What Do I Need to Know My First Week Breastfeeding?

Breastfeeding from the First Hour

You’ve read all the books, taken the classes, gathered your support village, registered for all the necessities and soaked up the good (and not so good) advice from everyone around you…so, you’ll certainly be off to a good start whenever baby arrives. But what about your first hours and days breastfeeding? These are the key things you should know about breastfeeding beginning with the very first hour after birth.

Immediate Skin-to-Skin Contact Should be a Priority

One of the most important things to do immediately following birth (so long as mom and baby are safe and sound) is placing mother and baby together, skin-to-skin. During this ‘Golden Hour,’ baby should have unrestricted, skin-to-skin access to mom (no clothes, down to the diaper). This is when the first feeding will occur with patience.

Skin-to-skin contact absolutely cannot be overdone. It helps encourage baby to nurse better and more often, increases prolactin and oxytocin (milk-making hormones), brings mature milk in sooner (and you’ll make more!), helps to regulate baby’s heart rate, respiratory rate and blood sugar levels, helps temperature regulation, and increases brain growth and development.

Skin-to-Skin in Practice

• All procedures should be delayed until after the first feeding, and if they cannot be delayed, these should be done while baby is skin-to-skin on mom’s chest. Delayed cord clamping (waiting until the cord stops pulsating) and delaying the bath is always a good idea.

• Feeding in the first hour makes it more likely that mom will exclusively breastfeed longer. This first feeding not only ingrains how to latch, but it is also important for bonding and contracting the uterus to stop bleeding.

• Visitors should wait until after the first 1-2 hours to meet the baby (even longer, if possible).

• Both parents should practice skin-to-skin, not just mom.

Take The First Day Off, Then Follow Baby’s Cues

The first 24 hours after birth are considered a time of rest and recovery for mom and baby. Most infants will be sleepy and disinterested in nursing. It’s okay! Enjoy this time. Rest, recuperate and snuggle your new bundle. Trust me, they will wake up as they are biologically programmed to do after 24 hours and want to nurse, nurse and nurse some more (hello, cluster feeding). You want to gently attempt the breast every 2-3 hours if baby isn’t cueing more often. Feeding on demand is the best thing to do.

Early Cues May Include:

• Lip smacking/mouthing
• Tongue extension
• Opening the mouth
• Rooting
• Bringing the fist to the mouth
• Eyes are wide open

Crying is Considered a Late Cue

It’s much more difficult to latch the crying baby, so it’s great to be able to recognize and react to the more subtle cues I mentioned above. If baby is showing late cues, place him or her skin-to-skin and calm before attempting to feed.

Colostrum is Liquid Gold

You can finger feed your colostrum to your baby if he/she will not latch. This is a great way to wake baby for feedings, as it stimulates appetite. If baby does not wake after 2-3 hours, place he/she skin-to-skin for 30-60 minutes, watch for cues, and continue finger-feeding colostrum until they are ready to wake and nurse. Can’t get colostrum out? This is actually pretty common. Practice gentle breast massage, perfect your hand expression technique, move your hand around the breast (thinking of it like a clock; there are ducts everywhere) and try both sides. One or two feedings in the first 24-hour period is really all your baby needs, as the tummy of a newborn is only the size of a marble this first day. That might be six suckles, or 20+ minutes of nursing.

Learn to Express Breastmilk by Hand (Hand Expression)

As mentioned above, hand expression is going to be incredibly helpful. Hone your skills, and don’t get frustrated if you don’t see colostrum right away; that’s normal. Hand expression should not hurt; don’t squeeze your nipple. Research shows that expressing milk by hand has the capability to increase your milk supply substantially. Learning to do this will be valuable down the line when you start pumping to get more milk. It’s a great skill to have in your back pocket.

Feed Early and Often

More is Better

The more nursing sessions the better! In the early days of breastfeeding, you are laying down the framework for future breastfeeding and milk supply. More nursing sessions = more milk producing glands = more milk production.

Feeding On Demand

After the first 24 hours, you will want to continue to feed your baby “on demand,” offering at least every 2-3 hours. Skin-to-skin will remain an important part of feeding and bonding, and it is recommend to continue this well beyond your hospital stay. The more you breastfeed, the more milk you will make. The baby is the best at regulating your supply.

Babies will cluster feed after the first 24 hours once they wake up. Cluster feeding is feeding back to back, on average every 1-1.5 hours, sometimes more frequently. This method of feeding is crucial for increasing milk supply and does not mean anything is wrong or that the baby isn’t getting nourished from the breast. It is their way of placing an order for future milk supply. Cluster feeding will happen during growth spurts in the first week, week three, week six, month three and month six.

Length of Feeding

The length of each feeding will vary from hour to hour and day to day. Infants will remove themselves from the breast once full. It’s much more important to pay attention to what the baby does while nursing. You should hear swallows and see long jaw movements. Baby should only be unlatched if the latch is shallow and/or painful. If they aren’t nursing despite tactile stimulation and breast compressions, you can slide them off and see if they are content, but really they know best. Both sides should be offered, but it is not mandatory that they take both sides. Nursing shouldn’t be painful, and there should be no damage, although slight tenderness can be common. You may feel sleepy and/or thirsty or experience cramping in the uterus when baby breastfeeds well.

Steer Clear of Booby Traps and Breastfeeding Myths

Arm yourself with knowledge, and don’t be afraid to advocate for yourself and your baby. Try to see through the fear mongering that sometimes may occur (most often in the hospital setting), and steer clear of these pitfalls:

• Avoid nipple shields (they are not without risks) until you have seen an IBCLC who can determine if you really need one.

• Avoid all artificial nipples including pacifiers and bottles.

• Don’t let someone test your supply by pumping; it’s not as efficient as a baby and is not an accurate assessment of milk supply.

• Avoid supplementation, unnecessary procedures, blood sugar checks and suctioning unless absolutely medically necessary.

• Try to avoid sending baby to the nursery for long periods of time, if at all.

• Delay bathing and circumcision (if you opt for it) until after breastfeeding is going well.

• Don’t attempt to schedule feedings. Watch the baby, not the clock. He/she will tell you what they need and when. Scheduling feedings can be bad news for your supply and breastfeeding in general.

• Don’t assume crying means that baby is not getting enough (pees, poops, and weight okay? You’re good!).

• A healthy-term baby does not “tire” or “burn too many calories” after 15-30 minutes of feeding, and the breasts are never empty.

• You cannot overfeed a breastfed infant.

• Weight loss is normal. Typically, as long as your baby does not lose more than 10-12% of their birth weight, all is well. Take into account all the IV fluids given before birth, cesarean delivery and scale discrepancies.

• Minimal pees and poops are expected early on (usually, more poops than pees the first few days). Only one of each on day one, two of each on day two, and three of each on day three. From day four to one month, 4-6 heavy wets per day and 3-8 stools per day are typical.

• Limit visitors. I know it can be hard, but, you will be glad you did.

• Say “No thanks” to the formula gift bag if offered.

• Take advice given from the myriad of professionals and loved ones around you, and pick and choose what works for you. It can be overwhelming trying to sift through all the differing advice. Get help from an IBCLC, and above all else, trust your body and your baby.

Reach Out for Help Early On

If you are having trouble after the first 24 hours with nipple damage/pain, if baby arrived early or your are separated from baby, if baby is struggling with jaundice or feeding, if output is low, weight loss is high, or you’re feeling concerned, don’t hesitate to ask for help. It may be necessary to start pumping early if there is a medical indication. There is a lot of support out there for you! Find a breastfeeding support group, surround yourself with positive people, don’t compare your experience to others’, take it one day at a time, and reach out to an IBCLC for breastfeeding help early on if needed.

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