Getting Started Breastfeeding

Your milk and the process of breastfeeding adapt to your baby's needs as he or she grows and develops. However breastfeeding contains certain milestones you should recognize.

Early Breastfeeding

The first weeks of breastfeeding should be considered a learning period for both you and your baby. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine and overcome any initial breastfeeding difficulties.

Day 1

Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to two hours after birth. Many then sleep or act drowsy for the next two to 20 hours, so a baby may not be very interested in breastfeeding again on day one. However, a baby should breastfeed several times that first day. Expect to change only a couple of wet and dirty diapers during the first 24 hours.

Days 2 to 4

Feeding Schedule

Although some babies may need practice with latching on and sucking, by the second day your baby should begin to wake and cue (show readiness) for feedings every 1 to 3 hours for a total of 8 to 12 breastfeedings a day. These frequent feedings provide your baby with antibody-rich first milk called colostrum and signal to your breasts that they should produce more milk.

Your baby should suckle for at least 10 minutes and may continue for about 30 minutes on the first breast before letting go, also known as self-detaching, without help from you. When she finishes at one breast, you can burp and change her diaper before offering the second breast.

As with day 1, you probably will change only a few wet and dirty diapers. Do not be surprised if your baby loses weight during the first several days. The number of diaper changes and baby's weight will increase when your milk increases.

Physical Side Effects

You may feel uterine cramping when breastfeeding during this time, especially if this is a second or subsequent baby. This is a positive sign that the baby's sucking has triggered a milk let-down, also called the milk-ejection reflex (MER). It also means your uterus is contracting, which helps minimize bleeding. A nurse can give you medication before feeding if needed for the discomfort. Some mothers briefly feel a tingling, "pins and needles," or a flushing of warmth or coolness through the breasts with milk let-down; others notice nothing different, except the rhythm of baby's sucking.

Because your baby is still learning, you may experience nipple tenderness when she latches on or during a breastfeeding. Usually it is mild and disappears by the end of the first week. If tenderness persists, develops into pain or nipple cracking is noted, contact a certified lactation consultant.

Days 3 to 5

The volume of breast milk increases dramatically at about 3 or 4 days after birth, when the milk is said to have "come in." Your baby probably will drift off after feedings and act more satisfied after a meal.

Diapers

Within 12 to 24 hours, you should be changing a lot more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and consistency. From the dark, tarry meconium stool, they should progress to being softer and a brown color before becoming a mustard yellow and loose and seedy. Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 grams) a day.

Breast Changes

You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some mothers find their breasts become uncomfortably engorged due to increased milk volume and tissue swelling. Then the breasts feel hard and tight; the areola and nipple may seem stretched and flat, making it difficult for a baby to latch-on. The most important thing to do when your milk first comes in is to move the milk out of your breasts by feeding your baby frequently.

If your baby has difficulty latching on:

• Soften the nipple and areola by expressing some milk and then let baby latch on.
• Breastfeed or express milk by hand or breast pump frequently (every one to two hours). Your breasts should feel noticeably softer after breastfeeding or pumping.
• Apply cold packs or sandwich bags filled with ice or frozen vegetables to the breasts for 20 to 30 minutes after a feeding or pumping session. The application of cold packs has been shown to relieve the swelling that may interfere with milk flow. Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes immediately before breastfeeding or milk expression, but there are no studies that support this as effective. Using heat for more than a few minutes could increase the amount of swelling.

Days 5 to 28

Feeding Schedule

Your baby will become more proficient at breastfeeding as the first month progresses. Expect to feed your baby about 8 to 12 times in 24 hours and for approximately 10 to 30 minutes at the first breast before she lets go of the breast without your help. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

Babies who guzzle their food nonstop may self-detach in 10 to 15 minutes; babies who prefer to savor their meals often take 20 to 35 minutes on the first breast because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let the baby choose when to let go of the breast, as this self-detachment will increase the amount of higher fat/higher calorie milk ("hindmilk") your baby takes in.

Your baby should continue to soak six or more wet diaper and pass three or more loose, seedy, yellow stools.

Beyond

Your baby probably will go through several two- to four-day growth spurt periods and seem to want to eat almost around the clock. Babies commonly experience a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let a baby feed more often during these spurts. Within a few days, your baby will have returned to a more typical pattern.

Let your baby set the pace for breastfeeding. Pay attention to feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby. Trying to force a breastfed baby to wait longer between feedings, or fit a particular feeding schedule, can result in poor weight gain.