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Breastfeeding Articles by Coastal Bend Breastfeeding Coalition

Breast Feeding: The First Few Days

Unless your baby needs special care due to birth complications, as soon as your baby is born, you can immediately continue the bonding that began in pregnancy by holding your baby skin to skin.  Your hospital staff and birth attendant should encourage you to nurse your baby within the first hour of birth, prior to bathing and any medical procedures.  The first hour is the time that your baby is most alert and ready to nurse or suckle at the breast.  After your baby has nursed and has had his/her bath you can keep your baby warm and content by placing him/her skin to skin; this skin to skin contact helps regulate your babies temperature, heart rate and breathing pattern.  This contact also helps with milk production as well. “Skin to skin” means literally that: your baby should be naked, not wrapped in a blanket, and your bra, gown or clothing should be out of the way so that your bare skin is touching, then the baby can receive warmth from your body. A blanket or warmer can be placed over you both if desired. Usually this feels good to you also, as the mother naturally feels cool after delivery, due to her giving off heat for the baby.

Nursing on Cue

In a healthy baby, it is usually a good idea to follow the baby’s cues to decide when it is time to feed. You should offer the breast at the first signs of hunger (see early hunger cues below). However, if the baby sleeps more than three hours during the daytime you should try to wake your baby by placing him/her skin to skin, (see Helpful tips below. For a sick, premature, or underweight baby, consult with your healthcare provider or a lactation consultant about their needs.

Early hunger cues:

Note that Crying is a late hunger cue; try to nurse before the baby is upset and frustrated! To do that, s/he needs to be close to you, not in the hospital nursery.

Some helpful tips on waking a sleeping baby:

Realize that babies can be awake with their eyes closed and you can put them to the breast even if they seem less than fully awake, especially if they are showing the “early hunger cues” listed above. Sometimes they are just “playing possum”!

Frequency of feedings

It is important to watch the baby, not the clock in the first few days. The baby will likely not be on a schedule and feedings may vary-- from several times in one hour to every hour on the hour.  More frequent feedings occur because baby’s stomach is so small in size and breast milk is so easy for a newborn to digest.  (Infant formula sits in the stomach longer because it is harder to digest.)  In the first 24 hours the baby’s stomach can hold from 5-7ml (1-1 ½ teaspoons) of fluid, which is about the size of a thimble. This amount of colostrum is readily available in the mother’s breast. Colostrum is very thick and rick, like honey, so not much is needed.  By day three the baby’s stomach will expand to the size of a shooter marble increasing his need for more feedings.  The frequent feedings will help bring in the mother’s milk to meet the baby’s growing needs. 

In general, a healthy, term newborn will feed about 10-12 times per day, but these feedings are not evenly spaced. They tend to “cluster-feed”. If a baby has been nursing as often as every 2 hours all day, it is OK for her to sleep up to 4-6 hours at a stretch, but this will generally only happen once in a 24-hour period. If you are lucky it will be at night! If your baby is well, do not be worried if they go over three hours between a feeding if they have previously been nursing more frequently. For the first two weeks you might want to write down the number of feedings, to be sure they are nursing up to 10-12 times in a 24-hour period, since their crazy “non-schedule” might otherwise worry you. After 2 weeks, the stomach gets larger and they begin to develop a pattern.

Duration of feedings:

In general, you do not need to time your baby’s feedings.  You usually can switch sides when your baby has stopped drinking.  He may only need to nurse off one breast at each feeding, or he may nurse more from the first breast offered and less from the second breast.  As long as the baby is positioned and latched correctly at the breast, you can allow her to end the feeding by letting go or falling asleep.  You can then try to burp baby, but she may or may not burp since not much air is swallowed when breastfeeding.  After a couple of minutes, if baby has not burped you can offer the other breast.  Always begin the next feeding by offering the breast that the baby either did not nurse from at the last feeding or only nursed on for a few minutes.  This breast may feel fuller than the one the baby previously nursed.

How will I know if my baby is getting enough milk?

In general, a healthy term newborn does not need to have feedings measured. If you follow these guidelines about feeding the baby on cue 10 - 12 times per day and the baby is latched on well, and there are for signs of adequate output (see chart below), you can be reassured that the baby will be getting enough milk. (See “Signs of Sufficiency”)
However, in the first few weeks it is also important to monitor your baby’s wet and dirty diapers, this will confirm your baby is getting enough milk.

Day 1

1 wet diaper

1 black tarry stool

Day 2

2 wet diapers

2 brownish black tarry stools

Day 3

3 wet diapers

3 greenish stools

Day 4

4 wet diapers

3 or more greenish/ yellow stools

Day 5

5 wet diapers

3 or more yellow, seedy soft stools

Day 6 to Day 45

6 or more wet diapers

3 or more yellow, seedy soft stools

Baby’s urine should be clear yellow, not dark yellow.  Count only stools that are at least the size of a quarter.  By day four, the stool should change in color and consistency as the mother’s milk “comes in” to replace the colostrum. A baby who is not getting enough milk may begin to show signs of dehydration and will need immediate medical attention.

Signs that your baby may be dehydrated:

It is very important that a baby who shows signs of dehydration get immediate medical attention so contact your health care provider right away!

Some ways to keep your baby awake during feedings:

Should I supplement with water or formula?

For a full term newborn, breast milk has all the nutrients your baby needs, and unnecessary supplementation with formula can sometimes be risky and cause problems, both with the breastfeeding, and for the newborn.  It is normal for a newborn to lose up to 7% of their birth weight in the first week, and then she will start to regain the lost weight. (See Chart of Normal Weight Loss)  Your baby should be weighed on a sensitive scale (like at the doctor’s office or at WIC) in the first week after discharge from the hospital to be sure they have not lost an excessive amount of weight. If your baby has not reached his/her original birth weight by 2 weeks of age, or has continued to lose weight, you will need to see a Lactation Counselor to evaluate the latch and your milk supply. LINK to http://www.ilca.org/falc.html

If your pediatrician is concerned about your baby’s weight, you might want to discuss options other than formula feeding, such as increasing the number of feedings per day or the duration of the feeding to ensure your baby is getting enough of the fat-rich hind milk.  You may also try pumping after each feeding to increase your milk supply. Sometimes medications can be used to stimulate the milk supply.  Supplementing with formula is not always the answer and it can be detrimental to your milk supply and your baby’s health. Sometimes, medications or other factors in a mother’s health can affect milk supply. In general, get some help from a pediatric care provider AND a lactation consultant so that your breastfeeding can get back on track. Formula supplementation may be advised, but this should be evaluated on a case-by-case basis.

Water is not necessary for breast-fed infants even in hot climates.  In the first few weeks, giving water to hold a baby over until the next feeding can have the effect of diluting their food. This can cause inadequate caloric intake and electrolyte imbalance.  Giving any kind of supplementation using a bottle in the early days can lead to nipple confusion, which causes the baby to “forget” how to nurse at the breast.  Because the bottle nipples have different taste, texture, and flow it is easy for a baby to become confused because he has to suck differently using a bottle than she does at the breast.  If your baby becomes nipple confused she can still learn to breastfeed, so do not give up the idea and seek help from a lactation counselor if needed! They can also show you methods of supplementation not using a bottle that can sometimes be helpful.

Pacifiers:

Pacifiers should not be used to replace a feeding and should be used selectively in the early days, if at all.  Baby’s need to suck and all their sucking should ideally be done at the breast in the first few days of life.  Although there are a few exceptions, for example, when you are driving and are unable to tend to your crying baby, a baby with excessive sucking needs, or if you are experiencing sore nipples and you need a break.  Some babies will not take the pacifier or they may have a preference to a certain type or shape.  Pacifiers are not needed for long-term use, and around 3 months of age babies tend to lose the desire for one. This may be a good time to follow your baby’s cues and limit use of the pacifier.

Finally:

The first few days can be a rough road for any new mom, but she does not have to go down this road alone.  Seek help when help is needed.  Talk to other mothers who are breastfeeding; they too may be able to share some ideas for how to overcome those little “bumps in the road”.  Others may try to discourage you by telling you to give the baby a bottle, or that your baby is “nursing too much”, especially if they are not familiar with what is normal in breastfeeding.  Remember you are the mom and you will do what is best for your baby. Follow your heart!

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