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. 

As your baby grows and develops, your breastfeeding routine will change. And so will your breastmilk. A newborn has a different feeding routine than a breastfeeding 6 month-old. The nutrients in your milk also change to meet your growing baby's needs. And the infection-fighting antibodies in your milk will increase if you or your baby are exposed to a new bacteria or virus.

Early breastfeeding

The first days home from the hospital can be busy and overwhelming. The first 3 to 4 weeks of breastfeeding are a learning period for both you and your baby.  Don’t expect to work as a coordinated team right away. Give yourselves plenty of time to recover from labor and birth, develop a daily routine, and learn what works for you and your baby.

Day 1

Most full-term, healthy babies are ready and eager to begin breastfeeding in the first 30 minutes to 2 hours after birth. During this time when they are most alert, we encourage you to place your baby skin-to-skin, or naked on your bare chest. This will help your baby wake to breastfeed when they need to.  They may sleep or act drowsy for the next 2 to 20 hours, but try to breastfeed your baby at least 8 to 12 times that first day.  Expect to change only a couple of wet and dirty diapers during the first 24 hours. 

Days 2 to 4

Your baby may need practice with latching on and sucking. But by the second day, your baby should begin to wake and give you cues that they are ready to feed. Your baby should eat 8 to 12 times per day. Babies OFTEN do not have a schedule and won’t eat at regular times. They may also group some of their feedings together, also known as “cluster feeding”.  These frequent feedings provide your baby with colostrum, your first milk, which has antibodies that help protect your baby. The frequent feedings also tell your breasts to make more milk.

Latching your baby at early signs of hunger will help them learn to latch well. If a baby gets too hungry, latching can be very difficult. Early signs of hunger include eyes fluttering underneath their eyelids, being awake, licking lips, rooting, or turning their heads toward your breast. A late sign of hunger is hand-to-mouth activity. A very late sign of hunger is crying.

If your baby is removing milk from your breast easily, they will show signs that include:

• A comfortable latch.
• Swallowing that you can hear.
• A good amount of wet and dirty diapers – see below.
• Making more breastmilk.
• Your breasts feeling more comfortable and less full after your baby is finished.

If you notice these signs, let your baby continue to suck until they are done. When they finish at one breast, you can burp them and offer the second breast. The next time you feed your baby, offer the breast that you ended with at the last feeding. 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.

Most of the time, having enough wet and dirty diapers means that a baby has at least one wet diaper and one dirty diaper per day of life. This means that on the first day of your baby’s life,   they have at least 1 wet diaper and 1 dirty diaper. On the third day of their life they have at least 3 wet diapers and 3 dirty diapers. This pattern should continue until about their fifth day of life, when you can expect 5 to 6 or more wet diapers and 3 or more dirty diapers each day. Having enough wet and dirty diapers is one way to tell if your baby is getting enough milk.

You may feel uterine cramping when breastfeeding for the first 2 or 3 days. This is even more likely to happen if this is not your first baby. This is a positive sign that the baby's sucking has triggered your milk to “let down”. It also means your uterus is contracting, which helps reduce bleeding. You can use a heat pack on your stomach to help relieve the pain.

Some mothers briefly have a tingling, "pins and needles" feeling, or a flushing of warmth or coolness through the breasts when milk is let down.  Others notice nothing different, except the rhythm of baby's sucking. In the early days of breastfeeding, nipple tenderness is common.  If you have nipple pain when your baby latches, ask your nurse to watch you feed your baby. The nurse may have suggestions that will make breastfeeding more comfortable. Nipple pain that lasts longer than 1 to 2 minutes during a feeding is not normal. If soreness lasts, develops into pain, or if you have nipple cracking, consider contacting a certified lactation consultant.

Days 3 to 5

The amount of breastmilk produced increases dramatically at about 3 or 4 days after birth, after your milk "comes in." Your baby will likely fall asleep after their feedings and act more satisfied after feeding. Even though your milk increases, it is still very important to watch for signs that your baby is removing milk from your breasts.

Over the next days, you will most likely be changing more wet diapers. The number of dirty diapers also increases, and their poop should be changing in color and thickness. Your baby’s poop should turn from a dark, tarry meconium stool, to a softer brown, before becoming mustard yellow, loose and seedy. Look for 4 stools by 4 days of life.

You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some people find their breasts become uncomfortably engorged, or swollen, due to the increased milk volume and tissue swelling. Then the breasts feel hard and tight, and the areola and nipple may seem stretched and flat. This makes it hard for a baby to latch. In these cases, it can be helpful to squeeze some milk from the breasts, or even use a breast pump for a few minutes before 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 is not showing signs that they are removing milk well, contact your care team.

If your baby has trouble latching on because of uncomfortable swelling in your breasts, your breasts could become engorged, which is a painful overfilling of the breasts. This happens when:  

• The amount of milk in your breasts increases, or comes in. This can happen within the first 5 days after delivering your baby.
• Enough milk isn’t being removed from the breast. This can happen both when breastfeeding or pumping.

If your breasts become engorged, try the following:

·       Soften the nipple and areola by expressing some milk and then letting your 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 to the breasts for 20 to 30 minutes after feeding or pumping. Using cold packs can ease the swelling that may interfere with milk flow. To make a cold pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin.
• Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes right before breastfeeding or pumping.  But don’t apply warm compresses for more than a few minutes because this could increase the amount of swelling.

Days 6 to 28

You and your baby will get better at breastfeeding as the first weeks progress. Expect to feed your baby at least 8 times in 24 hours; this is normal. If there are signs that your baby is removing milk, let them breastfeed until they release your breast or until you stop hearing frequent swallows. You can then burp your baby and switch to the second breast. A baby will often breastfeed for a shorter time at the second breast. Sometimes they may not want to feed at the second breast at all. Then just start with the second breast at the beginning of the next feeding.

Your baby should:

• Have 6 or more wet diapers a day with clear or pale yellow urine.
• Pass 3 or more soft, seedy, yellow stools a day.
• Begin to gain weight. Babies typically gain 1/2 to 1 ounce each day up to age 3 months.

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

Babies often take 20 to 35 minutes at the first breast. If they gulp breastmilk quickly they may let go of the breast in 10 to 15 minutes. The amount of time a baby spends at the breast is not a good way to tell if your baby is getting enough milk. The best way to know if your baby is getting the amount of milk they need is by looking for signs of milk being removed (see Days 2 to 4 for signs of milk removal).

Your baby likely will go through several 2 to 4 day "growth spurt" periods when they seem to want to eat almost all day long. Babies commonly have 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 growth spurts. Usually, it does not mean that a formula supplement is needed during these times. In a few days, your baby will go back to a more normal pattern.

Let your baby set the pace for breastfeeding. Pay attention to their feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Don’t try to force your baby to wait longer between feedings, or fit a particular feeding schedule. This can result in poor weight gain and decreased milk supply.