Preparing to breastfeed while you are still pregnant

Most of the preparation people do before a baby arrives is shopping. The things that actually make a difference are quieter than that, and they are mostly about knowing what to expect so that normal does not feel like failure at three in the morning.

Your breasts are already getting ready

You may have noticed changes from very early on. Tenderness, a heaviness, darkening around the nipple, and the little bumps on the areola becoming more obvious. Those bumps are glands that produce an oil which cleans and protects the nipple, and they are one reason nipples need no special washing or creams.

From around sixteen weeks your body is already making colostrum. You may or may not leak, and neither tells you anything about how much milk you will make. Plenty of women who never leak a drop go on to feed beautifully.

There is nothing you need to do to your nipples. No rubbing with a towel, no toughening, no creams. That advice belonged to a different era and it does not help.

Learn to hand express

If you do one practical thing, make it this. From around thirty six weeks, and with your midwife's agreement, learning to hand express is worth more than any piece of equipment.

It matters because in the first days after birth, hand expression gets colostrum out far better than any pump. If your baby is sleepy, or will not latch, or needs a top up, being able to get milk out with your hands changes what is possible. Learning it in a calm moment while pregnant is very different from being shown at two in the morning on a postnatal ward.

Collecting colostrum before birth

Some women collect and freeze colostrum in the last weeks of pregnancy. It is particularly worth discussing if you have diabetes of any kind, if a caesarean is planned, if your baby is expected to be small or large, or if there is a known condition that may make early feeding harder.

It is a conversation to have with your midwife rather than something to start on your own, because it is not advised for everyone. There is more in Collecting colostrum.

Know what normal looks like

More breastfeeding is given up because it felt wrong than because it was going wrong. The things worth knowing before you are in it:

• Newborns feed a lot. Eight to twelve times in twenty four hours is normal, and some of those will be close together.
• Cluster feeding is normal, usually in the evenings, and it is not a sign your milk is failing.
• Your milk coming in takes a few days. Colostrum is enough until then, and your baby's stomach is tiny.
• Babies lose weight at first, usually up to about a tenth of their birth weight, and regain it by around two weeks.
• It should not hurt. Some tenderness in the first days is common. Ongoing pain is a sign something needs adjusting, not something to endure.

What is actually worth having

• Nothing, to begin with. You can start breastfeeding with no equipment at all.
• A well fitting, comfortable bra with no wire. Get measured late in pregnancy rather than early.
• Somewhere comfortable to sit with support behind you and something to drink within reach.
• Breast pads, because leaking is common once your milk comes in.

What I would not buy in advance is a pump. Most people do not need one in the early weeks, the one you need depends on why you need it, and hospital grade pumps can be hired for short periods if the situation calls for it.

The conversations worth having

• With your partner, about what the first fortnight will actually look like, and what they will do. There is more in How partners can support a breastfeeding mum.
• With your midwife, about skin to skin at birth and keeping your baby with you, whatever kind of birth you have. There is more in Skin to skin and the golden hour.
• With yourself, about who you will call if it is hard, and at what point. Most of the women I see wish they had rung sooner. Having the number already saved makes that call much easier to make.

How an antenatal session helps

Seeing someone before your baby arrives is the calmest appointment you will ever have with me, because nobody is hungry and nobody is crying. We go through what to expect in the first fortnight, I teach you to hand express and watch you do it, and we talk through anything in your history that might make a difference, such as previous feeding, breast surgery, PCOS or a planned caesarean. If colostrum collecting is appropriate for you, we cover that too. Mostly what you leave with is the knowledge of what normal looks like, so that when it happens you recognise it instead of panicking.