One of the most unfair facts about breastfeeding is that if you start off on the right foot, your breastfeeding journey is so much easier. And if you don’t, you will struggle so much more and maybe even end up quitting. The worst part is if you only had the right knowledge, you could potentially not only increase your likelihood of succeeding but also make the initial months of breastfeeding, which are for everyone always the hardest, SO much easier.
I wouldn’t have succeeded without the lactation consultant at the hospital where I gave birth. While I tried to learn about breastfeeding before L was born, I didn’t know what I was supposed to be learning. Instead of finding the critical knowledge that is needed to succeed, I kept finding articles about how create a stash of frozen milk. While pumping and storing is essential, it has its place and time, and it’s NOT at the beginning. You should only focus on pumping and storing when it’s time to return to work. I got lucky that the lactation consultant clearly saw that I needed guidance. She spent hours upon end with me and I am truly thankful for that because she gave me the toolset I needed to succeed. I want every mama to also have that critical initial toolset, so here I share in detail everything you need to know to start your breastfeeding relationship out right.
Before even going to the hospital to deliver
If you are doing a hospital tour, try to find out if they have lactation consultants there to help you. Then ensure you are ready to utilize the help. Between now and then, write down every question you have to ensure you get them answered. Also, don’t be afraid to ask for help, even if it is to state “I have no idea what I am doing”. They want to help you succeed. Before labor and delivery, as you fill out your birth plan, ensure you prioritize breastfeeding.
Most hospitals will allow you to delay all routine procedures (weight, shots etc.) until after the first hour of birth. Ideally, the first hour of birth should be spent allowing mom and baby to breastfeed for the first time with lots of skin to skin. In fact, nursing in the first hour of life lowers infant mortality rate by 50%. Babies instinctively engage in breastfeeding around 30 minutes after birth so what better time to start your breastfeeding relationship. Nursing after birth will trigger those hormones to start increasing your supply, which is going to be your main goal over the next few days and weeks. After the first hour outside the womb, babies generally fall into a deep slumber, so this is the perfect time to get some much needed rest and recovery.
Start tracking right away at the hospital. It is so easy to lose track of time and forget to nurse often, simply because you aren’t yet in practice of feeding a baby who needs to nurse at least every two hours. I recommend using three trackers: a breastfeeding tracker, a diaper tracker, and a weight and gains tracker.
A breastfeeding tracker allows you to keep track of when you are starting each nursing session, how many nursing sessions you did each day, what side you started on each time, and how long baby nursed each time. Not only is this good information for you to have to understand how often baby nurses, but also if you are running into any nursing problems, this information is so essential to present to a pediatrician and/or a lactation consultant. The other two trackers on diapers and weight gains allow you to also see if baby is nursing enough and getting the hydration and calorie intake needed. Alli and found these trackers to be so important that we created printable versions of each one for our Breastfeeding Handbook.
Another trick I used early on with L was setting a timer. When I would start nursing, I would set a timer for 2 hours. The time between nursing is from the START of one session to the START of another. This simple reminder of a timer on my phone showed me just how quickly time went by and reminded me to really do a good job of nursing baby often during the day in those first days and weeks. The more feedings you get in during the day, the more likely your nights will go better. While baby will still need night feedings, they might be a little more stretched out if baby got a lot of feedings throughout the day.
Before you leave the hospital have a lactation consultant show you
Two techniques that are easiest to explain visually are hand expression and how to use a pump. Hand expression can be used to get some colostrum, or later on milk, on your breast to help baby find the breast and latch. It is also helpful sometimes to hand express while nursing to keep baby interested because newborns especially are super sleepy (see beware of the sleepy newborn below) and might not finish a full nursing session. The result is that they are upset and hungry again in no time.
Do not worry about pumping in these early days, but it is never a bad idea to know how to use your pump. If you are planning on returning to work, see Going Back to Work to find a timeline of how to start a freezer stash. I recommend not starting that now because your focus should be on figuring out breastfeeding and breastmilk changes SO MUCH in the early stages that baby might not even like it if you store. You really only need to be a few days ahead of baby in terms of leaving milk and that is best as milk changes on a daily basis to meet the needs of your child. Instead only use a pump if you are really struggling with getting baby to latch or are in pain and can’t nurse. If you are in either of these situations, get help (see bottom of article).
A trick the lactation consultant taught me was that if I couldn’t latch L because I missed her hunger cues and she was screaming, I could pump some colostrum and give it to L through a syringe. After giving her some colostrum, she would calm down and I could then latch her and allow her to nurse. If this is happening often to you, try to catch baby before they wake. This way, you are working on latching before they even start to show hunger signs. Most babies have a ~45 min sleep cycle so I would preemptively hold L after 35-40 minutes and be ready to latch when she started to stir. While this might seem over the top, it made a big difference in terms of sanity. I could latch L immediately if she wasn’t upset, and then I didn’t have to spend 20 minutes calming her down.
Beware of the Sleepy Newborn
After the first feed, babies go into a deep sleep and remain very sleepy for the first few days of life. It is essential in those early days to nurse often to start a good milk supply so in this section I want to give you some tips to encourage nursing, how to check if baby is swallowing, and some best practices for the sleepy baby.
If you have reached two hours and haven’t nursed yet or see baby start to stir, those are both good markers to get ready to nurse. Once you are ready to nurse, have someone bring baby to you or hold baby in a breastfeeding position of your choice. Next, get your boob out and hold baby close so if they turned their head they would find the breast. If baby is still sleepy and isn’t trying to latch (attach) to the breast, try one of these four tips.
- Gently stroke the cheek closest to the breast from ear to chin to get baby to turn in the direction of the breast.
- Stroke the mustache area as this will also start to awaken baby and get them to search for a nipple.
- Stroke from their chin up their cheek. You can do both sides at once as this also gets baby to start searching.
- Gently draw or massage circles under the chin to get them stirring.
Once stirring, they will start to search for a nipple and latch. The easiest breastfeeding positions to start with include: cradle, cross-cradle, and football holds. Remember, a newborn will almost always nurse. You can not over-nurse a baby, so if baby is challenging to latch, it is most likely a learning curve issue but could also potentially be a tongue or lip tie. For more information on how to get a great latch that won’t cause pain, see the section below on The Latch.
If the situation isn’t improving, get help ASAP. Many babies get easily frustrated and quickly go from calm to very upset fast. They can’t latch and nurse while upset so a good rule of thumb here is to calm baby down without a pacifier or a bottle and then try again. To see when it is appropriate to introduce a pacifier or a bottle if you want to breastfeed, see Alli’s article on pacifiers and bottles.
When does your milk come in?
During the first week and beyond, your milk is changing from colostrum to milk while also increasing in volume to meet baby’s needs. For a timeline on when milk changes, see Your Milk in the First Week below. If your milk isn’t coming in, you need to know. The first thing to check is if baby is swallowing. A baby might be “nursing” but might not be getting anything. To check if baby is actually getting milk during a feeding, simply have your partner, a relative or even a friend check that baby is swallowing by watching baby’s throat during a nursing session. If you look in the mirror and swallow, you can see the motion in the throat that you will look for in baby. You can also listen for gulping noises that sound almost like a click.
Other ways you know your milk is coming in is by tracking wet and dirty diapers. If baby is on pace for the correct number of diapers, baby is getting milk. If you are at all unsure, like always get help ASAP, and if you want, pump to ensure you can get milk out. While it’s rare, sometimes women don’t produce milk medical reasons. Don’t judge the amount of milk baby is getting by the amount you can pump. You produce different amounts during the day, and also baby is so much more effective than a pump. A baby applies compression and suction while a pump only does suction.
Remember: Quality not Quantity
You are learning a new skill here and so is baby. While baby has been practicing sucking his or her thumb in utero, breastfeeding is instinctual but for sure a new skill. I can’t emphasize this enough, use your time in not only these first few days but also weeks to focus on breastfeeding. When you are approaching the time that you plan to return to work, then start the process of preparing for that change by learning the basics of pumping, storing, and bottle feeding a breastfed baby. This time should be spent learning about baby’s hunger cues, getting a good latch, and finding nursing positions that work for you and baby. As you proceed in your nursing relationship, you will undoubtedly start to have questions as you learn more. Below, I focus on hunger cues and a good latch and answer other common questions like “When to switch sides?”, “When to feed baby?”, and “Is baby full?” in this post.
Frequency is KEY which is where the phrase feed on demand comes from
As you will find with reading my posts, I like to emphasize that frequency is the most important aspect of breastfeeding that directly relates to your supply. To better understand, I have written an article about how milk production and supply are related.
Knowing that frequency is key, baby will automatically (if given the opportunity) nurse more often when your supply needs to increase. The important part is to give baby the opportunities, hence feed on demand instead of on a schedule. It is not normal especially in those first few weeks to have a baby who wants to nurse back-to-back or nurse for what seems like hours on end (better known as cluster feeding). Cluster feeding results in the term “Velcro baby” as baby seems to be literally attached to the breast. Cluster feeding is most prominent during growth spurts, as it is meant to increase your milk supply. The first growth spurt happens right after the first week, around 10 days.
Hunger Cues can be categorized into three separate types: early, middle and late hunger cues. It is best to always latch baby during early hunger cues. Early hunger cues include: stirring, mouth opening, turning head, seeking and rooting. If these are missed, baby starts to show middle hunger cues, stretching, increased physical movement and hand to mouth (eating hands). At this point, baby is starting to become frustrated, which is why if these are missed the next set of hunger cues are late.
Late hunger cues are crying, agitated body movements, and color turning red. These mean calm me down first and then feed me. The early hunger cues happen fast, and it can be only 5-15 minutes between early and late hunger cues. If you find yourself with a baby who is screaming, the baby will mostly likely not latch and you might think baby isn’t hungry. When in fact, baby is extremely hungry but can’t calm down enough to latch. For strategies on how to calm baby quickly and effectively without the use of a pacifier, which can actually delay a feeding even longer, check out Alli’s post on pacifiers and bottles.
A note on rooting: Rooting is when baby turns their head from side to side and opens mouth to try to latch onto a boob. Often baby will only root on you, so ensure you always check in with baby to see if they are hungry especially if you know it has been awhile since the last nursing session. I highlight this point in the section of this article where I talk about visitors as you have so many in those early days.
Note on hand eating: Often moms hear that eating hands is simply baby exploring. Until about 4 months of age, eating hands is a hunger cue. Only at around 4 months can eating hands mean “I’m hungry”, “I’m teething” or “I’m exploring”. If your newborn baby is eating their hands, offer a feeding.
If you ask for help on anything at the hospital, the latch is probably the most important aspect of breastfeeding to get right. If baby’s latch isn’t correct, you could end up with pain and even supply issues. The latch is how baby “latches” or attaches onto the breast. If the baby only latches onto the nipple, baby can’t effectively remove milk will also cause so MUCH soreness. It is normal to have some soreness, but breastfeeding should NEVER hurt. Most pain is caused by latch issues.
To achieve a good latch, you can go one of two routes. If you are nursing in a position other than baby on belly, put your nipple right under their nose, which will result in them tilting up and opening their mouth to get a good latch. To better understand this point, see the tips on helping baby latch. The second option is to lay on your back and have baby on your belly near the boob, allowing baby to find the boob and self-latch. In neither case should you ever put your nipple in baby’s mouth. Sometimes it is helpful to hold your breast to support it. To do this, simply make a c with you hand on the same side as your nursing breast and hold your breast.
A good latch must have the following:
- The baby’s nose is free
- Most of the areola is inside the mouth (not just the nipple)
- Babies lips are curved out
- Baby’s chin is against the breast
Two tips to help latch baby:
- Due to the Moro reflex, babies like to be swaddled and this doesn’t change during breastfeeding. Ensure you are making baby feel secure by tucking and supporting their feet as well as their upper body
- To get a good latch, support baby’s neck and base of head instead of holding their head. To better understand this, look at the floor and try to open your mouth. Now look at the ceiling and try to open your mouth. Baby needs to be able to tilt their head back to open their mouth and get a deep latch.
Your Milk in the First Week
During the first day with you newborn, you can expect to produce around a 1 tsp of colostrum at each feeding to fill baby’s tummy, which at this point is about the size of a cherry. With such a tiny tummy, you should expect to nurse as often as possible. The first mistake that new mothers make in establishing a milk supply is that they don’t breastfeed frequently enough in those first few days. Newborns are very sleepy and might sleep through feedings. Don’t let this happen, if you are approaching 2 hours since the beginning of your last feeding, take your sleeping newborn into a nursing position and gently stir them until they begin rooting and latch. At night, just nurse every time baby wakes. During day 2-3, continue nursing as often as possible. Baby’s tummy is growing to a walnut size and you are producing around 2-3 tsp of colostrum at each feeding. You will most likely be heading home soon so remember to utilize the staff at the hospital for breastfeeding help, especially if they have a lactation consultant. Also, don’t leave until you ask about how you can acquire a pump from insurance, which is mandatory for all insurance companies to cover in the US.
Sometime between day 3-5, your milk should come in. If you have any concerns that your milk isn’t coming in or baby is always crying, see your pediatrician immediately as baby might not be getting proper nutrients or hydration. When your milk comes in, your breasts will feel fuller and hard. The milk will change from yellow (colostrum) to white over the course of the next two weeks. Over these days, the quantity of milk per feeding should increase to about 2.5 oz as baby’s tummy grows to the size of an apricot.
After day 5, your breasts should have returned to being soft, which is not a sign of low supply. Your milk supply will continue to increase based on how often you nurse baby. It is very common during these first few weeks to have a clogged duct. For understanding what a clogged duct is, how it can turn into mastitis and tips on clearing it, read Alli’s article on clogged ducts.
How Visitors and Family Fit into the Picture
Having a baby is an exciting time and everyone wants to see your new bundle of joy. When and where your visitors and family fit into this picture is completely a personal choice. Here are just a few things to beware of that you might not realize until after the fact. In order to allow you to better plan and fit your visitors into this exciting time, you might want to consider the following:
- You only have so many hours at the hospital with trained staff to answer your questions and provide help. After you leave, you are on your own outside of medical visits. Ensure that if you have visitors, you plan them accordingly, so you have time to get help with nursing, have time to nurse frequently, and have time to rest. Entertaining visitors can be exhausting and so is labor, delivery and taking care of your new newborn.
- Once you leave the hospital, still ensure you are leaving yourself with plenty downtime and time and not just entertaining guests.
- A lot of guests want desperately to help and two common but not necessarily helpful offers are “I’ll hold baby so you can have a break” or “I’ll feed baby so you can take a break”. The first one can be helpful if you want to take a shower or baby has just nursed, however, make sure you always check in with baby by holding them to see if they need to be nursed. If baby doesn’t root on your guest and misses a feeding, then you have a very fussy baby and missing nursing sessions hurts your supply. The second common one, of offering a bottle, even of expressed milk, can also hurt your supply, for more information on this topic, see pacifiers and bottles.
The best way to help your guests feel useful is to make a list of helpful things they can do before. This way when the questions start coming on how to help, you already have a list of helpful items. Another way that helps a lot especially for those who you know beforehand want to help, preemptively give them directions on what would be helpful when you set up their visit. This gives them time to be helpful such as make you a dinner but also makes them feel appreciated.
What to do if you are struggling?
Breastfeeding is hard. There is not only a learning curve in the beginning, but it is also crucial that you are able to nurse baby often. This means when you run into trouble, you need help right away. Decreased nursing due to issues can become a vicious cycle of supply problems. Don’t wait until there is a problem, start today by finding out resources and support groups in your area for breastfeeding. I would start by calling both your provider (OB or midwife) and your pediatrician. If you are currently handling an issue, don’t wait till your next appointment but keep searching, calling and finding resources to get help.
Want more resources?
Outside of this article, our breastfeeding section is full of resourceful posts covering an array of breastfeeding topics. We offer a free 5 day email course to help you develop tools and resources to succeed at breastfeeding if you are expecting or even if you are already nursing. We have also developed a quick, complete, easy to reference breastfeeding handbook along with trackers so you can quickly find answers to your breastfeeding questions.
If you found this post helpful, please share it on Facebook or Pinterest
Dr. Trina Fitzpatrick is a wife, mom, blogger, and a breastfeeding advocate. She is the co-author of the Week-by-Week Bump Smart Course, the Nesting Planner and the Breastfeeding Handbook. She attributes her success at breastfeeding her own children into toddlerhood with working with lactation consultants in the hospital in the early stages and on a weekly basis afterwards. By writing at MomSmartNotHard, she educates mamas-to-be on all things pregnancy, birth and breastfeeding. Read more about Trina.