Day 1: First feeding
Some babies seem to be born eager to latch on, while others take their time. “I had a really fast labour with Isabella,” says Elisa Brook about her four-week-old daughter. “I think she and I were both feeling a bit shocked and shaky once she was born. Then I remember thinking, “Gosh, I haven’t nursed her yet.” That was probably 15 or 20 minutes after the birth.”
To Brook, an experienced breastfeeding mother, that 15-minute wait seemed like a long delay, but other mothers sometimes wait an hour or two while the baby is weighed and cleaned up before getting a chance to hold her and start breastfeeding. A mother who’s had a Caesarean may wait even longer, and that’s less than ideal.
The Baby-Friendly Hospital Initiative guidelines, established by UNICEF, recommend that all mothers be helped to initiate breastfeeding within half an hour after the baby’s birth. The baby seems to be primed to start then, and the antibodies in the first milk will protect her at a time when she’s most vulnerable to infection.
That recommendation includes Caesarean mothers as well, who — with a little help — can breastfeed while the incision is being stitched up, or in the recovery room right afterwards. If you’re feeling a bit shaky yourself after the dramatic experience of giving birth, the good news is that your baby knows what to do. Lactation consultant Diane Wiessinger of Ithaca, NY, recommends a “laid-back” nursing position for that first feeding, where the mother gets in a comfortable, semi-reclining position and lets the baby lie face down on her chest and abdomen.
“The baby can crawl to the breast on his own, using his senses of touch and smell,” Wiessinger explains. “Babies all do it a bit differently, but they will find the breast and latch on, and usually latch on beautifully. In that semi-reclining position, you don’t have to do much — gravity holds the baby against your body, and you can just give a little support if you feel it will help.”
If the baby’s first latch is not comfortable for you, Wiessinger suggests trying to adjust it a little while the baby is nursing. “Tuck the baby in a little closer, help him tip his head back a bit more, and wiggle around until it feels better,” she says. If it is really painful and the wiggling technique doesn’t help, you may want to slide your finger into the corner of his mouth to break the suction, then let him try again.
Often this first feeding is a fairly long one. The baby may nurse for 20 or 30 minutes on one side, take a little break, and continue for another 20 minutes on the other breast. Others will nurse only briefly before going to sleep. And still other babies won’t take the breast at all right after the birth. That’s OK. Keep your baby skin to skin with you, and he’ll probably latch on soon.
Days 1-3: Colostrum
What breastfeeding is like during the next few days depends, to a large extent, on the birth, says Wiessinger. “You are likely to have one of two kinds of babies. One is the unmedicated self-starter who eats when he’s hungry and sleeps when he’s sleepy, and you can just follow his lead. The other baby has been affected by labour medications and needs more monitoring, and may need to be wakened for feedings.”
At this stage, your milk is called colostrum. First-time mom Kay van Akker says, “I’d heard that colostrum was a yellowish colour, but I was surprised to see how golden mine was.” Colostrum is thick and creamy, and is produced in small amounts — ideal for your newborn’s tiny tummy.
Most babies will breastfeed frequently during the first couple of days after birth, getting small amounts of that colostrum (which is high in antibodies and helps to prepare the baby’s digestive system). Plenty of skin-to-skin contact will help you learn your new son or daughter’s feeding cues. Even with those frequent feedings, Wiessinger notes, “there won’t be a lot of wet or soiled diapers in the first day or two.” When the baby does poop, the stool will be black or greenish-black and sticky.
These frequent feedings serve another purpose: They signal the breasts to start up milk production. Later milk production is established to a certain extent by how much the baby feeds in these early days.
Days 3-4: Mature milk
Two to four days after the birth, your milk production begins revving up, as the colostrum is replaced with a much more generous volume of “mature milk.”
Your breasts will change — sometimes dramatically. As van Akker says: “Engorgement really surprised me! I had no idea that I would have so much milk all at once, or that my breasts would get so huge and hard.”
While it’s common, Wiessinger says, “engorgement really isn’t supposed to happen. If the baby is nursing early, well and often, the mother will probably only notice that her breasts feel heavier and fuller.” If the baby has gotten off to a slow start or been separated from the mother, engorgement is likely to be more pronounced. Intravenous fluids given during labour may cause even more swelling, making it hard for the baby to breastfeed effectively.
Some moms have an oversupply of milk at this stage — as though their breasts have geared up to feed twins. That was the case for van Akker, who says, “I expressed milk in the shower to relieve the engorgement pain and pressure. Sometimes it flowed too fast for James. I nursed him in a reclining position, so the milk had to travel uphill, and that seemed to help.” Your baby will probably lose weight at first. That’s normal. A Manitoba study found that exclusively breastfed babies lose, on average, 2.9 to 8.10 percent of their birth weight during the first few days.
By now, those black, tarry poops you were seeing in baby’s diapers on the first couple of days should be changing to brown or greenish-brown — a great sign that your baby is getting plenty of milk.
Days 4-5: Frequent feeds
As your baby takes in more milk, you should see her stool change again, to the very loose yellow seedy poops that are characteristic of a breastfeed baby. By day five or six, the baby will probably start having three substantial poops (or many smaller ones) every 24 hours. “I thought my first baby, Emma, had diarrhea,” says Brook. “I didn’t realize it was normal for the poops to be so liquid.”
It takes plenty of milk to create all that poop, but breastfed newborns don’t typically take in large meals at long intervals. Often at this stage, the baby’s doing a lot of “cluster feeding.” Wiessinger explains: “The baby has a hormone in his system that makes him sleepy after about 20 minutes of sucking, even if his tummy isn’t full. So typically the baby will nurse for 20 minutes or so, then fall asleep, then wake up again after 15 or 20 minutes and want to go back to the breast. He might repeat this a couple more times before he’s really full, and then he’ll sleep for a few hours.” This nursing pattern helps the baby get a maximum amount of milk and encourages the breasts to keep on making more.
The typical pattern of frequent feeding can surprise new mothers, as it did van Akker. “My illusion of having a baby who slept in a separate room, who didn’t need to be held much, and who nursed maybe every four hours was completely shattered. He nursed every hour in the beginning and liked to sleep at the breast.”
Days 6-7: Making Gains
At the one-week anniversary of your baby’s birth, your baby should be gaining weight, and should be back up to his birth weight within a few more days. Expect to see at least three good poops daily (each one larger than a loonie).
Leaking milk can become a challenge. “I thought I would only let down my milk when the baby nursed,” says van Akker, “but actually I would let down randomly, and I quickly went through all my shirts until I started using disposable breast pads. And milk would leak in the night and soak not just my nightgown, but my sheets.” Sleeping on a waterproof pad helped make her nights a little less damp and cut down on the laundry she had to do.
By now the excitement of having a new baby may be wearing off. Brook says, “I was really on a high for the first few days, but by the end of the first week, I realized I was just exhausted. You can never really prepare for the constantly interrupted sleep.” Her tip for coping: “Accept any help that is offered, and sleep whenever the baby sleeps.”
Just ask Elisa Brook: “Isabella’s a month old now, and we've settled into our own rhythm. Breastfeeding her just seems so easy now, I hardly think about it.”
Why it’s worth it
Some moms and babies enjoy breastfeeding from the start. They don’t need any other reason to breastfeed! But if your first few weeks are a bit of a struggle, it might help to remind yourself why it’s worth hanging in there.
Breastfeeding helps to protect your baby from:
• Ear infections
• Gastrointestinal infections
• Respiratory infections
• Pneumonia
• Obesity in childhood
• Sudden infant death syndrome
• Some childhood cancers
• Allergies
• Orthodontic problems
• High blood pressure
• Type 1 and type 2 diabetes
• Gastrointestinal infections
• Respiratory infections
• Pneumonia
• Obesity in childhood
• Sudden infant death syndrome
• Some childhood cancers
• Allergies
• Orthodontic problems
• High blood pressure
• Type 1 and type 2 diabetes
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