Novant Health ob-gyn Dr. Kyla Freeman specializes in pregnancy, childbirth and the female reproductive system — but even she faced a learning curve for breastfeeding when she became a mom 10 months ago.

“Culturally, women expect breastfeeding to be really easy and natural and beautiful sunshine — and it's hard!” Freeman said.

Freeman’s baby was born at 36 weeks, which led to what she describes as “a gauntlet of issues” with breastfeeding, including pain, latch issues, and a cycle of breastfeeding, pumping, and bottle feeding called triple feeding.

These days, breastfeeding is going well. But her early difficulties made Freeman realize “that there's so much more to learn about how to better support patients through this really challenging time.” She has since decided to pursue additional training in breastfeeding and lactation medicine.

Here’s what she’d like to share with pregnant women who hope to breastfeed.

How to prepare for breastfeeding

When should I start thinking about my breastfeeding plan?

Sometimes women can be so focused on pregnancy and preparing for delivery that they reach the other side feeling unprepared.

“Their focus hasn’t been on what it will be like when the baby’s actually here,” Freeman said.

Freeman’s advice: Think ahead about your feeding preferences while you’re pregnant. Use your prenatal appointments to talk with your ob-gyn about your feeding plan and ask questions.

How can I learn about breastfeeding?

Novant Health offers breastfeeding classes you can attend during pregnancy, including some in-person offerings and a virtual Breastfeeding Basics class.

Two other resources Freeman recommends are La Leche League and Physician Guide to Breastfeeding. “Both of these websites have ‘A to Z topic' pages where you can learn more about everything from latch, to nipple pain, to how to deal with infant issues like biting and distracted feeding,” Freeman said.

Are there women who should consider a prenatal breastfeeding consultation?

We know that some moms are at increased risk of low milk production, including those who:

• Have had breast surgery
• Have a history of insulin resistance or polycystic ovarian syndrome (PCOS)
• Needed fertility treatments
• Have a planned preterm delivery
• Are expecting multiples
• Have a history of low milk production

If this applies to you, tell your ob-gyn during pregnancy that you are hoping to breastfeed and they can provide specific support.

If you see a specialist for a health condition, review your medications during your pregnancy to make sure they are compatible with breastfeeding. Most medications are compatible, but it’s important to check.

Finally, if you’ve had a baby before and had trouble with breastfeeding — or weren’t able to breastfeed as long as you wanted — see a lactation consultant or a physician with knowledge about breastfeeding and lactation medicine while you’re pregnant to discuss strategies for this time.

What to buy for breastfeeding

What products do I need for breastfeeding?

There are no “absolute must-haves,” but there are some “nice-to-haves,” Freeman said. These include:

• A breast pump: One thing many moms take care of during pregnancy is selecting and ordering a breast pump. Most insurance plans cover one.

For your primary pump, Freeman recommends a double electric breast pump — popular choices include the Spectra S1 or S2 or the Medela Pump in Style, though there are many options on the market. These can help protect your milk supply in the beginning of breastfeeding.

Freeman doesn’t recommend a wearable or portable pump for your primary pump because women can have a variable response to them. Once your supply is well-established, you can consider wearable pumps as a secondary option. Freeman found that ultimately, a wearable pump did work for her.

“They’re very convenient,” Freeman said, adding that she uses a wearable pump during her workday. “But you may need to play around with the settings to get your best output.”

• A breastfeeding pillow: This can be helpful as you’re learning how to hold and position baby while breastfeeding — especially as you’re recovering from delivery and don't have your full strength.

Freeman recommends either a “Boppy” — a soft, C-shaped pillow — or a “My Breast Friend” pillow, which is a little more firm and buckles around your waist for extra support.

• Comfortable bras: You can try these on during pregnancy, especially if your older bras no longer fit.

Look for something that is supportive, but not tight and constricting.

If you’re buying a bra designed for both nursing and pumping, remember that a pump bra must be tight enough to hold your pump in place.

Once baby’s here

Novant Health hospitals are designated as “Baby-Friendly” by the national organization Baby Friendly USA. What does that mean, and how does it help me with breastfeeding?

It means they follow 10 evidence-based practices for supporting and promoting breastfeeding. In the hospital, this includes:

• Initiating skin-to-skin contact right away: The goal is to give babies uninterrupted skin-to-skin time with mom during the first hour after birth, if the health of mom and baby allow. This helps the body transition from pregnancy hormone levels to postpartum hormones that support breastfeeding.
• Rooming in: Unless your baby needs NICU care, your baby will stay in your room with you. This helps you learn your baby’s feeding cues — the signs that they're hungry — and respond to those as they occur. This is called “feeding on demand,” and it’s the best way to establish your milk supply.
• Support for breastfeeding: Lactation consultants will visit you while you’re in the hospital. After you leave, you can schedule one-on-one visits or attend a lactation-consultant-staffed support group called Baby Cafe. “I owe a lot of my own breastfeeding success to our lactation consultants,” Freeman said.

What should I expect when my milk comes in?

After delivery, your body first produces a thick, nutrient-rich milk called colostrum. Baby’s stomach only holds 1 to 3 teaspoons per feeding during those first few days.

It’s common for women to worry that they’re not making enough milk, but they’re making exactly what their baby needs — and by continuing to feed on demand, they’ll make the supply their baby needs.

Your body may take two to three days — or sometimes longer — to transition from making colostrum to breastmilk. During this time, you’ll still be encouraged to put your baby to your breast whenever they show signs of hunger.

Eventually, you’ll notice your breasts feeling fuller and your milk appearing thinner and whiter. You may begin leaking milk. This is when your milk “comes in.”

Can I share feeding responsibilities?

One of the most important concepts to understand before your baby arrives is supply and demand, Freeman said.

The best way to build a healthy milk supply is to remove milk from your breasts frequently.

“Often, women think, ‘If I combination feed with both breast milk and formula, a support person can help and I can sleep longer,’” Freeman said. “But any time you don’t empty milk from your breasts, your body thinks that milk wasn’t needed and produces less next time.”

So even if a support person helps with feedings, you may still need to pump to maintain your milk supply.

“There are no days off,” Freeman said. “It truly is a daily commitment for as long as you breastfeed.”

When should I seek additional breastfeeding support?

• Nipple pain: Many women are told that breastfeeding “has to hurt until your nipples toughen up.” In reality, nipple pain isn’t normal — it’s usually a sign that there’s a deeper problem with latch that a lactation consultant can help correct.

• If you or your baby are getting frustrated during a feeding: If your baby’s suck seems weak or they don’t seem satisfied after feeding, there may be a problem. A lactation consultant can observe a feeding, evaluate the latch and milk transfer, and suggest positioning adjustments.

• Redness and pain on one breast: Especially if you also have fever, body ache or chills, contact your ob-gyn promptly. You may have mastitis, a breast inflammation often caused by infection, or be in the early stages of developing it.

• Overwhelming frustration or anxiety: About 1 in 7 women will deal with some amount of postpartum anxiety or depression.

“It's very normal to find this journey overwhelming at times,” Freeman said, “But if these thoughts are impacting your ability to function or you can’t think about anything else, please tell your ob-gyn.”

Breastfeeding facts that can ease anxiety

What evidence — and experience — actually show

• Don’t start pumping right away unless directed by your doctor. If your baby's latching well, transferring milk well, and gaining weight appropriately, most moms don't need to pump until they’re getting ready to return to work or expect to be separated from baby for more than a couple of hours.

At that point, you only need a small stash — enough for the first day back at work or for a few hours away.

• You don't need hundreds of ounces of milk in the freezer. “Women on the Internet show how much milk they’re making and freezing, but pumping too aggressively may actually put you into oversupply,” Freeman said. This can mean discomfort from being engorged and more frequent mastitis.

While having extra milk sounds like a good thing, higher supply can lead to stronger letdown (milk ejection) that makes it harder for your baby to feed directly at the breast. “I tell moms, ‘Feed the baby, not the freezer,’” Freeman said.

• You can't spoil a baby. Skin-to-skin time helps establish your milk supply.

“Sometimes women are told not to let their baby ‘use them as a pacifier,’ but there are reasons beyond nutrition — like bonding — that baby may spend time at the breast,” Freeman said. “Just enjoy this time.”

Is there a mindset or goal around breastfeeding that can help new moms?

“It can be really easy to get hooked on milk production, putting milk in the freezer, or comparing your journey to other women’s breastfeeding journeys,” Freeman said.

“Remember that your worth and your value as the very best mom for your baby is not measured by how much milk you make. Your worth is not measured in ounces.”

She also advised moms to be cautious when it comes to social media influencers who claim to know a lot and have everything figured out.

And if it’s difficult, it doesn’t mean that you’re doing it wrong.

“Going into breastfeeding, I expected it to be challenging — but it’s also beautiful,” Freeman said. “Now I can relate to and understand what patients are going through, and validate them: ‘This is really hard, and you're doing a really good job.’”

What is breastfeeding success?

The length of your breastfeeding relationship is a personal choice.

The American Academy of Pediatrics recommends exclusive breastfeeding to six months, and then breastfeeding alongside complementary foods to two years or beyond, “as mutually desired by mother and child.”

That last piece is important: "No singular decision or time frame is right for everyone,” Freeman said.

“Your breastfeeding relationship, your mental health, and your situation are different for every mother-baby pair — and you need to continuously evaluate these. I hope patients feel empowered to make whatever decision makes sense for them.”

Freeman said to remember your ob-gyn is there to give you information and support to meet your goals.

“If that's a plan to transition back to work, and you’re wondering what it looks like to start to add pumping into your schedule — or if that's a plan to wean for your mental health or based on medical recommendations,” Freeman said, “my goal is to make sure you have support, your questions are answered and your journey is as positive as possible.”

Key takeaways: Breastfeeding often takes more preparation, patience and support than many expect — and that’s normal. Planning ahead, learning your options and seeking help early can make a meaningful difference in your experience. Most importantly, success looks different for every mom and baby, so focus on what works best for you.