New moms have many questions when it comes to caring for their baby. As a pediatrician and lactation consultant, I often answer a variety of them.
One of my passions is teaching women how to breastfeed their newborn babies. The benefits of breastfeeding are enormous for both mom and baby and pursuing an exclusive breastfeeding relationship is a worthy goal to achieve.
Overcoming the first two weeks of this process are often the most challenging. As a result, we will look at the top 5 most asked questions during the first two weeks of a new couplet’s breastfeeding relationship.
How do I know if my baby is getting enough breast milk?
If you are wondering this, you are not alone. A full term newborn baby has a fluid and fat reserve at birth that will help them get through the initially small amount of colostrum provided through breast feeding. It is normal for a new baby to have a short awake period immediately following birth and then enter into a more sleepy time period. This makes the first feeding at the breast an important milestone to accomplish. A new baby is not expected to breastfeed well on the first day of life.
Often, the second day of life is very different. Your baby should be more awake and demanding to be fed fairly frequently. This process is called cluster feeding and a baby often demands to be fed every hour or less during this time. It can be difficult to do, but catching a baby during their early feeding cues will allow for a more relaxed and successful feeding. Early signs of hunger are alertness, moving hand to mouth and turning head or rooting.
If the baby is latching well and feeding, you should be able to hear your baby swallow every few sucks. This is the main indication that the baby is transferring milk from the breast and therefore getting enough to eat. A relatively small amount of colostrum is produced by the breast in the first 2 days of life and is enough to sustain a healthy full term newborn. A small stomach capacity combined with the baby’s efficient use of breast milk requires frequent feedings. As a pediatrician and a lactation consultant, I recommend that you attempt to feed your baby at least 8-12 times per day around the clock during the first couple of weeks of life.
Counting diapers is a second way to ensure that a baby is getting enough breast milk. As a general rule, a baby should have one wet diaper for each day of age until day 4-5 when they should have > 6 wet diapers per day. Stool is variable, but babies should have their first stool within 24 hours of birth and then their stool should transition from the black, tarry meconium stools to yellow, seedy stools by day 4-5. After that time, they should have at least three stool diapers per day, but often breastfed babies stool after or during each feeding.
Another third important measure to judge whether or not a baby is getting enough milk is to follow their weight. It is normal for a newborn baby to lose weight in the first 3-4 days of life. They have significant fluid shifts after birth and should get rid of that fluid in the first few days of life. By one week of age their weight should stabilize and they should return to birth weight by 2 weeks. We, pediatricians often get nervous when a baby loses 10% or more of their birth weight. This kind of weight loss can be within normal for certain babies, but it is a cause for close follow up and involvement of a professional.
How do I know if I need to supplement?
There are many reasons why a baby may need supplemental feedings. Excessive weight loss is the main reason and is often caused by a poor latch, poor milk transfer or a baby that has increased fluid and/or calorie requirements. You should work with a professional lactation consultant or pediatrician to decide how much supplement your baby needs and what method to use. If your ultimate goal is to return to full exclusive breastfeeding, you may opt to use a medicine cup or a syringe to give supplements. There is also a product on the market called the SNS or supplemental nursing system that works well for certain situations. Your pediatrician may recommend that you use your own expressed breast milk, formula or donor breast milk depending on your preference and how concerning your baby’s weight loss is.
On the other hand, if your baby is eating well at the breast and maintaining all of the criteria that we discussed above, you do not need to supplement your baby with anything else. Babies should be exclusively breastfed whenever possible for the first 6 months of life and then continue breastfeeding after the introduction of complementary foods from 6-12 months of age. Often, mothers choose to continue breastfeeding beyond the first 12 months of their baby’s life. Of course, you should always be in communication with your baby’s pediatrician should any problems arise.
When will my milk come in?
Our bodies are amazing and the process of obtaining a full milk supply is equally amazing. There are two main stages of milk production. Lactogenesis I starts in mid-pregnancy and is in place for the first 24 hours after delivery. If the correct pregnancy and postpartum hormones exist in the body, a woman who gives birth will produce colostrum during lactogenesis I. The next step follows quickly and is called Lactogeneis II or copious milk production. This process of your milk “coming in” starts around 2-3 days postpartum for most women. Lactogenesis II is maintained by milk removal and nipple stimulation. Prolactin and oxytocin are the hormones that take over and milk supply is maintained in a supply and demand fashion from now on. This means that milk must be removed from the breast at regular intervals for it to be replaced by more milk.
By day 3-4 postpartum most women will have their milk in. There are many factors that can delay this process and keeping in close contact with your pediatrician or lactation consultant during this time is important. Most pediatricians recommend that exclusively breastfeeding newborns be evaluated in their office in the first 2-3 days after discharge from the hospital. An early appointment helps us monitor you and your baby’s progress through the first few days of breastfeeding and gives us the opportunity to troubleshoot any problems.
How do I know if I need to pump?
If you are needing to supplement your baby for any reason, you should be using the breast pump as we described above. Your goal should be to give your baby your own milk as much as possible. But, if your baby is doing well at the breast and not needing any extra milk, the recommendations are to wait to use a breast pump/give breast milk in bottles until breastfeeding is well established. This usually takes about 6-8 weeks for most mom/baby pairs. There are always exceptions to this so ask your baby’s pediatrician if you have specific questions.
On the other hand, some mothers experience engorgement (overly full breasts). Pumping off some milk with help to relieve the associated pain and pressure. If you are using your pump for this reason in the early days, you should pump for a minimal amount of time, usually just long enough until you are feeling better. Pumping until your breasts are empty will cause your body to think that you need to produce more and more milk. This can lead you down the path of oversupply which can lead to a whole new set of problems.
Is breastfeeding supposed to hurt?
Before your baby is born, you may think that breastfeeding is a natural and beautiful process and that your sweet baby will be born knowing exactly what to do. As we discussed earlier, the reality is that breastfeeding may be one of the hardest things that you will ever do. While, it is definitely beautiful and fulfilling, it takes a little bit of work to get to that point. In the beginning stages of breastfeeding, you and baby are trying to figure each other out. This, combined with the fact that babies nurse frequently the first couple of weeks of life, may leave you experiencing some pain. This is especially true for first time moms who do not have experience feeding a baby.
Extreme pain, bruising, creasing or cracking of your nipples usually indicates that there is a problem with your baby’s latch. It may be the way that he or she is getting onto the breast or it may be an anatomical problem either with your breasts or your baby’s mouth. This would be a situation where you should get your pediatrician or a lactation consultant involved to help you troubleshoot the problem. Allowing these problems to go on too long will affect your long term milk supply and the feeding relationship between you and your baby.
Hopefully, these answers will alleviate some of the stress you may feel in anticipation of this important milestone. There can be many tears and sleepless nights involved in the pursuit of exclusively breastfeeding a new baby. You are one among many women who have tried and succeeded in this process. An important thing to remember is that success looks differently for every mom and baby. If you have made it through this process and are not meeting your breastfeeding goals, take heart. Feeding and enjoying your baby is the most that any person, including yourself, can ask of you.
Dr. Andrea Wadley
127 Pediatrics | © 127 Pediatrics, 2019, all rights reserved. 33 Main Street, Suite 160, Colleyville, TX 76034
Grey's Cowbell specialises in lactation cookies, lactation muffins and lactation drinks as well as other products. Our primary focus is to provide a superior product that yields a highly effective result. Our cookies, muffins and bottled drinks help breastfeeding mothers dramatically increase and sustain their breast milk supply.