Early breastfeeding is like learning to dance with a new partner. It’s intimate, there’s a bit (or a lot) of “stepping” on each other and you tend to get sore if you’re not doing it quite right. There’s still a learning curve for even second-, third- or fourth-time moms because every baby is different.
If you are a new mom, you don’t have to struggle with breastfeeding; in fact, you’ll want to know what to expect in order to get the whole process going well. This article is meant to help new moms anticipate problems with early breastfeeding and define when an expert should be consulted. Perhaps even experienced moms will discover a fact or two!
Why should I breastfeed soon after birth, when I don’t feel like there’s much of anything in the breast yet?
Moms start to make tiny bits of early milk, called colostrum, before birth and right after birth as the baby starts to nurse. Colostrum is packed with the antibodies babies need in the first days of life—they get “immunizations” every time they nurse. There isn’t much volume produced, but the baby’s tummy is only about the size of a peanut; it doesn’t take more than a half-teaspoon or a teaspoon to make the baby feel full. After the colostrum, a transitional milk comes in on day two or three. Beginning a few days after birth, the mature milk starts to be produced.
It’s very important that babies go to the breast as soon as they can after birth—within the first 30 minutes to an hour if possible—because they are awake and alert at that time. They want to suck because it’s comforting. Sometimes within an hour or two after birth, babies (and moms) get sleepy and tired, and it can be hard to encourage the baby to suck once they hit that “wall.” It’s a great time to get started; footprints and a bath can wait. Also, the baby’s early suckling is what stimulates milk to start “coming in.” Isn’t the human body amazing?
How do I know if I’m doing it right?
Again, like learning to dance, mom and baby are learning how to breastfeed together and getting their “dance steps” down.
How the baby latches makes all the difference in the world. The baby is supposed to get a nice full mouth of breast tissue (a deep latch), not just the nipple (a superficial latch). Remember, it’s BREASTfeeding, not nipple feeding. If the baby is allowed to chomp down on the nipple and it gets sore, you’re not going to want to nurse again soon.
If moms could see through their babies’ cheeks, they would be shocked to see how elongated and far back in the baby’s mouth the nipple ends up being. That’s why it’s not supposed to hurt the nipple because there’s no trauma or pressure on it. It’s the breast tissue that’s in the baby’s mouth.
Nipples can be tender in the first few days, but nursing should not be painful; it shouldn’t make you want to curl your toes or cringe. If that’s the case, the baby should be unlatched, and a lactation consultant called to help.
The most important take-away is that mom needs to wait for the baby to open her mouth WIDE, so that she latches with her gums as far back on the areolar tissue as possible. The baby’s jaw literally needs to drop almost as wide as if she were crying. Babies will “root,” trying to feel the nipple on their face and lips. Sometimes, they look like little sharks moving their heads about quickly. Mom needs to be super patient and wait for a WIDE open mouth, then bring her in quickly so she latches deeply. A deep latch allows the baby to get more milk and feels much better to mom.
During early breastfeeding, how often are babies supposed to nurse?
Newborns typically nurse 8 to 12 times in a 24-hour day. That’s about every two or three hours but it is not a “scheduled” thing. Sometimes it is every hour. If they’re not overly medicated from birth, or sick, they will typically wake to nurse that often. Some babies are a little bit sleepy; or a little jaundiced, so they might need a little help to wake up and nurse at least 8 times in 24 hours.
In our technological age, some moms like to download an app to keep track of feedings, but it’s not necessary. Humans have survived for thousands of years without keeping track. A baby will tell you when he needs to eat. If a baby is sleeping excessively, mom’s breasts will feel too full and too uncomfortable, so she’ll wake the baby to nurse.
Why do babies breastfeed that often and what happens if they don’t?
Babies have tiny stomachs. Every time they nurse, it’s like Thanksgiving dinner. Over time, their tummies stretch and hold more milk. Plus, frequent suckling is what regulates the hormones to help mom’s body fine-tune how much milk to make, so she makes enough but not too much.
If babies aren’t nursing often enough, moms will get engorged and then the body will drop its milk supply very quickly. The demand (the baby latching well and removing the milk) is what controls the supply. And that’s why women must pump if the baby is sick or can’t nurse, or mom can’t be near the baby. The milk needs to be removed on a regular basis, so mom’s body is cued to keep producing. The body is very efficient; it’s not going to keep making something that’s not needed.
How do I know if the baby is getting enough milk?
If you put it in, it comes out! By the time babies are three days old, they should have at least six really wet diapers and two stools every 24 hours. Typically, in the first few weeks they have multiple bowel movements per day. Babies’ bowel movements change a lot. For the first day or two, they have a thick, black stool called meconium, which is the waste that’s been in their system during the pregnancy. Then their stool becomes greenish and then ultimately if they’re just breastfed, it turns into a yellow stool with small clumps the size of seeds.
A breastfed baby’s stool isn’t well formed; the milk is so well digested, not a lot of it is left. As the baby gets a little older, the stool will be a bit more formed, but it’s never going to be as hard as a formula-fed baby’s is. Breastfed babies are rarely constipated. People who haven’t been around breastfed babies may think she has diarrhea, but that’s not the case.
How much weight should the baby be gaining?
Babies lose somewhere between 5% and 8% of their birth weight in the first few days of life. That’s due to losing the extra fluid and meconium waste they have in their system when they’re born. By 5 to 6 days of age, they should be gaining weight and by 7 to 14 days of age, they should be back to or above their birthweight. Babies typically gain about a half an ounce to an ounce per day, for the next two months of life.
Should I eat or not eat certain foods during early breastfeeding?
Most moms find themselves hungrier and thirstier when they’re nursing. It’s a good idea to have a glass of water handy when you sit down to feed the baby. The hormone that is released to help milk flow makes you realize you’re parched, and you need to drink. Eighty percent of milk is water! Moms need to be hydrated and drinking water is important.
Some coffee and tea every day is ok. Nursing moms should generally avoid alcohol because it does go through to the breastmilk. You can be more lenient as the baby gets older and isn’t feeding as much. If you want to drink alcohol, have it after nursing at a time the baby won’t typically nurse again for at least 5 to 6 hours. You can also consider “pumping and dumping” once if you are really concerned about no alcohol going through to the baby. There are no hard and fast rules, but generally it’s not as strict as when you’re pregnant.
Moms can follow their normal diet; if they normally don’t eat gluten or dairy, it’s OK, the baby doesn’t need it. Babies get all the nutrition they need from what mom eats. Usually, eating about 500 to 600 extra calories per day will be plenty to make enough milk for the baby but generally moms don’t have to “work at” eating extra food. They’ll just be hungry. If you think about it, humans have successfully nursed their babies all over the world for thousands of years. Our bodies are very adaptable to our diets. If you want to take a probiotic or multivitamin, that’s fine, but it’s not necessary.
One caveat is to exercise moderation. Don’t go crazy with any certain kind of food. For example, dairy is an inflammatory food and is one of the most common foods that people don’t tolerate well. Eczema, allergies and asthma are believed in many cases to be related to dairy foods in the diet. Dairy milk is perfect for baby cows but not perfect for humans. Generally speaking, you can eat anything you want—in moderate quantities.
How important is it to get support for early breastfeeding problems?
You may have a sister or a friend who’s very experienced and can help with breastfeeding challenges, but if not, don’t struggle and cry alone at home—reach out to the help available. The earlier you get help, the easier it is to fix the problem.
Line up your support system before you deliver. A friend who has successfully nursed her baby is a good friend to have. Grandmothers are great for support to if they successfully nursed their babies, but sometimes they forget helpful details. The La Leche League is a lay support group available all over the world for breastfeeding moms. You can find both in-person and online breastfeeding classes for support. Ask your doctor, doula or midwife for referrals.
Breastfeeding is a simple, natural thing. But if you didn’t grow up around babies or watch your mom, your aunts or your mom’s friends, it’s hard to know what’s normal. You start to second-guess yourself and then if you don’t get the right advice, there’s not a lot of time to fix things before the little problems become bigger problems. Just a week or two of nursing issues can cause a significant drop in your milk supply, which can be hard to get back. If you are unable to nurse the baby at your breast, ask for help in using a breast pump so your body gets the idea to bring the milk in even though the baby isn’t nursing. Knowing what’s right and normal early on is important for success. Just remember, you’re not alone!
When should a lactation specialist be consulted during early breastfeeding?
The baby should be nursing 8 to 12 times per day in the first few weeks, have wet, dirty diapers and be gaining weight. If nursing hurts, if the baby isn’t latching well or if you don’t think the baby is getting enough milk, don’t just bury yourself on Dr. Google. Lactation consultants are widely available now through hospitals and doctors’ offices. Every pediatrician, and likely every family doctor, has a lactation consultant (or several) to whom they refer patients. Lactation specialists are available through WIC for moms that have WIC services.
There are lactation consultants who will come to your home or do telehealth or phone visits. They’re very tuned in to specific problems and remedies. The solutions are usually simple things that make a world of difference. Sometimes it’s just a matter of modifying positioning or latch technique, waiting for a wider mouth or bringing the baby in more quickly. Back to the dancing analogy, dance teachers ensure your arms are held right, that you’re maintaining proper distance from your partner, have the proper posture and execute the correct timing. Lactation experts are like dance instructors. They are worth their weight in gold!
How long should we nurse?
Breastfeeding goals are always personal. Mom (and dad) should make those decisions together. If you can nurse for a year, that’s wonderful. Babies typically do not spontaneously wean from nursing before a year of age. But if you can nurse for a month, that’s better than not at all. Three months is better than a month, and so on. Some babies start to show some weaning behavior around a year of age, but if mom is available to them day and night, they will usually continue nursing well into the second year of life.
This article only addresses early nursing, not three, six or nine months down the line. That’s a different experience and one we’ll address in a future article! Meanwhile, we hope you found this FAQ helpful and encourage you to share it with your friends and family members who are expecting!
Gail Ezell, APRN, draws on over 43 years of nursing experience to educate, support and treat her patients. For the first 20 years of her career, she worked in several areas: NICU, PICU, OB and lactation consulting. At the Cannizzaro Integrative Pediatric Clinic, she works collaboratively with families to share empowering health information and enhance their wellbeing in a more natural way. Gail’s 24-year career as a pediatric nurse practitioner has centered around pediatric otolaryngology (ear, nose, throat).
For a free meet and greet, visit www.MyCIPC.com or call 321-280-5867. To schedule a salt therapy session at The Salt Room Longwood (located inside the practice) visit www.SaltRoomLongwood.com or call 407-862-1163.
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