Breastfeeding

Getting started with breastfeeding

Breastmilk is the perfect food for your baby. It contains just the right amount of nutrients. It is also gentle on your baby's developing stomach, intestines, and other body systems. 

The process of breastfeeding and your milk change as your baby grows and develops. A newborn's feeding routine will be different from that of a breastfeeding 6-month-old. As the baby grows, the nutrients in your milk adapt to your growing baby's needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus.

Early breastfeeding

The first weeks of breastfeeding should be considered a learning period for both you and your baby. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine, and overcome any initial breastfeeding difficulties. Those first days home from the hospital can be busy and overwhelming. It may help to keep a simple checklist chart to mark daily feedings and diaper counts until your baby is gaining weight appropriately.

Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to 2 hours after birth. Then, they may sleep or act drowsy for the next 2 to 20 hours, so a baby may not be very interested in breastfeeding again on his or her birth day. However, a baby should attempt to breastfeed at least 8 times that first day. Positioning your baby skin-to-skin (naked on your bare chest) often on these first few days will help your baby wake to nurse when he or she needs to. Expect to change only a couple of wet and dirty diapers during the first 24 hours. 

Although he or she may need practice with latching on and sucking, by the second day, your baby should begin to wake and cue (show readiness) for feedings. Your baby should eat 8 to 12 times per day. Babies often don’t eat at regular time intervals and might cluster some of these feedings together. These frequent feedings provide your baby with antibody-rich first milk, called colostrum, and tell your breasts to make more milk.

Latching your baby at early signs of hunger will help him or her learn to latch well. If a baby gets too hungry, latching can be very difficult. Early signs of hunger include REM sleep (eyes batting in sleep), being awake, and licking lips. Late signs of hunger include rooting, hand-to-mouth activity, and a very late sign is crying! 

Allow your baby to suckle until he or she is finished. When he or she finishes at 1 breast, you can burp and change his or her diaper before offering the second breast. When you feed your baby next, offer the alternate breast first. Some mothers find it helpful to wear a bracelet or loose rubber band on their wrist to remember which side to offer first at the next feeding. 

As with Day 1, you probably will change only a few wet and dirty diapers on baby's second and third days. Almost all babies lose weight in the first week of life. If you are worried about your baby’s weight, talk with your pediatrician. The number of diaper changes and your baby's weight will increase when your milk "comes in."

You may feel uterine cramping when breastfeeding the first 2 or 3 days, especially if this is a second or subsequent baby. This is a positive sign that the baby's sucking has triggered a milk let-down. It also means your uterus is contracting, which helps minimize bleeding. You can use a heat pack on your stomach, or a nurse can give you something to take before feeding if needed for the discomfort.

Some mothers briefly feel a tingling, "pins and needles," or a flushing of warmth or coolness through the breasts with milk let-down. Others notice nothing different, except the rhythm of baby's sucking. Because your baby still is learning, you may experience nipple tenderness when he or she latches on or during a breastfeeding. If you have nipple pain when your baby latches, ask your nurse to watch you feed your baby. He or she can sometimes make suggestions that will make nursing more comfortable. Nipple tenderness usually disappears by the end of the first week. If tenderness lasts, develops into pain, or nipple cracking is noted, contact a certified lactation consultant.

The volume of breastmilk produced increases dramatically at about 3 or 4 days after birth, and the milk is said to have "come in." Your baby probably will drift off after his or her feedings and act more satisfied after a meal. Feedings generally last anywhere from 10 to 45 minutes. 

Over the next day, you will likely be changing more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and consistency. From the dark, tarry meconium stool, they should progress to softer and brown color before becoming a mustard-yellow and loose and seedy. Look for 4 stools by day 4 of life.  Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 g) a day.

You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some mothers find their breasts become uncomfortably engorged due to increased milk volume and tissue swelling. Then the breasts feel hard and tight, and the areola and nipple may seem stretched and flat, making it difficult for a baby to latch-on. In these cases, it can be helpful to massage the breasts, squeeze some milk from the breasts, or even use a breast pump for a couple minutes prior to nursing. The most important thing to do when your milk first comes in is to move the milk out of your breasts by feeding your baby often.

If your baby has difficulty latching on because of severe engorgement (uncomfortable swelling in your breasts): 

• Soften the nipple and areola by expressing some milk and then let baby latch on.

• Breastfeed or express milk by hand or breast pump often (every 1 to 2 hours). Your breasts should feel noticeably softer after breastfeeding or pumping.

• Apply cold packs or sandwich bags filled with ice or frozen vegetables to the breasts for 20 to 30 minutes after a feeding or pumping session. The application of cold packs has been shown to relieve the swelling that may interfere with milk flow. Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes immediately before breastfeeding or milk expression, but there are no studies that support this as effective. Using heat for more than a few minutes could increase the amount of swelling.

Your baby will become more skillful at breastfeeding as the first weeks progress. Expect to feed your baby about 8 to 12 times in 24 hours. Allow your child to nurse until he or she releases your nipple. You can then burp your baby, change his or her diaper, and switch to the second breast. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes he or she may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

Your baby should:

• Soak 6 or more wet diapers a day with clear or pale yellow urine.

• Pass 3 or more loose, seedy, or curd-like yellow stools a day.

• Begin to gain weight. Babies typically gain ¹/₂ to 1 ounce each day up to 3 months of age. 

• Talk to your baby's healthcare provider if you think that your baby is not eating enough or is not gaining enough weight.

Babies that guzzle their food nonstop may self-detach in 10 to 15 minutes. Babies preferring to savor their meals often take 20 to 35 minutes on the first breast, because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let him or her choose when to let go of the breast, as this self-detachment will increase the amount of higher fat and or higher calorie milk (hindmilk) your baby takes in.

Your baby probably will go through several 2-to-4 day "growth spurt" periods when he or she seems to want to eat almost around the clock. Babies commonly experience a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let your baby feed more often during these spurts. Generally, you should not need to supplement with formula during these times. Within a few days, your baby will have returned to a more typical pattern.

Let your baby set the pace for breastfeeding. Pay attention to feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Trying to force a breastfed baby to wait longer between feedings, or fit a particular feeding schedule, can result in poor weight gain and decreased milk supply.

For more information go to www.riversidehealthcare.org/breastfeeding.html