What are you doing???

She has been working on the neonatology ward for years, is training as a lactation consultant, and spends a day with me as a trainee.

After observing four visits she is clearly confused. “I don’t get it. We saw 2 mother-child dyads with similar issues and you offered them each a completely different plan. And those other two had very different questions and yet they went home with almost the same plan. How do you work, don’t you use any kind of protocol?’


And so I won’t use protocols in this book either.

In this book you will find evidence-based information, information based on (scientific) evidence. And practice based suggestions based on my experience in working with parents and babies.

And based on that I invite you to look beyond the existing protocols with me. So that we can tailor advice to what is needed for this mother and this baby at this time.

In my opinion, you only need a lactation consultant when the usual tips and tricks (read: protocols) don’t work.

After all, breastfeeding and being breastfed is in essence not particularly complicated.

During pregnancy, the human body develops the ability to make milk. A baby is born with reflexes to drink well at the breast. And the hormones involved in that process promote bonding, learning and patience in both mother and baby.

So in principle you don’t need a specialist for breastfeeding.

That is, until things don’t go according to principle.

For example, because expectant parents have no experience with babies and breastfeeding. Or, even more essential, because in our Western society parents and those supporting them (including healthcare professionals) have insufficient knowledge and experience with supporting breastfeeding.  Or because, for whatever reason, the delivery was medicalised and in those important first days the reflexes and hormones that help mother and baby could not function optimally.

And then there are the individual differences between women and babies. Breastfeeding is not a simple Verb. Breastfeeding does not exist by itself. Breastfeeding is a complex interaction between mother and child(ren) on emotional and physical levels, continuously evolving along with the growth of mother and child(ren).

So instead of focussing on theory I’ve decided to focus on casehistories, and offer theory and suggestions for practice on the side. Based on the individual situations, I hope to show you how a small factor like weight or age can make a big difference and require adaptations to protocols.

Because it matters:

  • Whether you have a 2700-gram or 4800-gram baby in your arms.
  • Whether a child is 10 hours, 10 days, 10 weeks or 10 months old.
  • Whether a child came at 28 or 38 weeks.
  • Whether the child was fat at birth or thin (and this is not the same as low or high birthweight!)
  • Whether the mother has a high or low BMI.
  • How comfortable the mother is in her skin.
  • Her cultural background
  • And many many more variables.

How to read this book

The cases are in random order, as if you are a trainee in my practice. I aim to offer a broad picture of breastfeeding.

In each chapter you can then choose whether you want to know more about the policy,  the outcome or  more specific suggestions per situation per period:

  • Prevention: what could have made a difference before the delivery
  • The first week after giving birth
  • The first 3 months (the 4th trimester)
  • And everything after month 3.

You will find references to scientific studies, if possible Open Access.

If I offer my professional opinion you will recognize that by this icon, and do feel free to form your own opinion!

In cases where the outcome of the issue I describe could have been different, and this described in another chapter , you will see this icon with a reference to the comparable stories:

There are also topics on which scientific and professional opinions differ. I will then aim to discuss these differences as best I can so you make an informed choice.  You can recognize those paragraphs by this icon:



My trainee went home a little discouraged, but thankfully also inspired. She told me that when she started the training to become an IBCLC she thought it would be easy.

Her partner had even commented that it seemed a bit much to spend a year training on something as common (read: simple) as breastfeeding.

She works in an environment where protocols are required. Now she saw how within a protocol there are nuances that can make the experience much better for mother and child. And how sometimes the protocol just doesn’t work.

With this book, I hope to inspire more people to use broad knowledge for tailored care.


I do encourage you to  read cases that deal with periods or issues that you don’t deal with in your work. Breastfeeding is a process and the more you know about the whole process, the better you can come up with fitting suggestions for the mother-baby dyad you meet at their moment in time.

The 1st week

If you work mainly in the first week after giving birth, you will be experiencing the most difficult period of breastfeeding.
Milk production starts slowly in humans and then quickly becomes abundant around day 3-6, babies go from being very fragile to hopefully more robust in a weeks time. And the first week after giving birth often brings general physical discomfort (or outright pain) for the mother, making every day a challenge.

In everything you say and do, use the words ‘at this moment’ to give yourself and the parents perspective. ‘At this moment breastfeeding is hard work’, ‘At this moment latching is quite difficult’, but also ‘At this moment the baby is delightfully happy and  calm’. This too can and will change from time to time.

The first 3 months

The first 3 months with a baby are intense, and it is important to acknowlegde this. For parents, it is a period of adjustment to the hardest job in their lives: parenthood.

It is important they know what they are working towards. If the aim is to breastfeed for 3 months, then 6 weeks of work to get it right may not be worth it. But if the aim is 6 months or more, then 6 weeks is a realistic investment.

Especially in the first few months, parents are looking for reassurance. And the online image is that if you get it right, you will be relaxed and rested at the end of your maternity leave, with a glowing baby and a clean house. And if that doesn’t seem attainable, people are quick to point to breastfeeding: it doesn’t get you anywhere, it drains you, it makes you so insecure. And most importantly: that’s why your baby isn’t sleeping well.

A lot of money is spent on marketing this image so that parents buy things and artificial feeding seems to be the solution. Good information and individual advice is all we can do in return.
Fortunately, there are more and more examples of people breastfeeding for more than 3 months and sharing their joy online. It is important that health professionals can also offer this perspective: after the first 3 months, everything with a baby gets easier, including and especially! breastfeeding.

After 3 months

Because bottle feeding has been the norm in our culture for many years, few people have an idea of how relaxed and fast breastfeeding can be after 3 months. If we want to support parents to breastfeed for longer, it is important to know and be able to describe this perspective.

Many normal and pleasant changes in breastfeeding are now seen as alarm signals. If breastfeeding is going well, it will become more comfortable and easier. Your breasts will become more supple, but this does not mean that there is no more milk. Babies will feed more quickly, but not less often: this is normal and convenient. Milk production becomes more stable, so it is fine to continue feeding with changes in sleep and introduction of solid foods.

So I hope that those who work with parents and babies mainly in the first week and first 3 months will also read the cases and comments on feeding after 3 months. For their own perspective and that of the parents.