Nursing a Newborn

Breastfeeding

Getting started with breastfeeding

Nature designed human milk especially for human babies, and it has several advantages over any substitute ever developed. Your milk contains just the right balance of nutrients, and it contains them in a form most easily used by the human baby's immature body systems. Because it was developed for your human baby, your milk also is gentlest on your baby's systems.

The process of breastfeeding and your milk change as your baby grows and develops. A newborn's feeding routine may be different than that of a breastfeeding six-month-old. As the baby grows, the nutrients in your milk adapt to your growing baby's needs. The anti-infective properties also increase if you or your baby is exposed to some new bacteria or virus.

• Early breastfeeding: The first weeks of breastfeeding should be considered a learning period for both you and your baby. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine, and overcome any initial breastfeeding difficulties. It may help to keep a simple checklist chart to mark daily feedings and diaper counts until your baby is gaining weight appropriately. To make a chart, take a piece of paper and number down 24 hours from midnight to 11 p.m. Then make several columns for breastfeeding, wet diaper, and stool, and put a check in the appropriate column as it occurs. (Some mothers add extra columns for pumping sessions and alternative feedings if a baby is having difficulty and they must express milk and offer it or a substitute at times.)

• Day 1: Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to two hours after birth. Then, many sleep or act drowsy for the next two to 20 hours, so a baby may not be very interested in breastfeeding again on his/her birthday. However, a baby should breastfeed several times that first day. Expect to change only a couple of wet and dirty diapers during the first 24 hours.

• Days 2 to 4: Although he/she may need practice with latching on and sucking, by the second day, your baby should begin to wake and cue (show readiness) for feedings every 1½ to three hours for a total of eight to 12 breastfeedings in 24 hours. These frequent feedings provide your baby with antibody-rich first milk, called colostrum, and tell your breasts to make more milk. Your baby should suckle for at least 10 minutes and may continue for about 30 minutes on the first breast before letting go, or "self-detaching," without help from you. When he/she finishes at one breast, you can burp and change his/her diaper before offering the second breast. As with Day 1, you probably will change only a few wet and dirty diapers on baby's second and third days, and do not be surprised if your baby loses weight during the first several days. The number of diaper changes and baby's weight will increase when your milk "comes in." You may feel uterine cramping when breastfeeding the first two or three days, especially if this is a second or subsequent baby. This is a positive sign that the baby's sucking has triggered a milk let-down, also called the milk-ejection reflex (MER). It also means your uterus is contracting, which helps minimize bleeding. A nurse can give you something to take before feeding if needed for the discomfort. Some mothers briefly feel a tingling, "pins and needles," or a flushing of warmth or coolness through the breasts with milk let-down; others notice nothing different, except the rhythm of baby's sucking. Because your baby still is learning, you may experience nipple tenderness when he/she latches on or during a breastfeeding. Other factors also may contribute to this tenderness, but usually it is mild and disappears by the end of the first week. If tenderness persists, develops into pain, or nipple cracking is noted, contact a certified lactation consultant (IBCLC).

• Days 3 to 5: The volume of breast milk produced increases dramatically at about three or four days after birth, and the milk is said to have "come in." Your baby probably will drift off after his/her eight to 12, 10 to 30-minute feedings and act more satisfied after a meal. Within 12 to 24 hours, you should be changing a lot more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and consistency. From the dark, tarry meconium stool, they should progress to softer and brown color before becoming a mustard-yellow and loose and seedy. Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 g) a day. You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some mothers find their breasts become uncomfortably engorged due to increased milk volume and tissue swelling. Then the breasts feel hard and tight; the areola and nipple may seem stretched and flat, making it difficult for a baby to latch-on. 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 frequently.

  If your baby has difficulty latching on because of severe engorgement:

  • Soften the nipple and areola by expressing some milk and then let baby latch on.

  • Breastfeed or express milk by hand or breast pump frequently (every one to two hours) - your breasts should feel noticeably softer after breastfeeding or pumping.

  • Apply cold packs or sandwich bags filled with ice or frozen vegetables to the breasts for 20 to 30 minutes after a feeding or pumping session. The application of cold packs has been shown to relieve the swelling that may interfere with milk flow. Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes immediately before breastfeeding or milk expression, but there are no studies that support this as effective. Using heat for more than a few minutes could increase the amount of swelling.

• Days 5 to 28: Your baby will become more proficient at breastfeeding as the first month progresses. Expect to feed your baby about eight to 12 times in 24 hours and for approximately 10 to 30 minutes at the first breast before he/she lets go of the breast without your help. You can then burp the baby, change his/her diaper, and switch to the second breast. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes he/she may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

  Your baby should:

  • Soak six or more wet diapers a day with clear or pale yellow urine.

  • Pass three or more loose, seedy, or curd-like yellow stools a day.

  • Begin to gain weight. Babies typically gain two-thirds to one ounce each day up to 3 months of age. 

  • Talk to your baby's care provider if you think that your baby is not eating enough.

Babies that guzzle their food nonstop may self-detach in 10 to 15 minutes; babies preferring to savor their meals often take 20 to 35 minutes on the first breast, because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let him/her choose when to let go of the breast, as this self-detachment will increase the amount of higher fat/higher calorie milk (hindmilk) your baby takes in.

Your baby probably will go through several two to four day "growth spurt" periods when he/she seems to want to eat almost around the clock. Babies commonly experience a growth spurt between two to three weeks, four to six weeks, and again at about three months. It is important to let a baby feed more often during these spurts. Within a few days, your baby will have returned to a more typical pattern.

Let your baby set the pace for breastfeeding. Pay attention to his/her feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Trying to force a breastfed baby to wait longer between feedings, or fit a particular feeding schedule, can result in poor weight gain.