You’re in the hospital, a new mom, trying to get your feet wet with the new baby feeding process. Well-wishers, relatives, and hospital staff all have a ton of advice. And given the gravity of the situation—the sinking feeling that you are now responsible for another human being and that his safety depends solely on you—it’s understandable that you would be a little overwhelmed.
Angela was a new mom who cared deeply about breastfeeding her son. When I met her in my clinic for a meet and greet appointment at the end of her pregnancy, she had already taken a prenatal breastfeeding class but felt nervous about putting all that confusing education into action when the big day came.
“The instructor had a lot to say,” she told me, “But I don’t know if I’ll remember it all. At about the 3-hour mark, my mind started to wander. I looked over at my girlfriend and she looked similarly dazed. The weekend before, we completed a childbirth class and the next weekend we had a baby care class. It’s all running together now. If you asked me to tell you the most important fact the breastfeeding instructor taught me, I’m not sure I could regurgitate it.”
Angela is not alone. Breastfeeding for the first time can be a daunting task, and while there are some amazing resources our there for fledgling feeders, sometimes, beginning by understanding the basics can be the most helpful.
These are the most important breastfeeding principles to help you feel confident as you start out.
You already know that babies need to eat. But the specifics of what they need and when they need it can be a bit more complicated.
Believe it or not, the first few days after birth have a huge influence on your breastfeeding success. No pressure, right? There is a ton you cannot control, so the most important concept is to know the basics of what to do when it goes right and then more specifically what can go wrong so that you can get help when you need it.
Watch videos about breastfeeding before you have your baby. The Stanford Medicine Newborn Nursery website (www.med.stanford.edu/newborns) has a great series about breastfeeding basics. Watch how the moms position their babies, and learn about latching properly. It will give you a book-level knowledge of what to do.
When you are in the hospital, ask for help latching your baby right away. If possible, choose a hospital with nurses who are lactation certified so that you get professional help as soon as possible. The “gold standard” is to get your baby latched to your breast within 1 hour after birth, setting both of you up for success. The best way to achieve this is to have your baby placed skin to skin with you immediately after birth. Ask your nurse at the hospital to verify if the baby is positioned correctly. Ask for a lactation consultation if you have any concerns at all (this is pretty much every new mom I meet, so don’t feel as if you have to have major worries in this area to justify getting extra assistance).
In the first few days to weeks, new babies need to have a feeding attempt at least every 3 hours. We call it “three hours start to start” in my office, which means it should be no longer than 3 hours from the start of one feeding to the start of another. Babies will often want to feed way more often than that, which is great and perfectly OK, but at the very least, they need that every-3-hour cueing.
Why? Breastfeeding is a 2-way feedback loop. The first feedback loop is for the mom: the more a baby’s suckling stimulates the breast, the more milk the mom’s body makes. The second feedback loop is for the baby: the more the baby eats, the more food he takes in and the more alert and hydrated the baby will be, driving hunger and allowing the baby to regulate his own feeding needs over time.
You may have heard 2 things that contradict this advice, so let me address them both.
First, people talk all the time about the fact that babies should feed on demand—that they should drive their own hunger and can do so, that breastfeeding should be natural. That’s totally true…eventually. But in the beginning, a baby needs help getting her system going. Breastfeeding is natural, but it’s not usually easy in the beginning for a new baby or a new mom—both have to learn new skills and how to rev up the system.
Second, there’s a lot of talk in prenatal classes about how a baby’s stomach is really small at first and how he doesn’t need much milk, about how he really needs only the tiny bits of colostrum in the first few days. That is absolutely true. Babies are often sleepy in the first 24 hours after they are born, and mom’s milk supply is limited in volume; the system is set up so that there’s a little grace period.
But there’s a catch: that is the time to prime the pump(s) by breastfeeding frequently so that the milk increases and so that baby is alert enough at day 3 to 4 to take the more copious milk mom starts making. In some cases, if that doesn’t happen, “blood sugar” (blood glucose) levels can drop, making babies lethargic and harder to feed. Babies can get dehydrated, and their bilirubin levels can rise, contributing to jaundice (the yellow color that can develop in a baby’s skin).
Ask the nurses to teach you tricks to get your baby to continue being stimulated when on the breast, if she starts to fall asleep soon after the feeding begins. We use techniques such as “the chicken wing” (moving the baby’s arm gently in a small circle), tickling her feet, using a cool cloth, and removing her clothing so that she is motivated to continue eating once she starts. Otherwise, the baby may burn energy on sucking without getting much back in return.
If you end up needing breastfeeding equipment such as nipple shields, make sure that you do extra pumping to offset the decreased stimulation to your breasts. Also, make sure that once your milk “comes in,” you are what they call “fitted” for breast flanges (the cones that attach to the pump). Our lactation specialist says that if your breast flanges are not the right size, it’s like walking around in shoes that are too big or too small.
Breastfeeding in the hospital can be hard because it’s all so new. Once they go home, a lot of moms realize those hours clocked in the hospital were really the Golden Days—a time when they had tons of help and resources. Take full advantage of your time before you go home.
A basic understanding of the way breastfeeding usually progresses allows you to recognize when things aren’t going quite as planned.
Now, sometimes, health issues or difficulties can arise or not go as planned. Most people do not talk much about this. I think it is in the name of not making people panic, but the reality is that breastfeeding can be challenging. A lot of moms tell me they wish that someone had been real with them about that aspect.
It can feel uncomfortable at first when most babies learn to breastfeed because their suction is stronger than anything their mothers’ breasts have ever experienced. But if the pain is severe or persistent, you need to get help. Pain in the first days is often caused by a poor latch. If you have nurses or a lactation specialist help you in the hospital, having either help you assess latch is one of the most important things you can do. This is one of those things that is impossible to know until you are doing it—watching a video can help you know the basics of latching, but it can’t replace the real thing.
If your baby isn’t getting enough milk, she can lose too much weight. By about day 3 to day 4, your milk should be in. You’ll start to see and hear your baby really swallowing when she is eating, and you may see milk at the corner of her mouth. If that isn’t happening, again, it means you need help.
We expect that babies will lose up to 10% of their birth weight in the first few days after birth. But once your milk is well established, weight gain begins.
One of the major indicators of a normal progression is poop, which changes rapidly as your milk comes in.
It is important to know that babies who are breastfed exclusively have very loose stools that are easy to pass. Some new parents mistake these typical stools for diarrhea.
| Poop Changes in the First Week | ||
|
Day |
Number |
Color |
|
1–2 |
1–2 |
Greenish black meconium |
|
2–3 |
3+ |
Green or mix of dark green and brown |
|
4–5 |
3+ |
Yellow, seedy, and runny |
All babies have a very floppy connection between the feeding tube (esophagus) and the stomach. This is called the lower esophageal sphincter. This acts as the gatekeeper for contents to pass through to the stomach. When this muscle is loose, it typically causes your baby to spit up. Pyloric stenosis typically causes babies to spit up around 1 month of age as well as can cause forceful and frequent vomiting, eventually leading to projectile vomiting. Consult your baby’s doctor sooner rather than later if projectile vomiting progresses.
Sometimes, though, if your milk is coming out superfast (called overactive letdown) or if your baby is spitting up all day, every day, it may be uncomfortable for your baby to eat. A lactation specialist can help you assess this and give you tips for positioning and for decreasing the flow to your baby.
About 20% of women choose not to breastfeed at all, but for the other 80%, many stop breastfeeding earlier than they intended. Only 25% are still exclusively breastfeeding at 6 months.
There are huge differences between communities around the world with large and small rates of breastfeeding success. In successful communities, new breastfeeding moms have extreme support from experienced breastfeeders. They also expect that breastfeeding will take time and effort to establish. Sometimes a new parent doesn’t realize the questions or issues she has until an expert helps.
The solution for many moms in modern America? Hands-on support from a lactation specialist. That way, as long as you recognize the challenges you may be encountering, you can make adjustments right away, not several days later. Things change quickly with babies. What is true for their health needs at day 3 can be very different at day 5. So if something is not working well at day 3, you want to address it quickly so that it isn’t a major issue later.
The best way to receive the right lactation help is to know your lactation resources and have them set up before you have your baby. Also, realize that hospital-based lactation specialists may have a different perspective than someone who primarily cares for babies once they are out of the hospital. Our lactation specialists in clinic see a range of babies from birth to 12 months, even 24 months, so they feel really comfy moving moms through all the stages of lactation.
The following options are the best resources for finding lactation help.
If you can swing it financially, a board-certified lactation specialist who comes to your home multiple times in the first few weeks is best. These specialists can assess your individual needs in your home environment. They should also be able to help you get through snags, because they are working directly with you and seeing your home setup.
When searching for a specialist, make sure you look for a lactation specialist who has a current International Board-Certified Lactation Consultant status. That way, you’ll find someone credible and reliable and who is as up-to-date as possible on current breastfeeding recommendations.
Call your potential pediatric office to see whether they have someone there who can help you. If they have someone who comes into each first visit, great. If not, ask for that once you arrive for your first baby appointment.
These experts are invaluable. They’ll work with you right after delivery to help you feel confident in the first several days postpartum, but they’ll also provide breastfeeding support to moms who have questions and need extra help after they leave the hospital. Hospital-based lactation specialists are especially important for moms who live in geographic areas without many other community lactation resources. If you’re considering using a hospital-based lactation specialist after your hospital stay, ask the hospital staff for help setting up your appointment so that you have less to arrange when you’re back home.
Doulas can work well if they are board-certified in lactation as well as certified to help with your postpartum care. You’re not just looking for opinions here; rather, you want someone who is confident and knows what is being talked about from a trained perspective.
This really depends on you and your needs. For me, I found it difficult to have a family member hovering around me while I worked on learning how to breastfeed my daughter. Even though my family meant well, their breastfeeding skills were rusty, so I found that they were greatest support for things such as laundry and meal preparation. If you have other children, this is a great time for them to help keep them busy, fed, and put to bed at their regular time(s).
If breastfeeding just doesn’t work for you, please remember, breastfeeding does not define you as a mom. It’s one small part of your motherhood journey. Being a mom is about so much more than breastfeeding.
Finding lactation help is one of the most important parts of breastfeeding success. Thank goodness there are caring, professional lactation experts waiting to guide you through the ups and downs of breastfeeding your baby.
If you’re using formula, remember these storage and preparation tips.
If you are formula feeding, take advantage of your ability to prepare ahead and to carry food portably. You can make a batch of formula in advance for the day (refrigerated continuously for up to 24 hours). Consider using a formula mixing pitcher for mixing larger amounts. This cuts down on the air bubbles that get introduced with shaking a bottle. Premeasured packets can help you feed your baby safely and easily if you’re on the go.
Once you prepare a bottle of formula, feed it to your baby or put it into the refrigerator within 1 hour. If it’s been at room temperature for more than an hour, throw it out. If you make a bottle of formula for your baby and she doesn’t drink the whole thing, discard it. You can prepare formula up to 24 hours ahead of time by storing it in the refrigerator (so that it doesn’t form bacteria). If you open ready-made formula containers, they can be stored safely in the refrigerator for up to 48 hours.
Just because most people heat their babies’ bottles, it’s not necessary. A lot of babies will tolerate cold or room temperature bottles of formula just fine, saving you headaches and time in the long run. If your baby prefers a warm bottle, never use a microwave to heat it. The microwave can create “hot spots” within the formula, leading to potential burns. Instead, run the bottle under hot or warm water for a few minutes or use a pan of hot water to heat the liquid. Bottle warmers also work well. However you heat your baby’s bottles, make sure to shake them well after heating and to test the formula temperature by placing a few drops onto the inside of your wrist to assure it’s lukewarm (not hot).