After your baby is born, it takes 3-5 days for your milk to “come in”. However, those first days of nursing are very important for establishing a good milk supply and latch. Try to have skin-to-skin time with your baby right after birth, and get a first feeding in the first hour. Babies are getting a very important fluid from mom in the first days – colostrum. While the volume of colostrum is only 5-15ml, it is full of protein, sugar, and important immune support. During the first 24 hours, your new baby may be very sleepy and not eat much at all. Try to nurse every 2-4 hours, but don’t get discouraged if it is difficult.
After the first 24 hours, your baby should be starting to wake up, and may even have a “feeding frenzy” where they want to feed constantly. This is normal, and usually improves once the milk comes in. During this time, you should nurse on demand – about every 2-4 hours or 8-12 times per day. Wake your baby at 4-5 hours during the first week if he/she is not awake by then to nurse. Nurse your baby for 5-20 minutes per breast on the first day and increase the amount of time gradually up to 20 minutes per breast by the fourth day. If your baby is still latched and sucking after 20 minutes, you can continue to nurse. Some babies require only 5 minutes to empty each breast while others require 20 minutes or more.
Milk “comes in” around the third to fifth day, with the breasts becoming hard, sore and full. You may start to hear the baby swallowing more during feedings, and may notice the frequency of wet and dirty diapers increase. Stools will also change from black and tarry to yellow and seedy – sometimes even liquidy. Burp the baby between feeding on each breast unless he/she is falling asleep, in which case move to the second breast and burp afterward. If the baby is sucking well at the above intervals, acting satisfied after feeding, wetting the diaper over 3 times a day and having several daily stools, then rest assured that he/she is getting enough. Breastfed babies normally lose up to 10% of their body weight during the first week of life, and then should be back to their birth weight by 2 weeks old.
We do not recommend routine formula supplements for breastfed infants unless the baby is sucking poorly or acts unsatisfied after nursing (crying and showing other feeding cues). If the baby wants to suck more after nursing and you are not having latch issues, you may choose to introduce a pacifier. You’ve got enough to do with feeding and caring for the baby, and many babies have a need to suck more than they can satisfy by nursing alone. While nursing, continue to take your calcium supplements and prenatal vitamins, drink plenty of fluids, and make sure you’re taking time to eat well.
The American Academy of Pediatrics recommends vitamin D supplementation (400 units a day) for all babies who are exclusively breastfed. These supplements can be purchased over the counter at any grocery store or pharmacy. Most medications are okay while breastfeeding, but some can cause side effects for baby or decrease milk supply. Check with the office prior to taking medications other than Tylenol while breastfeeding. Alcohol in moderation is okay after baby is 1 month of age. Try to limit your intake to 1 drink at a time, and wait about an hour to nurse or pump. For nursing babies, it can be helpful to introduce a bottle of pumped breast milk at 4 weeks of age, and continue a bottle feeding 2-3 times a week so the baby knows how to take a bottle in the future. It also allows dads to be involved and not feel left out!
Some babies learn to nurse with ease. For others, it is more difficult, and in about 15%, breastfeeding won’t be successful. Use the nurses at the hospital to coach you in the many “tricks” to help babies learn to nurse. For support after you go home, please ask us! We can arrange a lactation consultation in our office. Other great resources include the La Leche League and ilca.org. If nursing doesn’t work for you and your baby, try not to take it personally as a failure; instead, acknowledge the disappointment and move on. It is more important for the baby’s health and wellbeing for you to have a good mothering experience, and if that means bottle-feeding, so be it. Because your hormones are wreaking havoc with your emotions, such disappointments may seem devastating. If you are feeling very blue, overwhelmed, depressed or “stuck” – please call us at 480-860-8488 or come see us – we can help you find appropriate resources.
Our wonderful Dr. Caplan and Dr. Wiersma are certified lactation consultants who can provide lactation visits at our Ironwood office for any babies seen in our practice. Please call the office at 480-860-8488 to schedule a lactation appointment.
Other Resources:
Kelly Mom is a great source of general breast feeding information.
La Leche League can provide breast feeding information and support.
Find a lactation consultant or call 480-860-8488 to schedule a lactation appointment with Dr. Caplan or Dr. Wiersma.