Getting started with breastfeeding
Breastmilk is the perfect food for your baby. It contains just the right amount of nutrients. It is also gentle on your baby's developing stomach, intestines, and other body systems.
As your baby grows and develops, your breastfeeding routine will change. And so will your breastmilk. A newborn has a different feeding routine than a breastfeeding 6-month-old. The nutrients in your milk also change to meet your growing baby's needs. And the infection-fighting antibodies in your milk will increase if you or your baby are exposed to a new bacteria or virus.
The first weeks of breastfeeding are a learning period for both you and your baby. Don’t expect to work as a coordinated team right away. Give yourselves plenty of time to recover from labor and birth, develop a daily routine, and overcome any initial breastfeeding problems. Those first days home from the hospital can be busy and overwhelming. It may help to keep a simple checklist chart. Use it to mark daily feedings and diaper counts until your baby is gaining weight appropriately.
Most full-term, healthy babies are ready and eager to begin breastfeeding in the first half hour to 2 hours after birth. Then, they may sleep or act drowsy for the next 2 to 20 hours. So a baby may not be very interested in breastfeeding again on his or her birth day. But a baby should try to breastfeed at least 8 times that first day. Placing your baby skin-to-skin (naked on your bare chest) often on these first few days will help your baby wake to nurse when he or she needs to. Expect to change only a couple of wet and dirty diapers during the first 24 hours.
Days 2 to 4
Your baby may need practice with latching on and sucking. But by the second day, your baby should begin to wake and show readiness (cue) for feedings. Your baby should eat 8 to 12 times per day. Babies often don’t eat at regular times. They may also group (cluster) some of these feedings together. These frequent feedings provide your baby with antibody-rich first milk, called colostrum. They also tell your breasts to make more milk.
Latching your baby at early signs of hunger will help him or her learn to latch well. If a baby gets too hungry, latching can be very difficult. Early signs of hunger include REM sleep (eyes batting in sleep), being awake, and licking lips. Late signs of hunger include rooting and hand-to-mouth activity. A very late sign is crying.
Let your baby to suckle until he or she is done. When your baby finishes at one breast, you can burp him or her and change the diaper before offering the second breast. When you feed your baby next, offer the other breast first. Some mothers find it helpful to wear a bracelet or loose rubber band on their wrist to remember which side to offer first at the next feeding.
As with Day 1, you likely will change only a few wet and dirty diapers on baby's second and third days. Almost all babies lose weight in the first week of life. If you are worried about your baby’s weight, talk with your baby’s healthcare provider. The number of diaper changes and your baby's weight will increase when your milk "comes in."
You may feel uterine cramping when breastfeeding for the first 2 or 3 days. This is even more likely to happen if this is not your first baby. This is a positive sign that the baby's sucking has triggered a milk let-down. It also means your uterus is contracting, which helps reduce bleeding. You can use a heat pack on your stomach. Or 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 have nipple tenderness when he or she latches on or during a feeding. If you have nipple pain when your baby latches, ask your nurse to watch you feed your baby. The nurse may have suggestions that will make breastfeeding more comfortable. Nipple soreness often goes away by the end of the first week. Contact a certified lactation consultant If soreness lasts, develops into pain, or if you have nipple cracking.
Days 3 to 5
The amount of breastmilk produced increases dramatically at about 3 or 4 days after birth, and the milk is said to have "come in." Your baby likely will fall asleep after his or her feedings and act more content after a meal. Feedings generally last anywhere from 10 to 45 minutes.
Over the next day, you will likely be changing more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and thickness. From the dark, tarry meconium stool, they should progress to softer and brown color before becoming a mustard-yellow and loose and seedy. Look for 4 stools by day 4 of life. 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 swollen (engorged) due to increased milk volume and tissue swelling. Then the breasts feel hard and tight, and the areola and nipple may seem stretched and flat. This makes it hard for a baby to latch-on. In these cases, it can be helpful to massage the breasts, squeeze some milk from the breasts, or even use a breast pump for a few minutes before nursing. 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 often.
If your baby has trouble latching on because of uncomfortable swelling in your breasts (severe engorgement):
Soften the nipple and areola by expressing some milk and then let your baby latch on.
Breastfeed or express milk by hand or breast pump often (every 1 to 2 hours). Your breasts should feel noticeably softer after breastfeeding or pumping.
Apply cold packs to the breasts for 20 to 30 minutes after a feeding or pumping session. Using cold packs can ease the swelling that may interfere with milk flow. To make a cold pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes right before breastfeeding or expressing milk. 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 get better at breastfeeding as the first weeks progress. Expect to feed your baby about 8 to 12 times in 24 hours. Let your child nurse until he or she releases your nipple. You can then burp your baby, change his or her diaper, and switch to the second breast. A baby will often breastfeed for a shorter time at the second breast. Sometimes he or 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 6 or more wet diapers a day with clear or pale yellow urine.
Pass 3 or more loose, seedy, or curd-like yellow stools a day.
Begin to gain weight. Babies typically gain 1/2 ounce to 1 ounce each day up to age 3 months.
Talk with your baby's healthcare provider if you think that your baby is not eating enough or is not gaining enough weight.
Babies that guzzle their food nonstop may let go of the breast (self-detach) in 10 to 15 minutes. Babies who like to slow down and enjoy their meals often take 20 to 35 minutes on the first breast. That’s because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let him or her choose when to let go of the breast. This self-detachment will increase the amount of higher fat or higher calorie milk (hindmilk) your baby takes in.
Your baby likely will go through several 2-to-4-day "growth spurt" periods when he or she seems to want to eat almost around the clock. Babies commonly have a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let your baby feed more often during these spurts. Generally, you should not need to supplement with formula during these times. In a few days, your baby will go back to a more normal pattern.
Let your baby set the pace for breastfeeding. Pay attention to 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 and decreased milk supply.
June 14, 2018
Eidelman A. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):e827-41.
Adler, Liora C, MD,Freeborn, Donna, PhD, CNM, FNP