How to Make Baby Feed Longer on Breast
How to Breastfeed During the First 2 Weeks of Life
The most important piece of advice: Be easy on yourself.
This guide was originally published on May 5, 2019 in NYT Parenting.
Though breastfeeding can be a beautiful experience for many, it isn't always easy. As you hold your newborn for the first time after enduring one of the most physically and emotionally demanding feats of motherhood, it's normal to feel a range of emotions: from joy and elation to stress and anxiety. These feelings can be compounded during the first two weeks of your baby's life, which are the most challenging and important for establishing milk supply — especially for first-time mothers.
As a 25-year neonatal intensive care unit and newborn nurse, a board-certified lactation consultant and the mother of three exclusively breastfed boys, I know firsthand what basic information is most helpful for nursing mothers, from how to achieve a proper latch to how to recognize your baby's hunger cues.
I've also reviewed the most current scientific research and clinical guidelines, and spoken with a neonatologist, a pediatrician and a neonatal nurse practitioner, to help you recognize what is and isn't working so you can breastfeed with confidence during the first two weeks after birth.
On day 1, recover from birth and master your latch.
As soon as you're medically stable and aware after birth, your provider will likely place your newborn on your chest for skin-to-skin time. This, studies suggest, can help stabilize her breathing, body temperature and blood sugar levels; and set her up for her first breastfeeding. "Make sure you can see her face when she is placed on your chest," said Nancy Forsyth, R.N., N.N.P., a neonatal nurse practitioner at Beebe Healthcare in Delaware. "Her head should be turned to one side and tipped back as if she is sniffing something." This is especially important if you're fatigued or on pain meds, said Forsyth, since improper placement can lead to a blocked nose or mouth, which in turn can stop her breathing.
Babies are most alert during the first couple hours of life and will instinctively begin to root and try to suckle. While you're doing skin-to-skin time, encourage your baby to search for and latch on to your nipple. Your first milk — or colostrum, which is thicker than breast milk — is typically all the nutrition your baby needs; and contains antibodies and other substances that protect her against gastrointestinal and respiratory infections. If she is struggling to reach your breast, help her. It's more comfortable to bring your baby to your breast and not your breast to your baby.
While holding her, position your baby's mouth toward the bottom of your areola, while touching her upper lip with your nipple. When she opens her mouth, aim your nipple toward the roof of her mouth while she latches. Most of your areola should be visible while your baby's lower lip, chin and cheeks are touching your breast. Her nose should be up and clear for breathing with her lips flanged out.
Your baby will likely be sleepy as she recovers from birth, so try to keep her close so you can learn her early hunger cues. These can include turning her head to the side, rooting, mouth movements and sucking on her hands. Crying is a late sign of hunger. Gentle stimulation, such as diaper changing or rubbing your baby's feet or back, can help rouse her for breastfeeding if she's sleepy. Sometimes, hand expressing your colostrum and putting it in her mouth to taste will encourage her to latch for a feeding.
It's normal for your breasts to feel tender during your first feed (that tenderness should subside after a few sucks); but if you feel pain and don't hear her swallowing, her latch is incorrect. Get your latch checked often by a nurse or lactation consultant, if one is available, to ensure your baby is getting enough colostrum and to prevent nipple damage. How breastfeeding feels is more important than how it looks; you should feel a strong pulling sensation.
Experts recommend nursing your baby for at least 10 to 15 minutes per breast every two to three hours. This works out to eight to 12 feedings per day. If you need to delay your first breastfeed (if you or your baby are unstable after birth, for example) don't worry. You'll continue to produce colostrum until your full breast milk supply comes in (which typically happens two to three days after birth).
Colostrum helps your baby pass meconium, their first bowel movement, and removes bilirubin — a yellow-pigmented compound that can build up in the blood and cause jaundice. Most cases of jaundice are benign, but if your pediatrician determines that your baby's bilirubin levels are abnormally elevated, your doctor may recommend supplementation with formula or donor breastmilk and phototherapy (an ultraviolet light treatment of the skin) to reduce bilirubin levels. A lactation consultant should also confirm that your baby has a correct latch and is removing milk properly.
After a successful feed, your baby should produce at least one wet (urine) and one bowel movement in her diaper within 24 hours. The first bowel movement should look dark green and tarry.
On day 2, expect your baby to be hungry and to breastfeed frequently.
Today, your baby is likely much more alert and hungry, and will want to nurse every two to three hours (which is normal and will help bring in your milk). Your baby should be content between nursing sessions.
On day two, you will likely be discharged from the hospital. Your nurse will weigh your baby to determine how well she is feeding. Keep in mind that if she was born at term, she'll lose weight in the three to four days after birth. According to Dr. Enrique Gomez-Pomar, M.D., a neonatologist at Rush Foundation Hospital in Meridian, Miss. and an assistant professor of pediatrics at the University of Kentucky, "your baby can lose up to 5 percent of the birth weight on day one, up to 7.5 percent on day two and up to 10 percent on day three." If your baby is losing more than that, said Dr. Gomez-Pomar, it could be a sign that your breastfeeding technique isn't working and should be further evaluated.
In some cases, you might not produce enough colostrum to satisfy your baby, which could increase her risk of jaundice, dehydration, excessive weight loss or low blood sugar. "When a baby is showing hunger cues and is persistently crying, especially after nursing, they are hungry," said Dr. Gomez-Pomar. In that case, your doctor might consider supplementing your baby's diet with donor breast milk or formula until your breast milk volume is sufficient to meet your baby's needs. Pasteurized donor milk is available through some hospitals and through Human Milk Banking Association of North America, and typically costs $3 to $5 per ounce (check with your insurance plan for coverage).
If you're concerned that temporarily giving your baby donor milk or formula will ruin your breastfeeding relationship, don't be. Recent, albeit small, studies have found that supplementation can prevent excessive weight loss in infants while satisfying their hunger, and doesn't seem to impact future breastfeeding success. A 2018 study published in The Journal of Pediatrics, for example, found that of 164 breastfed newborns who had lost excessive weight within the first 72 hours of life, those fed about 2 teaspoons of formula after every breastfeeding were no less likely to breastfeed at 3 months than those who were exclusively breastfed. Babies in the formula-supplementation group were also less likely to be readmitted to the hospital later for feeding complications, and their gut microbiomes were not significantly different from those fed formula.
If your baby isn't latching or nursing adequately, you may need to self-express or pump your breasts for colostrum and feed it to her with a syringe, tube, cup or slow flow bottle. Your nurse or lactation consultant can teach you how. This will be necessary until your baby can breastfeed on both breasts for 10 to 15 minutes per session.
If your nipples are painful, cracked, bruised or blistered, correct your baby's latch and positioning to prevent additional damage. To speed healing, apply nipple cream or gel pads to your nipples after nursing.
Around this time, your baby's bowel movements should change from meconium to a brownish-green color, indicating that she is digesting colostrum and reducing her jaundice levels. Your baby should have at least two wet and two greenish-brown bowel movement diapers by the end of day two.
Breastfeeding is a learned experience and each session will probably be different. Being flexible will provide relief from feeling pressured to do everything perfectly. It's also important to take care of your own needs as you recover by resting, showering, eating and drinking, and relieving any pain you may have from delivery.
On day 3, keep monitoring your baby and milk supply, and prepare for your first pediatrician appointment.
Before you leave the hospital, make sure your baby has a follow-up appointment scheduled with his pediatrician for the day after discharge. "Days two to five are critical days for normal newborns to be seen by their pediatrician," said Dr. Vicki Roe, M.D., a pediatrician at North Point Pediatrics in Indiana. "They are still losing weight and their jaundice levels could be increasing. A healthy baby can become a very sick baby quickly and we must monitor them closely to prevent complications."
According to Dr. Roe, it's important for your baby to have a physical exam every day or every other day after you're discharged, "until it's clear that your baby is feeding well and that their jaundice is improving."
On day three, your breasts will begin to feel fuller and heavier and possibly start leaking as your milk comes in, though it could take six or more days after birth for your full milk production to start, especially if it's your first baby or if you delivered via cesarean section. Delayed milk production typically has no bearing on your ability to have a full milk supply, but catching and managing it early and appropriately is important. If your full milk production is delayed, continue nursing every two to three hours and then supplement right after, until your milk comes in. Your pediatrician will advise you on how much banked donor milk or formula is needed and how to wean off it once your milk arrives.
Most mothers, however, don't need to supplement their babies and can continue breastfeeding, following their babies' hunger cues. (If you're dealing with low milk supply, see our guide on that here.)
You can expect three wet and three greenish-brown bowel movement diapers or more by the end of day three. When you are napping, make sure your baby is sleeping safely alone, on his back, in a crib, according to the American Academy of Pediatrics guidelines.
On day 4, manage engorgement and expect changes in baby's bowel movements.
By day four, your full milk supply has probably come in, which can happen suddenly or gradually. You'll also notice your baby swallowing much faster than before, with about three sucks for every swallow. Because latching can be difficult when your breasts are full, try hand expressing or pumping some milk briefly to reduce their fullness and to help soften the nipple for easier latching. If breast engorgement interferes with your milk flow or let-down, apply cold packs to your breasts between feedings to reduce swelling and consult with your doctor or lactation consultant for additional help.
By the end of day four, your baby should have six to eight wet diapers and four bowel movements. Her bowel movements should change from greenish-brown to a seedy mustard yellow, indicating your baby is being fed mature breast milk.
Around this time, you might experience rapid hormonal shifts, including crying for no reason, or difficulty sleeping, eating or making decisions. This is known as postpartum blues, and commonly resolves within one to two weeks after birth. If it doesn't resolve, you might have postpartum depression and you should discuss it with your doctor.
[How to recognize and seek treatment for postpartum depression ]
On day 5, expect your baby and your body to start adjusting to breastfeeding.
At this point, your baby is likely waking up on his own to feed every two to three hours, and producing at least six wet diapers and three to four yellowish, seedy stools. Your breasts should begin softening after each feeding, indicating your baby is removing milk, and your baby is likely beginning to gain weight. Your breasts may feel excessively full, and leaking milk is common.
Between days 6 and 10, start settling into a more predictable breastfeeding routine.
Because your baby is likely receiving more milk than she did before, you may notice a more regular pattern of nursing, sleeping and alert periods after your milk comes in. If your baby likes to suckle for comfort, you may find that she prefers to "cluster feed" at certain times of day, meaning she'll nurse almost continuously for a few hours, rather than nursing only once every two to three hours.
By this time, your baby should be producing four or more yellowish bowel movements and six or more wet diapers every 24 hours. Consult the A.A.P.'s breastfeeding guide to help ensure you and your baby are still on the right breastfeeding path. It's also important to continue to find time to rest when your baby is sleeping.
Between days 11 and 14, prepare for a growth spurt.
Near the end of her two weeks, your baby will likely have a growth spurt and will want to nurse more often than normal, acting ravenously hungry. This can last for a few days until your baby meets his increased milk needs, and your milk supply will likely adjust to meet these increased demands.
Your breasts may not feel as full as they did during the first two weeks. This does not mean that you don't have enough milk. If your baby seems satisfied after feedings and is gaining weight, he is getting enough. Weekly weight checks with your baby's pediatrician can help you stay on track in the first month, until breastfeeding is fully established. Babies who are breastfeeding well will gain 5 to 7 ounces weekly.
Nursing your baby is a special experience. Though there may be challenges along the way, breastfeeding often becomes much easier, more enjoyable and more rewarding over time.
When to Worry
If your baby is not getting enough breastmilk, he will likely exhibit the following signs: nursing constantly and crying after most feedings; yellowing skin; not waking spontaneously or inability to stay awake for feeds; trouble latching or sustaining breastfeeding for at least 10 minutes at a time; fewer wet or dirty diapers than expected; or dry lips. If you notice any of these warning signs, contact your pediatrician or family doctor.
If you have persistent nipple or breast pain or a fever, call your ob-gyn or midwife, as it may require medical treatment. A consultation with a lactation consultant can help resolve latching pain or any other breastfeeding concerns.
If your postpartum blues are persistent after the first two weeks, contact your obstetrician who may screen you for postpartum depression.
Jody Segrave-Daly is a registered nurse, lactation consultant and mom of three.
Source: https://www.nytimes.com/article/breastfeeding-newborn.html
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