The Womanly Art of Breastfeeding by Diane Wiessinger, Diana West and Teresa Pitman (8th edition)

Read this book if: want to learn more about breastfeeding from the creators or La Leche League (check out their website for local chapters in your community)


If you like the summary, support the authors by purchasing a copy here:


Editions since 1958; before that passed on by mothers from one generation to the next. 7 women from Franklin Park area chose name La Leche League and committed themselves to reaching out to help other mothers who also longed to breastfeed their babies. They began holding monthly get-togethers in their homes for other women interested in (shhh) breastfeeding (because the word was shocking in those days, they chose a code name: La Leche League). First group quickly became multiple groups.


Breastfeeding is a connection as well as a food source, a baby’s first human relationship, designed to gently him into the world with far more than just immune factors and good nutrition. Visit forums at and share your experiences.


Part I – New Beginnings


  • Nesting


Welcome to La Leche League meeting in a book. At a real meeting, you’d see a mix of pregnant women, mothers w new babies and moms w older babies or children. Cornerstone of meetings is addressing questions.


“The newborn baby has only 3 demands: warmth in the arms of his mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three” – Grantly Dick-Read


How Important is Breastfeeding, Really? Extremely – there is almost nothing you can do for your child in his whole life that will affect him both emotionally and physically as profoundly as breastfeeding.


Your Milk Is Your Baby’s Normal Food – there’s no formula that comes even close to the milk your body creates; your milk has every vitamin, mineral and other nutritional element that your baby’s body needs, including many that haven’t been discovered or named yet, and it changes subtly through the meal, day and year to match subtle changes in his requirements. Living cells unique to your milk inhibit the growth of harmful bacteria and viruses in his still-maturing system. Interferon and interleukins are powerful anti-infectives. A squirt of your milk can even treat eye infections and speed the healing of skin problems!


Without his normal food, a baby is at higher risk of ear infections, intestinal upsets, and respiratory problems. Allergies and dental problems are more common. Vision, nerves and intestines don’t develop fully. A formula fed baby has a different metabolism and different development, and gains weight differently during his first year. His kidneys and liver work harder to process the waste products from formula. He needs more of any medication to get the same effect. His immune system’s response to vaccinations is less effective. The risk of SIDS and infant death from many other causes is higher if a baby isn’t breastfed.


As an older child or adult, he is at greater risk of Crohn’s disease, ulcerative colitis, type 1 diabetes, heart disease and certain cancers. He responds to stress more negatively and has higher blood pressure, both as an infant and in later life.   There’s a higher risk of obesity, type 2 diabetes, heart disease and osteoporosis in later years. Numerous IQ studies showing deficits in children who didn’t breastfeed, or who didn’t breastfeed for long.


Colostrum, the milk you produce in small amounts in the first couple days after baby is born (and which you started producing during pregnancy) has concentrated immunological properties that are your baby’s first protection against all the germs he is suddenly exposed to. This first milk contains high concentrations of secretory immunoglobulin A, or sIgA, an anti-infective agent that coats his intestines to protect against the passage of germs and foreign proteins that could create allergic sensitivities. Scientists have also recently discovered a new ingredient in human milk called pancreatic secretory trypsin inhibitor (PSTI), which protects and repairs the infant intestine. Its present in all human milk but 7x higher in colostrum providing extra protection to that delicate and vulnerable newborn intestine.


Colostrum has an acid level that encourages baby’s intestines to welcome just the right mix of beneficial bacteria. Is it a laxative that gets his intestines up and running and helps clean out all the tar-like stool called meconium that built up in his system before birth.


Mature milk, which phases in during the first 2 weeks, has a still-unknown # of ingredients that contribute to lifelong health. Along w interferon, interleukins, white blood cells, and SIgA, the breastfed baby gains an immune system nearly as sturdy as his mothers. Human growth factor continues to develop those intestines, bones and other organs. Insulin for digestion, long-chair fatty acids for a healthy heart, lactose for brain development are all there. Iron is added to formulas in forms that baby can’t readily use and which can actually be harmful since it increases the risk of intestinal infection, intestinal bleeding and anemia.


When baby breastfeeds, the muscles in his jaws are exercised and massaged in a way that causes the bones in his face and jaw to develop more fully. The jaw that results from bottlefeeding and pacifiers is narrower, w a higher palate that’s more likely to restrict nose breathing. Babies who use pacifiers, instead of soothing themselves at the breast, are more likely to need speech therapy later. The child who breastfeeds for less than a year is much more likely to need orthodontia later on. Snoring and related breathing problems more common as well.


Baby regulates milk – if thirsty, nurses for a short time and gets low fat milk. Still thirsty? Switches sides and gets from other side. Extra hungry? Stays longer on 1st side and nurses more vigorously, to pull down more higher-calorie fat globules. Growth spurt? If takes more than usual, hell have more milk the next time. If drinks less, milk production scales back. Moving into toddlerhood and nursing less often? More immune factors to keep him factor. Pick up germs from grocery cart? He communicates those germs to your breast and it starts cranking out specialized antibodies.


Breastfeeding Helps Keep You Healthy, Too


When newborn takes breast soon after delivery, uterus contracts and bleeding slows. Hemorrhage is greater risk w formula feeding, and belly stays larger longer.


If breastfeed exclusively (no water, solids, formula) and baby nurses often, at least 1x during night, periods mostly likely wont come back for at least 6 months. Chances of getting pregnant will be extremely low during that time.


It helps many (not all) women lose weight readily. Natural design is for it to melt away by the time baby is well started on solids.


Women who haven’t breastfed are at greater risk for metabolic syndrome, a cluster of risk factors that makes heart disease and diabetes more likely. If have insulin-dependent diabetes, likely to need less insulin while a nursing mother.


Insurance policy against breast, uterine and cervical cancer (may be the lower estrogen level of lactation provides the protection; the longer you feed, the stronger your insurance). Doesn’t mean its impossible to get these cancers, but less susceptible to them. Osteoporosis and fractures more common in those who don’t.


Formula feeding mothers blood pressure likely to be higher, prob bc her neurological and endocrine responses are more pronounced. Her overall physical and mental health take a hit as well, as in later years she remains at increased risk of developing autoimmune diseases such as rheumatoid arthritis.


How Reliable Is Breastfeeding Research?


Virtually all research down backward, evaluating what’s normal instead of evaluating experiment (formula). Makes high rates of formula-fed illness seem like normal baby health and breastfeeding seem like bonus points.


Breastfeeding doesn’t reduce risk of infection, illness, disease, doesn’t’ add IQ points. When babies aren’t breastfed, they are at increased risk for short-term and long-term illnesses and disease.


More and more research articles using normal breastfed baby as starting point, and looking at what happens to babies when normal system is altered. Breastfeeding doesn’t give you brownie points. Its simply the normal way to raise a baby.


“Breastfeeding is a safety net against the worst effects of poverty…exclusive breastfeeding goes a long way toward canceling out the health differences between being born into poverty and being born into affluence. Unless mom is in extremely poor nutritional health, breast milk of mom in African village as good as breast milk of mother in Manhattan” – UNICEF


Breastfeeding Deepens Your Attachment to Each Other – all part of the way Nature encourages us to take care of our babies and transition from birth. There’s a surge of hormones in your body every single time you breastfeed that makes you feel loving and nurturing. These hormones – prolactin and oxytocin – not only foster a connect w your baby but also help you recover from emotional and physical stress of birth. Without these hormones, mothers tend to talk to their babies less, interact less, touch less.


“Bottle feeds baby’s stomach but breastfeeding fills baby’s soul”


Many bottle feeding moms wish they would have breastfed, yet very few breastfeeding moms wish they bottle fed. Not to say moms who bottle feed don’t love and value their babies. But there’s a difference. When formula feeding mom hears baby fuss or cry, she responds using her mind. Breastfeeding mom – whole body chemistry responds.


When a mom bottle feeds, she holds baby loosely or off to side so breasts don’t get in way. Baby feels clothes against his face and hands. As baby gets older and more curious about world, mother may find its easier if he faces away from her or if baby holds bottle himself. When mom breastfeeds, baby’s cheeks on moms skin; nursing is a full body hug.


Emotional connections created is a strong one – probably find that being away, esp in early months, can be just as difficult for you emotionally as it is for your milk supply.


Breastfeeding experience can help heal many emotional wounds, from a difficult or traumatic birth to an abusive past. Baby blues more common in societies such as ours where mom and baby not able to stay together, nursing, from birth.


Breastfeeding Helps Teach You How to Be a Mother – you are baby’s food source and the one who can comfort him best, so you’re the one he turns to. With all this intimate time together, you get to know his body and his personality better than anyone else. You know how to interpret his cries sooner than your partner. Day by day, breastfeeding builds confidence and mothering skills.


“What is established in the breastfeeding relationship constitutes the foundation for the development of all human social relationships, and the communications the infant receives through the warmth of the mom’s skin constitute the first of the socializing experiences of life” – Ashley Montagu “Touching”


And Then There Are Practical Reasons – after the early weeks when you’ve learned the ropes and breastfeeding becomes second nature, you’ll find you can gentle your baby out of almost anything – hunger, tiredness, overstimulation, fear, pain – w a little nursing. Breastfeeding stops being a feeding device and becomes an all-purpose mothering tool. Its these little social at breast exchanges that keep milk supply in good shape and baby growing well. Scheduling nursings, like scheduling kisses, would just make life harder for both of you.


Some moms say they don’t want to breastfeeding because they don’t want to be tied down, but most breastfeeding moms will tell you it actually frees them up – no cans of formula or bottles, no washing, sterilizing or storing. No measuring, spilling, or heating. No planning, leftovers, or spoilage. Most likely a lot fewer trips to the dr. your milk is always available, always the right temp, never spoiled, no matter how hot or cold it is outside. Money you spend on formula in a year could pay for a high end appliance. In an emergency of any kind, from a minor problem to a natural disaster that means shortages of formula and clean water to prepare it.


Will My Breasts Work? Most of us don’t look like women in the breastfeeding videos. Your baby will love your shape, whatever it is. Breast size doesn’t matter. How much milk you make isn’t related to how big your breasts are. There are a few breast shapes and breasts that have had surgery that have trouble making enough milk and some women do need to breastfeed more often than others to keep a good supply flowing, but there are many ways to help any breast-related problems.


Nipple size doesn’t matter. If nipple is too big or wide for baby to latch, baby just needs to grow until he has a bigger mouth and then he’ll do fine. Some prominent nipples become temporarily flat right after birth if too many IV fluids during birth caused breasts to swell. Some nipples inverted, but there are ways to untuck them. Breastfeeding can almost always work. Find tips for breastfeeding w all kinds of different nipples and breast in Ch 18.


Will My Baby Latch? Baby is born expecting to breastfeed. Has many innate reflexes designed to help him do it well, even if birth is tough or problems come up. Babies designed to deal w difficult births, cold, hunger, separation and germs and still breastfeed well. Its how babies have survived difficult environments throughout history.


Videos that show newborns placed on moms body right after birth who wriggle way to breast and latch without help (Youtube). Its not all on your shoulders to make breastfeeding work.


Most moms, without thinking, pick up crying baby and hold him vertically so that baby’s chest and tummy are against her shoulder and chest. Not only calms baby but puts him in good spot to head toward breast if hungry.


Some babies cant get it for a while – usually because systems overwhelmed with birth medications and interventions. Ch 3 will help you understand and avoid or minimize possibility of this. If baby has difficulty latching, see Ch 18.


Will Breastfeeding Hurt? If mama cat gets bothered by kitten on breast, she shakes kitten off and starts over. Same for humans. Nipple sensitivity is common in early days. If breastfeeding actually hurts, that’s your body’s signal to change something. “Pain is the body’s way of guiding us to find a more comfortable position – if you get a pebble in your sandal, you don’t keep walking. You stop to do something, get it out. If that doesn’t work out, you’ll intuitively do something else so you can walk comfortably.”   Find simple changes in Ch 4. Nipple pain and damage are not normal.


Will I Have Enough Milk? Its natural to worry about, esp if friends didn’t seem to have enough.   Most mothers able to make plenty – chances are really good that you will be able to as well.


Some women do have difficulties w milk production, but most of the reasons are fixable. Medicalized births can make it difficult to get breastfeeding off to a good start. Sometimes mom has hormonal problem that affects her ability to make milk and occasionally women have anatomical problems, such as previous breast surgery or breast/nipple problem. There are lots of ways to increase milk supply. LLL Leaders are ready to help you at any time.


If suspect supply problems, consider hand-expressing some colostrum to freeze ahead of time (see Ch 15 for hand expression technique). Not only can it give you a small “just in case” supply of colostrum, but there’s some evidence that it may also boost your future supply.


If still not able to make a full milk supply, can still breastfeed successfully. Many moms who breastfeed satisfactorily w a partial milk supply. They supplement to make up for the milk they can’t make. They look at breasts as half full instead of half empty. One mom could only produce 1 tsp of milk each day and considered it medicine for her baby, which she proudly gave him.


Every single drop your baby gets is beneficial, containing all the immunities of a full milk supply and many, many elements absent from formula.


How Long Will I Be Doing This? As long as you and baby want. Once things going smoothly, may decide to go longer. Many women end up weaning sooner than planned because run into challenges and didn’t know how to get help (you have LLL).


WHO recommends exclusive breastfeeding for 6 months w solid foods gradually added and breastfeeding continuing for at least 2 years.


What “Stuff” Do I Need for Breastfeeding? – Breastfeeding baby doesn’t need much.

  • Nursing Clothes – Not Really; most moms wear a top that’s loose enough to pull up from hem. Shirt can droop over baby and hide any bare skin. Or wear a shirt that buttons in front and unbutton from bottom. Can wear loose jacket or over shirt w a t shirt or tank top underneath to cover more
  • Nursing Bras – Not Necessarily – bras are never a health necessity; “if you’re happy braless, stay bra-less”. If you like wearing one, whatever you wore in last trimester will prob fit after baby’s born, though cup size may run somewhat bigger for first couple of months. You’ll want 2-3. Regular bra that’s loose enough and flexible enough that you can pull cup down or up to breastfeed works well. Good idea to avoid underwires, at least at first. Can cut across milk making tissue and increase risk of milk plugs or infections. Avoid any bra tight enough to leave marks on skin. Cotton most comfortable. LLL carries a line of nursing bras. Ask other moms.
  • Breast (or Nursing) Pads? It depends – some find helpful to soak leaking milk; some don’t leak at all. (Leaking has nothing to do w milk supply). Disposable and washable available – or make own washable pads from layers of soft cotton circles sewn together. Leave a cloth diaper here or there to catch any drips while nursing.
  • Breast Pump? Not always. If won’t be separated regularly, don’t need a pump at all. Many moms never need to pump/express milk. If want one for occasional night out, hand expression or good quality manual pump may be all you need, which are relatively inexpensive and may remove milk better than mid-priced electric pumps.   Hand expression works and doesn’t cost a thing (Ch 15). If going back to work while baby is small, investigate pumps (insurance usually covers).
  • Nursing Footstool? Not necessarily – mothers who nurse sitting up w short legs may find a low stool raises lap to support baby and relaxes lower back. Moms who lean back or cross one knee may have no need. Doesn’t have to be commercial product – thick book, diaper bag, coffee table works. Try raising one foot so baby’s feet are lower than his head.
  • Soft carrier? Almost Always – one of most helpful tools of motherhood is cloth carrier, sling, or wrap so you can wear baby. babies get heavy fast and it’s much easier on back and arms to have baby secured to you in fabric. Can use from birth until ~35-40 lbs – much heavier than you’d be able to manage w a car seat. Having hands free is great. Baby wearing even more important to baby – research shows babies who aren’t worn by adults for much of day fuss more. Partners can carry too (feel free to put sports logos). Come in all different fabrics – mesh, cotton, washable silk, all colors and patterns. Ones that tie in criss-cross pattern to ones secured w 2 large rings. They’re not just baby carriers – but clean surface for diaper changing (in a pinch) and blanket to cover sleeping baby. Some even have pockets for cell phone and keys (Ergobaby has big enough one to fit diaper and wipes).  Patterns to sew your own available online. Wearing takes practice – be sure cinched firmly so baby is secure and fairly upright against chest, not flopping loosely in hammock and avoid positions that have baby w head tucked toward chest. Google sling instructions, check w moms at LLL meetings, see Ch 6 or experiment until you find what works. *BabyWearing International has local chapters and meetings where you can try different types. Try baby consignment shops.


What Do I Need To Do to Prepare Body? Not much – all prep is automatic


Before Very First Period – some of earliest milk-carrying ducts formed at this time.


Before Each Period Pre-Pregnancy – ducts added more and more branches, which began to sprout buds, and milk-making tissue grew, causing the breast tenderness you may have felt just before your period.


During First 3 Months of Pregnancy – growth accelerates at this time, and more buds added. Breasts more tender than before periods and internal growth causes visibly larger breasts in coming months. Each bud grows into a tiny cluster or milk-making cells called alveolus. Alveoli are hollow, surrounded by microscopic bands of muscle. Milk collects in hollow center and will be squeezed out by tiny muscles and will follow ductal branches and trunks toward nipple. Some of ducts will join along the way, so that you will have ~4-18 nipple pores where milk flows out.


Outside of breast might begin to have visible blue veins, and areolae (dark area around nipples) may be getting darker and larger. Small bumps begin to form on areolae – Montgomery glands, which secrete a small amount of oil and maybe milk after baby comes and which help to keep nipples clean and moisturized.


If feel that breasts look different or not experiencing tenderness or changes, talk to health care provider or Ch 18 to get breastfeeding off to best start.


During Middle 3 Months of Pregnancy – breast growth continues, inside and out. Lifting and shifting will give you a better sense of changing weight and contour.

  • Moving Breasts – Author of Happy Breast Book suggests all women (esp pregnant/nursing) move their breasts at least 2x/day. Reaps many benefits – improved lymph drainage to remove toxins and improve immune system, reduce breast tenderness during pregnancy and improve woman’s awareness of changes in breasts. Bend at waist, cup hands under each breast, gently move hands in up and down motion as if fluffing pillow.


During Last 3 Months of Pregnancy – many moms can express, or even leak drops of colostrum (thick, yellowish or other colored early milk – baby’s first food). Colostrum is a mix of carbs (sugars), proteins, lipids (fats), and immune factors. If you express, you’ll make more to replace it – there isn’t a finite amount. If pregnancy ends at any time from this point on, almost all moms will automatically begin full milk production within a few days. Great time to learn hand expression – even though it’s usually just drops (or less); handy skill in months to come (Ch 15)


After Birth – the hormonal “wall” that held back milk production comes down when placenta is delivered. In first few days, alveoli continue to secrete colostrum. Sugar and fat rise dramatically on 3-4th day, pulling additional water (and may other elements) into alveoli, so milk is now whiter and increased in volume. Mothers often say milk is coming in, but basics were there from start, in smaller amounts w different concentrations. During first 2 weeks, extra sugar, water and fats increase volume. Will happen whether or not milk is removed. Even if you do nothing at all – even if you don’t want to breastfeed – your body’s going to do everything it can to feed your baby.


Gradual increase in milk gives baby time to practice everything from breathing to digesting. By ~10 days, you’re near full production and supply won’t increase much from about 1 month on. Baby may have growth spurts, when he nurses a lot and increases supply for a few days, but then he’ll slow down and production will return to normal.


Shortly After Baby is Born – milk production will start to work on a supply and demand system, meaning that amount created depends on how much has been taken out. Process can continue for years as long as milk keeps being removed from breasts.


Milk removal esp important during first 2-3 weeks because that’s when milk production capability is established. Its like calibrating milk supply and happens w each new baby. Each breast calibrated independently – the more milk you remove during the early weeks, the more milk you’ll be able to make for this baby. if don’t remove much milk in first few weeks, it will be harder (but not impossible) to make more milk later on. System is built to work, even w a rough start, but getting started well helps a lot.


Once you start, milk is always being made. Made more rapidly when breast is less full. Fuller the breast, more slowly milk is made. Milk production starts to slow if you wait to feed baby until breasts fill up. Breasts never truly empty.


When baby nurses, nerves in nipple and areola send signal to pituitary to release hormone called oxytocin. Oxytocin causes little muscles around alveoli to squeeze, building milk pressure inside breast and creating a milk release (or milk ejection reflex or let down). Tiny ducts yawn open as milk spurts down them. Might feel tingling in breasts or shoulder blades, might feel thirsty or sleepy or might feel nothing at all. In early weeks, milk release may be triggered just by thinking about nursing or by hearing a baby (any baby) cry. Your body wants to breastfeed!



What Do I Need to Do to Prepare My Head? Talk to friends and relatives who’ve enjoyed breastfeeding. If you know someone currently breastfeeding, hand out w her. Read. Check out a LLL meeting (no pressure, no commitment). Watch casually to pick up tips and tricks. Will help you picture yourself happily feeding baby.


Most important, decide this is something you are GOING to do, not going to TRY to do. Can make all the different. Most women who can’t simply don’t have enough info or support. Now all it takes to become a breastfeeding mom is the realization that you already are one.


Other Great Books: The Breastfeeding Café, Breastfeeding Made Simple, So That’s What They’re For, The Ultimate Breastfeeding Book of Answers…


Good Videos: Baby-Led Breastfeeding…The Mother-Baby Dance, Biological Nurturing: Laid-Back Breastfeeding, Follow Me Mum: The Key to Successful Breastfeeding, Breastfeeding: A Guide for Success


Good Websites: (La Leche), (International Lactation Consultant Association), (U.S. Breastfeeding Committee),,,


Who Will Help Me? Everyone. Formula companies, furniture companies, pump companies, baby food companies, ointment and cream companies, relatives, friends, website and authors (those funded by formula might have different agenda). Commercial companies put bottom line first. Friends think their experiences are always how it works. Not all experts are. Not all websites/books fit your style.


  • LLL Leader: in person, phone help, leads meeting, finds info/resources
    • Experienced nursing mom, not medically trained, can direct you to medical and other resources in community
  • OB: minimizes intervention and keep you and baby together
    • May have little or no training
  • Midwife: facilitating normal birth and keeping you and baby together
    • May have little or no training
  • Doula: help w smoother birth and early breastfeeding
    • Usually trained in basic help; some postpartum doulas had extra training
  • Hospital Nurse: keeping mom and baby together
    • May have little or no training
  • Pediatrician: keeping mom and baby together
    • May have little or no training
  • Lactation Consultant, Counselor, Educator, Specialist: may be able to help w basic problems
    • Titles have no standardized or legal meaning; individuals may have very little or no experience helping moms
  • IBCLC (International Board Certified Lactation Consultant): experienced and legally certified to give breastfeeding help in special situations
    • May not have breastfed own children


When it comes to breastfeeding, decision is up to you. Listen to your heart and trust that you know – or will know- your baby better than anyone else.


…to be continued…




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