Right from the Start

I think of the first two weeks after birth like this: you are in “survival mode”. You do whatever it takes to help you make it through the early weeks of parenting/breastfeeding. Days three and four are usually the roughest. There are many reasons for this: the physical stress your body has been through, the hormonal upheavals, sleep deprivation, and the overwhelming pressure of being the one person totally responsible for the nourishment of this new little person in your life. In most cases, you are home before your milk even comes in, and that’s why the support you have after you leave the hospital is crucial.

During the first 48 hours after birth, both you and your baby are recovering from the stress of giving birth and being born. Babies tend to be sleepy during this time, and while you will be sleepy as well, it is often difficult to get much rest in the hospital. There is so much going on – blood pressure checks, temperature checks, visitors in and out, dealing with paperwork and trying to close your eyes for a few minutes in the midst of all this is near impossible. Do whatever you have to do to survive the first two weeks. The most important thing is that you make sure your baby is at the breast, you are building your milk supply, getting your strength back, and enjoying your baby.

There are some basic things you can do from the beginning to help get breastfeeding off to the best start.

Breastfeed early

Put your baby to the breast as soon as possible after birth, while his sucking instincts are strongest. Babies are most alert during the first hour after birth, and soon settle into a sleepy stage than can last for hours. Try to take advantage of this early alert period. Early breastfeeding helps contract your uterus, reduces bleeding, and helps speed up delivery of the placenta.

Breastfeed often

Keep your baby with you at all times and learn to recognize his feeding cues (such as wriggling around, rapid eye movements, putting his hands in his mouth). Try not to wait until he is crying before you offer the breast. When he is crying and upset, he is less likely to be willing to settle down and nurse, and may respond by shutting down and falling asleep. Crying is a late feeding cue, learn to recognize the early ones. Newborns usually need to nurse 10-12 times or more in 24 hours. The more he nurses, the sooner your milk will come in and the more milk your body will produce.

Breastfeed for comfort as well as nourishment

Plan to spend most of your time breastfeeding in the early weeks. Babies nurse for lots of reasons, and they are all valid. You really can’t overfeed him, so put him on the breast whenever he fusses. One of the greatest things about nursing is that you always have a built in pacifier – it works if he’s hungry, tired, lonely, sick, or scared. Don’t be afraid to use the breast as a pacifier – it works, it makes your baby happier, it builds your milk supply, and it forces you to stop and rest. If friends and family members want to help, let them take care of you while you take care of the baby. While everyone wants to hold the baby and give you a break, the most helpful thing they can do at this stage is to cook, clean, run errands, entertain older children, etc. There will be plenty of opportunities later on for them to play with the baby.

Set up a ‘nursing station’ in the living room and the bedroom

Get all the supplies you will need together so you don’t have to move once you get settled: pillows, diapers, change of clothes, towel or cloth diaper for leaks or spit up, nursing pads, wipes, change of crib linens, bottle of water, remote control, book to read, etc.

Do not limit the time baby spends at the breast

Let him nurse as long as he seems interested. Especially in the early days of nursing, it may take several minutes for the let down reflex to ‘kick in’. Allow your baby to breastfeed as long as he wants on the first breast. Ideally he’ll pull himself off or fall asleep and look content. Always offer the second breast. If he’s fed well and asleep, he may not take it and that’s fine, start the next feed on that breast.

Don’t be surprised if your baby ‘cluster feeds’

This means that he may nurse constantly for several hours, then conk out and sleep so soundly you can’t wake him up for four or five hours. It really doesn’t matter, as long as he is getting enough to eat. For most babies, this means nursing at least 8-10 times in 24 hours. However, if your baby has regained his birth weight, there is no reason to set your alarm and wake him up every 2 hours to nurse. As long as you keep track of his urine and stool output and his weight gain, it really doesn’t matter whether he nurses every one and a half hours or every four hours, whether he took both breasts or one, or whether he nursed for five minutes or thirty. Remember that babies do not know how to tell time and mothers have successfully breastfeed in areas of the world where women do not have nor wear a watch to monitor what time their baby last fed. Throw away all your preconceived notions that your baby should be on a schedule and you will be a much happier parent with a much happier baby.

Avoid artificial nipples and supplemental feeding during the early weeks of breastfeeding

While some babies switch back and forth from breast to bottle easily from the first day, many babies will develop a nipple preference if you introduce artificial nipples before they have mastered the art of breastfeeding. Colostrum is the perfect first food for your baby and will meet all his nutritional needs for the first couple of days until your milk comes in. Colostrum provides immune factors that newborn infants can’t receive anywhere else. It is easy to digest and is full of antibodies. Colostrum is often called “liquid gold” or “baby’s first vaccine”. During the first couple of days after your baby is born, he will take in only teaspoon amounts of this precious fluid. His immature kidneys are not meant to handle large volumes of fluid at this time. Colostrum has a laxative effect that clears the meconium (the black tarry stool) out of his system. Excreting the meconium will help him avoid becoming jaundiced. Your baby is born with extra fluid in his tissues, and will excrete it during the early days. Most babies will lose some weight in the first couple of days after birth. This is normal, and he will quickly regain his weight once your milk comes in larger volumes.

Giving formula supplements at this early stage can cause all kinds of problems including decreasing your milk supply. Formula takes longer to digest than breastmilk so your baby stays full longer and is less likely to nurse as often as he needs to stimulate your supply. While many babies tolerate formula, the younger your infant is when he is exposed to artificial milk, the greater the chance of allergies or digestive problems. If supplements are medically indicated, it is best to use alternate feeding methods rather than bottles. If you are at this point please contact your lactation consultant for advice.

Make sure that your baby is latched on correctly and is nursing effectively

His mouth should be open wide, his lips flanged out, his tongue extended over his gum and under your nipple, and he should have not just the nipple but some or all of the areola in his mouth as well. He should be pulled in close with his chin touching the breast. His whole body should be facing yours, tummy to mummy, so that he doesn’t have to turn his head to nurse.

Learn signs of effective, nutritive nursing

Look for a long, drawing, rhythmic motion along his jaw-line, and a wiggling at his temple. You should be able to hear him swallowing after your milk comes in. Some babies will stay on the breast for long periods of time, but will ‘flutter suck’ ineffectively in their sleep, and won’t get the milk they need or supply you with the stimulation to produce more.

Learn how to tell if your baby is getting enough milk

Keep track of your baby’s urine and stool output. Your milk will ‘come in’ 2-5 days after birth, usually on the third day. For the first couple of days, your breasts will produce sticky yellow or gold colostrum. Once your milk comes in, you will produce transitional milk – a mixture of colostrum and mature milk, which may be yellowish and creamy looking. During the next week or so, less and less colostrum is produced, and by the time your baby is two weeks old, mature milk has replaced the transitional milk and no more colostrum is produced. See post... Is My Baby Getting Enough Milk?!?!?!

Be prepared for growth spurts

These are periods of time when your baby wants to nurse constantly and never seems satisfied, and usually occur around 7-10 days, 3 weeks, 6 weeks, 3 months, and 6 months. Remember that they rarely last longer than a few days to a week. If you have been feeding every 1-2 hours around the clock, and your baby doesn’t go any longer stretches than that in 24 hours, call your lactation consultant. The baby who nurses ‘constantly’ for several hours, then sleeps for a 4 or 5 hour stretch, is probably still getting in his minimum of 8 feedings in 24 hours, and is likely to be getting enough to eat. However, if he nurses ‘constantly’ around the clock with no long stretches between feedings and never seems satisfied, he may not be getting enough milk for a variety of reasons, and a consultation with your LC is recommended.

Know When to Ask for Help

  • Your breasts are engorged, or you are having breast or nipple pain, especially after the first couple of weeks or after a period of pain-free nursing.

  • Your baby is not latching on well.

  • Your baby is a week old and is not having 6-8 wet diapers and 2 or more bowel movements in each 24 hour period.

  • Your baby is sleepy and hard to wake up for feedings. He is nursing less than 8 times in 24 hours.

  • There are special circumstances such as jaundice, prematurity, low weight gain, cleft lip/palate, or neurological problems.

  • You develop a breast infection (mastitis) or plugged ducts.

  • You intend to return to work or school, or to be separated from your baby due to travel or hospitalization.

  • You have any questions or problems related to breastfeeding.

Remember that almost all breastfeeding problems can be solved if you are committed to nursing your baby because I am committed to helping you. Don’t ever be afraid to ask for help.

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