What you need to know about breastfeeding and your baby
When should milk come in? How much is enough? What to do if it hurts... And why is my baby losing weight?
The first days after having a baby are full of wonder, awe and excitement, but those days can also bring anxiety. Breastfeeding can be one of the largest sources of this. If you are feeling this way, know that you are not alone! Many doctor moms say that newborn breastfeeding was harder for them than medical school. But having the right expectations and information can change that and make a world of difference for you and your baby.
ENOUGH MILK ON DAY ONE?
Many parents worry their baby is not getting enough milk. Did you know a baby’s stomach is the size of a cherry when first born? And the drops of milk you are making the first day or two are normal! The milk you make these first days is called “colostrum” and is highly concentrated, yellow, and sticky, full of easy to digest carbohydrates and proteins that help your baby fight off infections.
SUPPLY AND DEMAND:
The more you breastfeed, the more your brain will make hormones that increase your milk supply and switch it over from drops of colostrum to larger volumes of mature milk. The larger the “demand” for milk, the larger the supply you will make. That is why frequent breastfeeding in those first days after birth are crucial! A general goal is 8-12 feeds during a 24 hour period. Watch the baby for hunger cues like opening their mouth, putting their hands to their face, sucking on their hands, or moving their head around as if they are searching for something. Your baby might even begin to cluster feed, where the baby will want to feed seemingly right after you just fed them! This is their way of getting your milk supply to come in. They cannot overfeed at this stage. Sometimes pumping during this stage can be beneficial to the supply/demand effect. The more you stimulate the breasts, by direct breastfeeding with the baby, and by using a pump, the more milk you will produce. To get an idea of what amount is typical, see the chart below for average volumes of milk intake.
|Age of Baby||Average Volume per Feed|
|Day 1||½– 2 tsp|
|Day 3||½– 1 oz|
|Day 7||1-2 oz|
|Week 2||2-3 oz|
MILK COMING IN
Mature milk usually will come in around day 3-4 of life and will be creamy, fatty, and white. Your breasts will likely feel firm, warm, tender, and full. But remember it can take up to four days for this to happen. If your milk has not come in by day 4, see your pediatrician and your OBGYN in addition to optimizing breastfeeding techniques with a lactation consultant.
LOSING WEIGHT (For baby, not mom!)
Some weight loss in the first days of life is normal. Your pediatrician will check the baby every day in the hospital and again a few days after leaving the hospital to make sure the baby’s weight loss is in a safe range. It is normal to lose up to 10 percent of birthweight in the first week, so for a 7 pound baby that means losing up to 11 ounces. Once the milk is in, the weight should start going up, and babies are expected to be back up to original birthweight when they are 2 weeks old. In addition to weighing, a good way to gauge if the baby is hydrated and getting enough from feeds is to check the number of wet diapers. Lots of full wet diapers means your baby is staying hydrated from feeds. If weight loss is beyond the normal range, your pediatrician will guide you through ways to help, which can include supplementing and/or pumping.
The most common cause of discomfort with breastfeeding is not having the right latch onto the breast. Try to make sure that the baby is opening up wide to get the entire areola and not just the nipple. You may need to take the baby off the breast and try again if the latch is not right. Both lips should be open wide and curled outwards if the latch is ideal. Lactation consultants in the hospital can help you each day to make sure you and your baby have a good latch. You can also try to use Lanolin creams to help soothe your nipples after feedings. With the proper latch onto the breast, your discomfort should be a temporary issue that gets better with time.
Sleep deprivation combined with a crying infant can make pacifiers a tempting choice in the first days of life. However, studies show that pacifiers are best introduced AFTER breastfeeding is “established” meaning it is going very well, typically at 3 weeks of life, to prevent the baby from being confused between the pacifier and the nipple. Many parents don’t know this, but pacifiers are actually recommended because in the long run they reduce the risk of sudden infant death syndrome. So DO use a pacifier, but try to wait until feedings are going well first.
PRACTICE MAKES PERFECT
I always grew up hearing my dad say “practice makes perfect!” I wonder if that’s why I ended up becoming a doctor. I got used to practicing new things over and over again until it felt like second nature. The same can be said about breastfeeding. It is a skill, and it takes practice and most importantly, patience, but sleep deprivation added into the mix can make this easier said than done! If you are looking for further breastfeeding support from other parents, more resources, lactation consultant recommendations, or free breastfeeding classes, check out the following resources:
- Breastfeeding Tarrant County Coalition website
- Mobile app LatchMe
- Mobile app LactMed - information about safety of medications and their effect on babies through breastmilk
Dr. Rachel Hamilton
About the author
Rachel Hamilton, M.D., is a pediatrician at the Henderson Clinic. To make an appointment, call 817-783-4109. Dr. Henderson grew up in the Dallas/Fort Worth area. She obtained her bachelor’s degrees in chemistry and biology and graduated as a president scholar from Southern Methodist University. She completed medical school at the University of Texas – Southwestern Medical Center in Dallas and pediatric residency at the University of Texas at Austin – Dell Medical School. She is a member of the medical honor society Alpha Omega Alpha, and has been recognized for humanism in medicine. She is married to David Hamilton and enjoys traveling, SCUBA diving, bass fishing and other outdoor activities. Her favorite aspects of being a doctor include life-long learning and the joy of helping children live fulfilled, healthy and happy lives.