The best indication of whether your baby is getting enough milk is a consistent weight gain. In the short term, there are ways to know if your baby is satisfied by looking at how well they feed and how well your baby settles after a feeding.
When your baby is at the breast they should have a consistent sucking pattern. When a baby goes to the breast they initially have short sucking bursts to stimulate your body to let down milk. Once the milk starts flowing their sucking pattern will change. They will do longer sucks with a chin pause (this is when their mouth is filling with milk) followed by a swallow. This pattern repeats itself for the length of time the milk is flowing. Think about how you drink from a straw. You take a long suck, your chin comes down and pauses and is then followed by a swallow. The pattern is very similar for babies drinking at the breast. The average letdown lasts 2-3mins and there will be several let downs during a feed. You will notice that your baby’s sucking pattern will change according to the milk flow. Once the flow starts to slow, the baby will go back to the short sucking pattern to stimulate another let down. Once the milk starts flowing again you will notice the change in pattern to the long, chin pause, sucking pattern.
If you baby goes to the breast their sucking pattern does not change from short sucks to long, nutritive sucks try some breast compression to help stimulate the milk to flow or adjust the latch to ensure that your baby is deeply on the breast. A baby who nibbles on the nipple is not nursing and is not feeding. The baby needs to be deeply latched to the breast to stimulate milk flow and compress the milk ducts.
Your newborn should have at least one bowel movement a day. Initially it will be much more than one a day but once the meconium stage passes (usually around day 3-4) the stools should be a mustard yellow color and seedy or watery in consistency. If your baby is still passing thick, tarry, meconium stools by day 4-5 you should see your lactation consultant the same day. By three weeks of age it is absolutely normal for an exclusively breastfed baby to go several days without a bowel movement. Breastmilk is completely digested and as long as your baby is happy and feeding well this is a normal change in their bowel habits.
By the time your baby is 5 days old they should be having 6 wet diapers in a 24hrs period. The baby’s urine should be almost colorless after the first few days. On day 2-3 you may notice a reddish tinge in your baby’s diaper. This is completely normal passing of uric acid crystals.
However, if the reddish color persists after day 3 it can be a sign of dehydration and you should talk to your lactation consultant immediately!
The following are poor indicators:
Your breasts feel soft. It is normal for your breasts to feel softer once your body adjusts to your baby’s needs. It is very normal to not experience engorgement. Mother’s often talk about how engorged they are in the first few days but engorgement is easily avoided when you have a baby that is breastfeeding well right from the start.
Your baby is sleeping a lot, is “too good” or is sleeping through the night. Newborns should not sleep through the night and should be waking themselves up to feed frequently. A baby that is “too good” or who sleeps a lot is likely not getting enough milk. They need the energy and calories of breastmilk so they can wake themselves, if they are not getting those calories they will continue to sleep to conserve the little energy they have. In this situation you need to call your lactation consultant immediately.
Your baby cries after a feeding. Babies cry for several reasons, not just because they are hungry. Observe your baby during the feed to ensure that they are actually drinking rather than just going through the motions. Allow your baby to dictate the “schedule” and don’t restrict or limit feedings. Babies need unrestricted access to the breast. The length of feeds will vary throughout the day. Think about they way that we eat during the day. We have a few bigger meals and a few smaller snacks throughout the day, your baby will do the same thing. Sometimes they only need a snack or a drink and other times they will feel like they need to have a long, lengthy meal with appetizers, a main course, dessert and an after dinner drink.
You pump and only get half an ounce. The amount of milk that you pump is totally unrelated to the amount of milk you have or the amount of milk the baby takes in. All it signifies is the amount of milk you can pump, nothing else.
Your baby will take a bottle after being at the breast. Babies will often take more liquid from a fast flowing or an even steadily flowing bottle while their brains slowly get the message from the stomach that they are more than full. The firm bottle nipple stimulates their sucking reflex and the fact that they will drink from the bottle has nothing to do with them being hungry.
The five week old is suddenly pulling away from the breast but still seems hungry. This does not mean your milk has "dried up" or decreased. During the first few weeks of life, babies often fall asleep at the breast when the flow of milk slows down even if they have not had their fill. When they are older (four to six weeks of age), they may no longer fall asleep but rather start to pull away or get upset. The milk supply has not changed; the baby has changed. Get the best latch possible and use compression to help you increase flow to the baby.