Three rules to guide you if breastfeeding gets tough

Three rules to help when breastfeeding gets tough (with thanks to Barbara Wilson-Clay and Kay Hoover for the inspiration).

While breastfeeding is something you’d think would come naturally to mammals, it is a learned skill for both parent and baby (or babies). To make things even more interesting, we may carry forward experience and knowledge to subsequent babies, but we’re still presented with a new person who we are getting to know under new circumstances.

Breastfeeding can be right in so many ways, but it can also be difficult. Lactation professionals and peers have the honor of sharing in the joys of breastfeeding/chestfeeding and parenthood, as well as the challenge of helping you meet your goals when the going gets tough.

When people come to me for help with breastfeeding, they may have one issue or several. Although there are some common questions I hear as an IBCLC (International Board Certified Lactation Consultant), every single family is unique. In my mission to help everyone reach their infant-feeding goals, I think of three simple rules. While there are a few IBCLCs who have come up with “rules” for breastfeeding, mine are based on those explained by Barbara Wilson-Clay, IBCLC, FILCA and Kay Hoover, M.Ed., IBCLC, FILCA. When I learned of their three rules, my less-than-photographic memory recorded my own version, and this is what I use to guide my practice.

1. Feed your baby.

This may sound like a no-brainer—of course it’s important to feed babies! It’s not just the act of feeding or how you are doing it that is important, but ensuring that a baby is fed and growing well. Babies must be fed well to keep feeding well.

Here is where the twist comes: Sometimes this means not breastfeeding, and sometimes this means using something other than breastmilk. There are times, for example, when a baby is too sick to breastfeed, breastfeeding is ineffective, or nursing causes too much pain for their parent. Sometimes a parent’s milk supply is insufficient at the time, and donor milk or formula will need to be used.

Supplementing doesn’t have to be done with bottles, although bottles are often an efficient way to supplement with larger volumes (an ounce or more) and using paced bottle feeding can help avoid flow preference (aka “nipple confusion”). Cups, droppers, syringes, and supplemental nursing systems can be used. In hospital settings, a baby may fed by a nasogastric tube (also known as gavage feeding). An IBCLC can help you figure out which methods may be best for your circumstances.

Supplementing doesn’t have to be done with breastmilk, although fresh (or frozen) expressed milk from baby’s parent is the preferred food. If this isn’t available, donor milk (from a milk bank or peer) can be considered. Commercially prepared formula—not homemade formula or animal or plant milk—is the next option. Give your baby every bit of breastmilk you can, and ensure that your baby is fed enough and fed safely.

2. Protect your milk supply.

The more milk is removed from the breast, the more milk will be made. While the lactating mammary gland is not totally emptied, a buildup of milk can lead to lowered milk supply, plugged ducts, and mastitis. At times, circumstances (such as illness) prevent timely or effective milk removal, but some is better than none in order to continue making milk.

It’s common to hear that babies should eat 8 times a day, or every 3 hours. This is a minimum number of feedings per day. Most newborns want to eat 10, 12, or more times per day, sometimes as frequently as constantly (or what feels like it). Whether a baby is doing the work, or hand expression or a pump is, frequent milk removal is important for building and maintaining milk supply. Aim for a minimum of 8 effective breastfeeding or pumping/hand expressing sessions a day.

Effective is the key word. Here’s more on how to make enough breastmilk for your baby.

3. Keep something happening at your breast.

Wilson-Clay and Hoover say, “protect breast focus,” and this can be something as simple as holding your baby skin to skin. Skin-to-skin contact can help you see subtle feeding cues that show you your baby might be ready to eat. Watching these and offering the breast, or allowing your baby to latch on his own, before baby gets upset can ease him into breastfeeding. Even attempts at breastfeeding count, and sometimes your baby may surprise you with what she can do.

Nipple shields can be used as a bridge between bottle and breast. They can be helpful when getting premature infants to breastfeed and for protecting nipples that have been damaged. While nipple shields are best as a temporary solution and the reason you’re using one should be addressed, they can help babies to latch, which can protect breastfeeding in the long run.

You may be breastfeeding for every feeding or trying once a day until you or baby gets frustrated, but if direct feeding from the breast is the goal, allowing baby to spend time at the breast—while making sure baby is fed and your breasts are stimulated—helps move toward that goal.


As mentioned earlier, every breastfeeding relationship is unique, and I cannot cover every scenario in a single blog post. There are consults where someone’s breastfeeding challenges melt away when positioning is tweaked, and others when the focus is taking baby steps forward to whatever your goals may be. There may be more than one issue to address at a time, and feeding plans help to break things down into easy-to-understand pieces.

When developing a feeding plan, your IBCLC wants you to find it manageable. If you need to change something to make it sustainable, speak up. It’s our job to help you reach your goals.