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The first few days after a baby is born is a whirlwind. Moms are expected to learn all sorts of new things when they are running on little sleep and high levels of adrenaline.
There will be a laser focus on breastfeeding. If you give birth in a hospital, you will be asked how often your baby is breastfeeding. The nurses will want to know how long the feedings last. Is he swallowing?
Take a deep breath and focus on these things that will help you with establishing breastfeeding.
WHEN IS BREASTFEEDING CONSIDERED ESTABLISHED?
I tell moms that breastfeeding is established when the following criteria are met:
- Baby is back to birth weight.
- Baby is solely breastfeeding and gaining an average of one ounce a day.
- Mom is maintaining her supply by breastfeeding only.
- Mom has no nipple pain or trauma.
- Engorgement has resolved.
- Mom is breastfeeding without thinking about the details.
I want to elaborate on that last one. In the very early days of breastfeeding, you are thinking about every little thing.
Is my baby hungry? Is my baby swallowing? Am I having any pain? Is my baby having enough diapers? Are my breasts sore from engorgement? Am I holding my baby the right way for a pain-free latch?
Then one day, you are just doing it. You don’t think about it. You just do it.
In this post, I will take you from, “I haven’t got a clue” to “I’ve got this!”
Let’s get started!
SKIN TO SKIN AND BREASTFEEDING
Do lots of skin to skin. You can’t do too much skin to skin.
It is important to know how to do skin to skin safely.
Skin to skin is so valuable for so many reasons (Source).
- Helps baby stabilize their body temperature
- Helps a cold baby get warm
- Stabilizes heart rate and breathing
- Helps regulate blood sugar
- Babies cry less
- Provides pain relief
- Do skin to skin if your baby needs a heel stick for a blood test
- Increased weight gain for premies
Skin to skin is also valuable for breastfeeding.
- Encourages baby to start breastfeeding
- Babies breastfeed sooner
- Babies exclusively breastfeed for longer (Source)
- Babies breastfeed more frequently
- More babies exclusively breastfeed (Source).
Sometimes it is not possible to do skin to skin right after birth because the baby or mom requires medical attention. That’s okay. Do skin to skin as soon as you can.
Do skin to skin:
- As soon as you can
- As long as you can
- As frequently as you can
BREASTFEED EARLY AND OFTEN
Skin to skin will help your baby start breastfeeding. Rooming-in round the clock will help with breastfeeding frequently.
Frequent breastfeeding helps in establishing breastfeeding because of these many advantages:
- Your milk comes in sooner.
- Baby will lose less weight
- Baby will have fewer problems with jaundice.
Your baby will tell you when he wants to eat by showing feeding cues. Learn them and watch for them. Feed your baby whenever you see her feeding cues.
ROOM IN WITH YOU BABY ALL THE TIME
Keeping your baby in your room all the time helps you to learn her feeding cues.
Babies are easier to latch when they are offered the breast when they first start showing signs of hunger.
If a baby is not offered the breast when she is showing early feeding cues, two things can happen.
- She may fall back to sleep and not be interested in eating again for a few hours.
- Remember, more frequent feeding results in the milk coming in sooner, less weight loss, and fewer problems with jaundice.
- She may start crying. Crying is a late sign of hunger, and babies are harder to latch when they are crying.
LEARN YOUR BABY’S FEEDING CUES
HOW TO TELL WHEN YOUR BABY IS HUNGRY
Your baby is hungry when you see him do these things.
HOW TO TELL WHEN YOUR BABY IS FULL
When your baby first starts feeding, he will have his hands clenched by his face. As his tummy gets full, he will unclench his hands, and his arm will become relaxed.
COLOSTRUM – BABY’S FIRST MILK
Many new moms worry about what their baby will have to eat before their milk comes in. Mother nature has provided well for your baby.
During pregnancy, your breasts start making a special milk called colostrum. It is full of antibodies. It has a lot of protein and carbohydrates and is low in fat.
Your colostrum is exactly what your baby needs in the first days of life in exactly the right amount.
Colostrum is made in tiny amounts because your baby’s tummy is tiny. It is about the size of a cherry when your baby is born. It will stretch in the first few days and be able to hold more each day.
HOW OFTEN DOES MY NEWBORN NEED TO EAT?
The answer to this question will change often in the first few days.
In the first 24 hours, a baby may eat only a few times. It’s possible he may not eat at all. On the other hand, he may want to eat every couple of hours.
In the second 24 hours, a baby should be eating a minimum of eight times.
Because cluster feeding is common during a baby’s second night, there may be more than eight feedings. Many more. That is fine.
In the first 6-8 weeks, most babies will need to eat at least 8-10 times in 24 hours to gain an average amount of weight.
- This will be every two to three hours.
- The frequency of feeding is measured from the beginning of one feeding to the beginning of the next feeding.
- Periods of cluster feeding are normal.
- One four hour stretch between feedings is okay.
HOW LONG SHOULD A BREASTFEEDING SESSION LAST FOR A NEWBORN?
The length of feedings is another thing that can vary a lot in the early days. A baby may feed for only a few minutes or a feeding can last an hour. If a baby breastfeeds for less than ten minutes, it shouldn’t be counted as a full feeding.
An average feeding is about 30-40 minutes of active feeding. Active feeding is when the baby is sucking vigorously and swallowing at least every 2-3 sucks. A baby can be on the breast and comfort sucking, but not really eating.
Comfort sucking is fine but should not be counted feeding.
If most feedings are taking longer than one hour you should have a visit with a lactation consultant. She may be able to help you make feedings more efficient. She can also determine if there is a problem that is causing feedings to be so long.
HOW TO KNOW IF BABY IS EATING ENOUGH WHILE BREASTFEEDING
This is a top concern for a new breastfeeding mom. You want to know that your baby is getting enough to eat from breastfeeding. The main answer to this question will come from your baby’s diapers and the scale.
In the first 2-4 days before your milk comes in, you will look for signs that your baby is staying well hydrated. Her mouth should be moist, not dry and sticky
HOW MANY DIAPERS SHOULD A NEWBORN HAVE A DAY?
This is something that will change every day for almost the first week. The number of both poops and pees are important.
Once your milk is in your, your baby should have at least six wet diapers and four dirty diapers of moderate quantity. These are considered reassuring signs that your baby is getting enough to eat.
Newborn Weight Loss When Breastfeeding
It is normal for a baby to lose weight in the first few days after birth. This is true whether they are breastfed or formula-fed.
- Up to 10% of weight loss is considered normal.
- Once your milk comes in, your baby should start gaining an ounce a day.
- A breastfed baby needs to be seen for a weight check within 48 hours of leaving the hospital or at 3-5 days of age.
- A baby should be back to birth weight by two weeks of age.
ADEQUATE WEIGHT GAIN IS THE ONLY WAY TO KNOW A BABY IS EATING ENOUGH.
GET REGULAR WEIGHT CHECKS.
BREASTFEEDING POSITION AND LATCH
These are two things that are critical to your baby getting enough milk and your comfort.
Watch this video for a demo of how to properly position baby for breastfeeding.
Using the correct latching technique is key to breastfeeding going well.
Important things to remember are:
- Support baby’s neck and shoulders
- Keep your hand off the back of baby’s head
- Tummy to tummy
- Nose to nipple
- Wait for a wide root
- Quickly bring the baby to the breast.
- Do not move your breast to the baby.
ESTABLISHING YOUR MILK SUPPLY
For the vast majority of women, milk supply is going to depend on supply and demand. The more you tell your body to make milk by breastfeeding and/or pumping, the more milk you will make.
I often get asked by moms if they should pump to help the milk come in faster. Most moms should focus on breastfeeding in the early weeks. This will allow your baby to tell your breasts how much milk to make.
Pumping when you have a baby who is breastfeeding an average amount can result in an oversupply of breast milk. Too much milk can cause problems.
There are times when a baby may not stimulate a good milk supply. In these cases, a mom should pump in addition to breastfeeding.
- Baby born before 38 weeks
- Baby weighs less than 6 ½ pounds
- Baby is not eating at least eight times a day
WHEN DOES YOUR MILK COME IN AFTER GIVING BIRTH?
A mom’s milk comes in between 48 to 72 hours after giving birth.
It can come in after that but is considered delayed.
How Long Does It Take To Establish Milk Supply?
In the first few weeks, most moms feel like they are making more milk than their baby needs. This usually gets better by the end of the third week.
Your milk supply is usually established by eight weeks. Before that, you should not miss any feedings. That means if your baby gets a bottle instead of you breastfeeding, then you should pump. This is true even if the bottle is your pumped milk.
Once your supply is established, many moms will say they don’t feel as full. That is normal. As long as your baby is gaining enough weight, you are making enough milk.
BREAST ENGORGEMENT WHEN MILK COMES IN
When your milk comes in, there will probably be a moment when you look in the mirror and say, “Whose breasts are those because mine have never looked like this before?”
Most women experience some degree of breast swelling when their milk comes in. This is called breast engorgement — the tissue around the milk-producing glands swell.
The most important thing to remember is to keep the milk moving. Breastfeed frequently when your breasts are engorged. If your baby does not nurse enough to soften your breasts, then you should pump.
- Pump only if you get milk out
- Pump only until your breasts are softer
- Pumping frequently until your breasts are empty can cause an oversupply problem
Ice packs or chilled green cabbage leaves can help decrease swelling (Source).
Ice packs can be left on for up to twenty minutes. There should be at least a twenty-minute break before reapplying.
HOW TO USE CABBAGE FOR BREAST ENGORGEMENT
I am not sure who the first person was that suggested cabbage for engorgement. But it does work to decrease swelling.
- Use green cabbage
- Chill the leaves
- Make the treatment more effective
- Cold leaves are soothing to the inflamed breast.
- Rinse the leaves thoroughly to minimize the risk of bacteria that is occasionally found on fresh produce.
- Crush the leaves to makes them easier to mold to the breast.
- Wear a bra or tank top to hold them in place.
- Cover the breast with the leaves.
- Leave the nipple exposed.
- Leave them on until they wilt, usually 20-30 minutes.
- Can reapply fresh leaves for up to one hour of continuous application.
- More extended periods of continuous use have resulted in decreased milk supply for some moms.
- Take a break for at least a couple of hours before reapplying.
ESTABLISHING A BREASTFEEDING ROUTINE
I like to say in the first week it is like you get a new baby every 12-24 hours because they change so much.
After the first week, most moms and babies start to settle into a breastfeeding routine.
To encourage your baby to sleep at night, do not let her sleep longer than two to three hours during the day.
Most babies will have their days and nights mixed up in the early weeks of breastfeeding. This tends to get better after three weeks.
Babies go through a growth spurt at three weeks. They will all of a sudden want to eat very frequently. Moms often worry that they are losing their milk. The frequent feeding is normal and lasts for 24-48 hours.
In the first week, your priorities should be:
- Feed your baby
- Feed yourself
- Rest as much as possible
- Limit visitors
I know your friends and family are going to want to see the baby. But a baby who is being held by someone other than mom or dad often will not show feeding cues. They get overstimulated and check out by sleeping through all the visitors. This can be counterproductive to getting breastfeeding established.
After the first week wearing your baby will allow you to keep her close while you get things done. My baby wrap was my favorite baby accessory when my kids were first born. It is something that I highly recommend to new moms.
The Baby K’Taan is a super easy to use baby wrap.
NIPPLE SORENESS FROM BREASTFEEDING
Sore nipples are a very common complaint in the early days of breastfeeding. It is usually the worst between the second and fourth day after you start breastfeeding.
Gel pads were one of the best things invented. I have recommended Ameda ComfortGel for over twenty years. Have a couple of pairs so that you can wear one pair and put one pair in the fridge. That way, you will always have a cold pair ready.
Nipple pain is considered “okay” if the following things are true:
- Pain is with initial latch
- Goes away after 30 seconds
- The is no trauma (cracks, bruises, bleeding, blisters)
- Is much better by the end of the first week
- Is entirely gone by the end of the second week
If the pain is severe or there is trauma, then you should call a lactation consultant ASAP for a consult. If you do not have a lactation consultant nearby, you can have an online consult.
GET HELP SOONER RATHER THAN LATER
If you are struggling with any aspect of breastfeeding, contact a lactation consultant ASAP. Most problems are much easier to resolve when they first start to occur.
FINAL THOUGHTS ON ESTABLISHING BREASTFEEDING
Breastfeeding will be a journey. There will be ups and downs. But the first few weeks is usually the most intense.
Following these tips will help you feel confident sooner. Before you know it, you will be “just doing it” and not thinking about the details.
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.