalizations. It supports your baby’s long-term health — and yours. For example, breastfeeding lowers the risk of maternal Type 2 diabetes and obesity in both mother and baby.

If exclusive breastfeeding isn’t possible for you, know this: your baby still benefits from whatever breast milk they receive. Supplementing with formula is safe, and the immune-protective value of breast milk doesn’t disappear just because it’s part of the picture.

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What to do and what not to do

What’s the most common first-week mistake?

Overdoing it. Many parents panic-pump during engorgement or when they feel a clog coming on, which signals the body to make even more milk. The gentler path works better: feed on demand and manage swelling.

Can you drink alcohol while breastfeeding? What about using cold medicines, ibuprofen, acetaminophen, retinol, hair dye or GLP-1 medications?

Two very different questions live here, and Dr. Tucker wants parents to know the difference. “Whether it is safe in breast milk is a very different question than whether or not it impacts milk production.”

Here’s a quick guide:

• Ibuprofen and acetaminophen (Tylenol): Generally safe during breastfeeding and useful for managing pain and swelling.
• Cold medicines: Watch out for anticholinergics, a class of drugs that dries out bodily fluids. They dry up breast milk too. Products like Sudafed and some antihistamines fall into this category and can lower supply.
• GLP-1s (Ozempic, Wegovy): “Semaglutide (the molecule most GLP-1s use) is safe in lactation,” Dr. Tucker says. However, make sure to keep an eye on the pace of weight loss so it doesn’t impact milk supply.
• Retinol and hair dye: Check with your care team for guidance tailored to you.

Most medications don’t require pumping and dumping. “The advice is typically not to pump and dump. The advice is to pump and store, and then once the radioactivity has decayed, you can safely feed that milk back to your baby.” When in doubt, look it up. “Check InfantRisk because the number of medications that actually require pumping and dumping is so small, and almost every medication is safe in breastfeeding.”

InfantRisk, run by Texas Tech University, is the leading research center on medication safety in lactation and offers a helpline for parents and clinicians. Get answers for whether or not specific medications are safe on their website or by calling their helpline.

Are the 4–4-4 and 5–5-5 breast milk storage rules accurate?

They’re catchy, but they’re not reliable. Stick to official CDC guidance instead. Freshly expressed milk is safe at room temperature (77°F or colder) for up to four hours, in the refrigerator for up to four days, and in the freezer for about six months (up to 12 months is acceptable).

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When to visit a lactation consultant

IBCLC versus lactation medicine specialist: What’s the difference?

Think of them as a team. An IBCLC provides hands-on latch and feeding support over time. A medical lactation specialist handles the medical side: running tests, evaluating tongue ties, prescribing medications and managing more complex cases like recurring mastitis.

When should I visit a lactation consultant?

Earlier than you think. “Seeking care with an IBCLC or lactation medicine specialist can change the course of your journey,” Dr. Tucker says. “The earlier you can intervene, the shorter the duration of the problem lasts and the earlier it resolves.” An IBCLC can help with latch, positioning and everyday feeding questions.

What Is the OhioHealth Fourth Trimester Clinic?

The OhioHealth Fourth Trimester Clinic provides comprehensive postpartum support with full-time lactation medicine, perinatal psychiatry and care for mood and anxiety concerns after birth. You can self-refer, which means you don’t need to wait for a healthcare specialist to make the call.

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You don’t have to figure this out alone

If breastfeeding is hard right now, that doesn’t mean you’re doing it wrong. It means you might just need extra support — and that’s normal. Lean on your care team, ask questions early and give yourself some grace.

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Get to know the expert