Initial Breastfeeding Guide

Getting Started

Bring on that breast milk!

  • The early breast milk you produce is called colostrum.
    • This is a nutrient-dense fluid that is sometimes considered the baby's "first vaccine" because it has lots of antibodies and antioxidants that help build up their immune system.
    • It's made in small amounts because babies only need a few ml of this to be satisfied after a feeding! (see photo below)
  • Your mature milk will come in around 3-5 days, be a lighter white color, and there will be more of it.
  • Adequate and frequent stimulation of the breast is the best way to bring in your milk supply.
    •  Empty breasts signal the brain to produce more milk, so be sure to give your baby plenty of suckling time on the breast.

How often do I need to breastfeed?

  • In the first two weeks of life, the general rule of thumb is- if baby is awake, baby is hungry. If baby is crying, baby is really hungry.
    • It can be harder to latch a crying, hungry baby, so try to get them on the breast before this point if possible.
  • Aim for 8-10 breastfeeding sessions per day.
  • If you have a sleepy baby, remember to wake him at least every 3 hours to nurse.
    • That time frame is from the start of one feeding, to the start of the next.
    • To keep them awake try changing their diaper between feedings, rub their head, wipe their head or body with a baby wipe, gently rub the soles of their feet, talk to them, lights on, etc.
  • How long you feed for depends on a few factors, but in general your newborn will nurse at the breast for about 20-30 minutes.
    • Sometimes this means 10-15 minutes on each breast, or in some cases it will be a full 20-30 minutes on one side.
    • Remember- some babies will take longer, and some will be quicker! Each feeding can also be a little different. This is OK!

Getting a deep LATCH

  • A good latch is required for emptying the breasts. The latch is how your baby is attached to the breast and nipple.
  • Start by performing the “finger exercises” prior to putting infant to breast to strengthen tongue muscles and enhance the infant’s sucking skills.
    • Do this by putting your finger in your baby's mouth and stroke the roof of their mouth until they start to suck. Use your other hand and pull down on the lower lip/jaw to observe for cupping of the tongue on your finger.
    • Pull your finger in and out of the mouth and side to side, allowing the tongue to remain suctioned to your finger.

  • Position yourself comfortably, and slightly reclined to promote suckling
  • Have your baby in just a diaper to aid in skin-to-skin contact which helps promote breastmilk production
  • Choose a position/hold that is most comfortable to you 
    • Cross-cradle: hold the breast with the same hand as the side you're feeding on (ex: nursing on left breast, hold breast with left hand), and cradle the baby in your opposite arm
    • Football: baby's body will be alongside your torso, held in same arm as the side you're feeding on (ex: nursing on the right side, hold. baby with the right arm and support breast with the left). 
      • Good position for immediate post c-section as infant is not putting pressure on incision.
    • Side-lying: laying on your side on a firmer bed or couch and having baby lay facing you to nurse. Can use either the bottom breast or the top breast depending on size and comfort
    • Prone/Koala: baby facing you sitting up on your knee and latching directly onto the breast, then lay back a bit so baby is laying on your chest 
      • This is good for women with a fast let down and helps prevent choking on a fast milk flow
  • Place your thumb behind one ear and middle finger behind the opposite ear so you have control of their head position. Support the baby's upper back using the palm of your hand. 
  • Aim your erect nipple at the baby’s nose so they can smell the milk and let it touch the top lip slightly, this stimulates the rooting reflex.
    • When baby opens their mouth wide and chin is down, quickly bring baby onto your breast with the nipple aimed at top of mouth.
    • Think about taking a bit out of a sandwich - let lower jaw/lip touch the breast, below the base of the nipple first, then bring baby's head down on the rest of the areola and nipple.
    • Remember to keep them in a neutral position: chest to chest, head straight not turned to the side, and neck slightly extended.
    • When baby is latched properly you will feel pulling, suction & pressure. But it should NOT be painful!

  • Your baby's suckling will be faster in the beginning, then will slow as milk starts to flow.
    • You should notice the jaw moving up and down, and long sucks in a rhythmic pattern throughout the feeding 
    • Listen for swallowing sounds as well
  • Massaging the breasts throughout the feeding can help increase the flow of milk and loosen clogged ducts.

FAQs

  • What if my baby is losing weight?
    • Babies are expected to lose about 10% of their birth weight in the first week. 
    • Our goal is for them to be back to birth weight by about 2 weeks of life.
  • How do you know if they are getting enough milk?
    • There are 2 ways to determine this- wet diapers and the "hunger test."
      • The hunger test = after feeding your baby at the breast, put him down in his back. If he stays asleep out of your arms he is full, but if he wakes crying he is still hungry and we recommend supplementing with pumped breastmilk or formula.
      • Wet diapers = Babies should have 1 wet diaper per day of life (ie: 2 wet diapers on day 2), or 6-8 wet diapers after they're a week old.
  • Is it ok that my nipples are sore?
    • A little nipple soreness/tenderness is normal for the first few weeks, but should start to go away fairly quickly once they toughen up and you establish a deep latch.
    • Expressing some breastmilk after feeding and rubbing it on the nipple can help with soreness/cracks/etc. Make sure to allow the breastmilk to dry on the nipple before putting a bra or shirt back on.
    • If your nipples are bleeding, getting frequent breakdown, or you're having extreme pain you should seek medical attention because there may be an infection or other complication.
  • When should I start to pump?
    • If you plan to offer a bottle to your infant at any point in the future, you will want to start pumping once a day around 3-4 weeks of age
      • Best time to pump is in the morning between hours of 5-8 am. The volume of milk is highest at that time. I recommend breastfeeding first, then pumping both breasts together. 
    • If you plan to introduce a bottle, the best time to do that is also around 3 weeks of age. You can offer 1 bottle every few days just to allow the infant to get used to it. 
      • Most breastfed babies are satisfied with about 4 oz bottles
    • If your baby is not emptying your breasts or you feel uncomfortably full after they breastfeed, then you should pump to establish your supply.

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