Breastfeeding Right from the Start

by Nancy Mohrbacher, IBCLC

You may envision breastfeeding as a Madonna-like experience, with you and your baby snuggled close as she contentedly nurses at your breast. In reality, breastfeeding doesn’t always start out so smoothly. It might take several tries before your newborn learns to take the breast into her mouth, and you may be unprepared for how often she wants to nurse in the beginning. But knowing what to expect should ease you through those early breastfeeding days and help you handle difficulties if they occur. Breastfeeding is natural, but it is also a learned art. Knowing what’s normal and what to expect can make the early days and weeks easier and more enjoyable. It can also give you the confidence to know when breastfeeding is going well and the knowledge to decide if and when you need help.

First Feedings

Ideally breastfeeding begins within the first hour or two after birth, when babies tend to be most alert and eager to nurse. During the first few days, while a baby gets colostrum (the first milk) and before the mother’s milk supply increases, he may want to nurse often and for long stretches, even hours at a time. Although many mothers are told to limit early feedings to prevent sore nipples, studies show that this does not help. Also, nursing long and often in the early days lessens breast engorgement in the mother.

The colostrum, or first milk, contains high concentrations of antibodies to boost baby’s immune system. Colostrum also has a laxative effect, which stimulates babies to pass stools more quickly. That’s why long and frequent feedings in the first few days have been found to help prevent jaundice. Newborn jaundice is caused by a build-up of bilirubin, a by-product of the breakdown of the extra red blood cells present at birth. The more stools the baby passes early on, the less jaundiced they become.

Although many newborns nurse long and avidly during their first days, some babies to want to nurse less often or for shorter periods. Some babies are uninterested in nursing or sleepy during their first few days. Even if baby seems uninterested in breastfeeding, encourage him to nurse at least every couple of hours. If he is sleepy, watch his cues, and try stimulating him to nurse when he is in light sleep (eyes moving under eyelids) or beginning to stir. Try rubbing her feet jiggling her a little, talking to her or rubbing her back.

When your milk supply becomes more plentiful on the third or fourth day, a baby’s nursing pattern may change. The baby who was nursing for long stretches may finish more quickly because he’s getting more milk sooner. Babies who were less eager to nurse may now become more interested. Also, look for more wet diapers and bowel movements. Rather than the one or two wet diapers that are normal during the first few days, once the milk increases expect at least five to six wet disposable diapers and at least three to four stools per day.

Your breasts may become uncomfortably full when your milk increases. Called engorgement, this condition is caused by extra blood rushing to the breasts and will subside within days as long as you continue to nurse frequently. It might also help to take a warm shower, apply heat before nursings, cold between nursings and gently massage your breasts.

Sometimes engorement causes the nipple to flatten out, which makes it difficult for babies to take the breast into their mouth. If this happens, hand-express or pump enough milk to soften the nipple and areola before you offer your baby the breast, which will relieve some of the fullness and make it easier for her to nurse.

Follow Baby’s Cues

Your milk supply is based on supply and demand, so the more you nurse, the more milk you produce. To ensure your milk supply keeps up with your baby’s changing needs, follow his cues as to how often and long to breastfeed.

Many babies go through growth spurts when they need to nurse much more often. After at most a few days, these extra nursings will stimulate your milk supply to step up to meet your baby’s needs and he’ll return to his normal nursing pattern. Growth spurts usually occur at about two weeks, six weeks, three months and six months.

As long as baby nurses actively, switch breasts when your baby has finished with the first one. Human milk increases in fat as the baby nurses, so letting baby “finish the first breast first” insures that baby receives the right balance of fluid and fat. Switching breasts too soon or limiting feeding times can cause a baby to fill up on the watery foremilk at the beginning of a nursing without getting the high-calorie hindmilk that comes at the end. A baby getting too much foremilk and not enough hindmilk may not gain weight well, may be colicky or gassy, and may have green stools.

If you wonder whether your baby is getting enough milk, keep in mind that during the newborn period most babies need to nurse at least eight to twelve times a day. But this doesn’t mean that feedings will be spaced every two to three hours. Newborns tend to “cluster” nurse, or bunch feedings together during one part of the day, often the evening. It is best to ignore the length of time between feedings and keep track instead of whether the number of feedings every 24 hours falls within this 8-12 range. If a baby nurses fewer than eight times per day, this may be a baby who needs to be wakened and stimulated to feed more often.

Many newborns are also night owls, so their long sleep period may not come until the sun rises. There is a wide range of normal nursing patterns, from babies who nurse every half hour for part of the day and every hour-and-a-half for forty to sixty minutes for another part of the day to babies who nurse every four hours for ten minutes. As long as a baby has at least five to six wet disposable diapers and at least three to four stools each day (fewer stools may be normal for a baby older than six weeks) and is gaining at least four to seven ounces a week (at least a pound per month), a mother can be sure her baby is getting enough milk.

Latching On

A good latch-on is critical during the early weeks because it makes breastfeeding most comfortable for mother and allows the baby to get the most milk for his efforts. When a baby goes onto the breast, he needs to take the breast deeply into his mouth, bypassing the nipple and latching on to the darker area around the nipple. The milk sinuses (where the milk ducts widen) are located about an inch behind the nipple.

When the baby takes the breast deeply enough into his mouth to compress these milk sinuses during nursing, he is rewarded with more milk. Latching on closer to the tip of the nipple gives baby less milk and may also cause sore nipples. In most cases, if the baby latches on well, breastfeeding will not hurt the mother, no matter how long or often baby nurses. To help the baby latch on well:

  • Support the breast while the baby is going on to the breast and throughout the feeding with the breast held between thumb on one side and fingers on the other. Make sure fingers and thumb are well back from the nipple and surrounding area so they don’t get in baby’s way as he goes on to the breast. (Unless the mother has large breasts, she may not need to support her breast during feedings after the early weeks.)
  • Hold the baby so that he is approaching the from underneath (with his head angled slightly back) rather than straight on. If he is in the cradle hold, be sure his legs and hips are pulled in close to mother’s body.
  • Encourage the baby to open his mouth wide (like a yawn) by tickling his lips lightly with the nipple. If this doesn’t work, try again even more lightly. Keep lightly tickling until baby opens really wide.
  • As the baby opens wide, pull him far onto the breast–chin first–so that he takes the breast deeply into his mouth. The most comfortable latch for most mothers is off-center, with the baby’s lower jaw latched on as far from the base of the nipple as possible. Baby should lead with his chin, so that when he is latched on his chin is pressed into the breast but his nose is angled out to allow for breathing. If baby’s nose seems blocked by the breast, pull his body and feet in closer to mother. After the baby latches on, if breastfeeding hurts or is uncomfortable, don’t let him keep nursing this way. Break the suction gently by putting a finger between the baby’s gums, take him off, and try again. The baby’s mouth may need to be open wider or he may need to be pulled on farther (with more oomph!). Some babies latch on well at the first try while others take many tries before breastfeeding feels comfortable. With practice, getting a good latch-on becomes easier and more automatic, but it is well worth the time in the beginning to help baby learn to do it right.
  • Comfort is also important when choosing a nursing position. Depending on the size and shape of the mother’s breasts and the length of her arms and torso, one position may be easier than another. The best position is one that allows the mother to hold the baby close to the breast and relax without straining any muscles. In some positions, it may help to put pillows or cushions behind her back or under the baby to support his weight. The baby will find it easiest to breastfeed if he is directly facing the breast without having to turn his head to nurse and if his head, shoulders, and hips are in a straight line, not twisted or turned. The mother will be more comfortable if she brings the baby to the breast, not the breast to the baby.

Common breastfeeding positions include:

  • Cradle hold–With mother sitting up, baby lies on his side, across the mother’s lap, his whole body facing hers, with his head resting on her forearm near the crook of her arm and his body pulled in close. A pillow or cushion under baby may make this position more comfortable.
  • Cross cradle–Like the cradle above, but with the mother’s hands reversed–the mother supports her breast with the same-side hand and holds the baby upper back with the opposite hand. This puts a hand behind the baby’s head for better control. A pillow or cushion under baby makes this position easier.
  • Football hold–With mother sitting up, baby lies at mother’s side with his upper back resting along the mother’s forearm while she supports his neck with her hand. A pillow or cushion under the mother’s elbow can help support baby’s weight.
  • Lying down–Mother and baby lie on their sides facing one another with the baby’s feet pulled in close to the mother’s body. A pillow under the mother’s head and between her knees may make her more comfortable and a pillow or rolled blanket behind baby may help keep him in close. The baby’s head may rest on the mother’s arm or on the bed.

Take Care of Yourself

Breastfeeding will be easier if you make your needs a priority as well as your baby’s. Ask a friend or relative to help with household chores so you can nap when the baby naps and relax while nursing. Many mothers find that once they learn to get comfortable nursing lying down they can nap while breastfeeding.

Eat a well-balanced diet to keep up your energy and stay healthy. Although studies indicate that eating a less-than-ideal diet will not affect the quality or quantity of your milk, eating well will help you meet the physical demands of new motherhood. Contrary to popular belief, there are no foods that you must eat or avoid while breastfeeding. Most mothers can eat any food in moderation (even coffee, chocolate, and spicy foods!) without effect on their baby. The same principles of good nutrition apply to the nursing mother as to the rest of the family. As for fluids, the simple rule-of-thumb is drink to thirst.

Health experts advise nursing mothers to wait two months before trying to lose weight. This gives your body time to recover from birth. Plus most women lose weight naturally during this time. Breastfeeding seems to make it easier to shed extra pounds, mobilizing even the fat accumulated before pregnancy.

If after two months you want to lose weight, do so gradually. The body stores pesticides and other environmental contaminants in body fat, and when you lose weight too quicky–more than a pound a week–they can be released into your bloodstream and go into your milk. So its healthier for both you and your baby to take it slow.

Exercise is also compatible with breastfeeding. The real challenge for most new mothers is finding the time. But keep an open mind and be creative. For example, rather than trying to schedule regular time away from baby, some mothers find it easier to use exercise videos at home, join a mother-baby exercise class, or go for walks with baby.

Although learning to breastfeed requires an investment in time, it can simplify life with a baby in other ways. You’ll have the satisfaction of knowing that you’re providing your baby with the best possible nourishment, you won’t need to prepare bottles, and the closeness of nursing may comfort you as well as your baby. Soon you may find you and your baby have settled into a smooth nursing rhythm and resemble that Madonna-like image you once envisioned.