Class 2 - Breastfeeding 101

I spend a lot of time chatting with pregnant couples and answering questions about their future as parents. Far and away, breastfeeding is the most common topic we discuss, as it seems to cause a great deal of anxiety for expecting parents. In this course, my hope is to provide a clear set of instructions, tips, and tricks for new parents to refer back to as they embark on their breastfeeding journey.

Please read our resource center article for information about preparing for breast feeding during pregnancy.

Review from Class 1 - Newborn Care 101

The Hunger Test

  • How Do I Know My Baby is Hungry?
    • In the first 2 weeks of life, if your baby’s eyes are open, you can assume he is hungry
    • If he crying, he's very hungry.
    • Try not to let yourself consider other reasons your baby may be crying, or why he won't sleep outside of your arms.
      • Common examples include: gas, colic, only wants to be held, hates being on his back, hates the bassinet, hates the swaddle, too cold, dirty diaper.
      • In the first 2 weeks of life, crying = hungry.
  • How Do I Know My Baby is Full?
    • He is asleep, and stays asleep when you put him down.
    • The Hunger Test:
      • After 10-20 minutes of feeding on both breasts, put your baby down on his back.
      • If he stays asleep outside of your arms, he is full.
      • If he wakes up and cries, he needs more food.

The First Two Weeks

  • There are two goals for the first two weeks of life:
    1. Bringing in your breast milk on time.
    2. Making sure the baby gets back to birth weight by two weeks of life, and doesn't lose too much weight in the process.
  • There are two goals for every feed, in order to make this happen.
    • The feed is not complete until:
      1. Both of Mom's breasts have been stimulated for 10-20 minutes.
      2. The baby is asleep outside your arms (not being held).

Bringing in Your Breast Milk On Time

  • When the baby is born, Moms produce early breast milk, called colostrum.
    • Perfect nutrition for a newborn.
    • Clear fluid, which can be surprising to new Moms.
    • Smaller amounts. Perfect for those tiny tummies!
  • The later “mature” breast milk will come in on days 3-5 of the baby’s life.
    • Usually sooner for Moms who have breastfed before.
    • The mature milk is white in color, and there’s a lot more of it.
  • Adequate, and frequent stimulation is the key to bringing in the mature milk on time.
    • Empty breasts signal the brain to make more milk.
    • Incomplete emptying is the most common reason mature milk doesn't come in on time, which is the most common reason breastfeeding doesn't work out.

Getting Back to Birth Weight

  • Babies lose up to 10% of the birth weight during the first week of life.
  • The goal is to be back to birth weight by the end of the second week of life.
  • Once baby gets back to birth weight, the new rule is never wake a sleeping baby. This rule will apply to sleep both during the day, and at night.
  • Until that happens, we recommend the following schedule:
    • How Often?
      • Feed baby at least every 3 hours. 
        • At the beginning of every feed, set an alarm for 3 hours.
        • If she wakes up before the 3 hour mark, she is hungry and you should start a new feed. Restart the 3 hour alarm.
        • Wake your baby after 3 hours if she is still sleeping.
    • For How Long Should I Feed?
      • Feed on both breasts every time.
      • 10-20 minutes on each side.
        • After 20 minutes of good feeding, the baby will probably have emptied that breast.
        • If baby keeps feeding, she may slip to the end of your nipple, causing pain, cracking, bleeding, etc.
        • She may also lose extra weight trying to get food from an empty breast. Eating takes energy!
    • What If My Baby Has Fed For 10-20 Minutes on Both Breasts and Is Still Crying or Won't Stay Asleep When I Put Him Down?
      • He is still hungry.
      • Putting him back on an empty breast will cause the problems discussed above.
      • If this happens, we recommend giving pumped milk or formula from a bottle.
        • This should be done by another caregiver.
        • Give 15 mL amounts over and over until baby falls asleep, and stays asleep when you put him down.
        • You can’t overfeed a baby! When your baby is full, he will stop eating.
      • We recommend Mom pump her empty breasts during this time until the other caregiver completes the process.
        • This tells Mom’s body to increase production because baby needed more food than she had during that feed.

Good Latch vs Bad Latch

  • A good latch is required to empty each breast. If the latch is poor, baby cannot empty the breasts.
  • Unlike the sucking that occurs on a pacifier or bottle nipple, a baby must use his gums to massage the milk down the milk ducts towards the nipple for transfer to the mouth.
  • To accomplish this, your baby should have most of the areola, the dark circle around your nipple, in his mouth.
  • A deep latch is a good latch. A shallow latch is a poor latch.

  • To accomplish this, hold his head steady with your thumb on one of his ears, and another finger on the other ear.
    • This is the safest place to put pressure on his head, and provides traction for you to control his head as well!
  • Wait until his mouth is open very wide, so he can get a big mouthful of breast tissue.

  • Take that opportunity to immediately bring his head and mouth to your body, ensure he take "a big bite of breast."

  • Always bring the baby to the breast, and not your breast to the baby.

How to Make Sure Your Baby is Getting Enough

  • There are two simple ways to know your baby is getting enough to eat in the first two weeks:
    1. After every feed, your baby stays asleep when you put her down (see "The Hunger Test" above). 
    2. She has at least one wet diaper for every day of life, counting from midnight to midnight:
      1. At least zero on day of life 0.
      2. At least one on day of life 1, two on day of life 2, three on day of life 3, four on day of life 4, five on day of life 5, six on day of life 6.
      3. After day of life 6, your baby should have a least six wet diapers every day (at least six on day of life 7, at least six on day of life 8, etc).
    3. We encourage parents to ignore the frequency of poops, because wet diapers are a much better real-time measure of how well your baby is feeding.
  • If you follow these two rules, your baby will not lose more than 10% of her birthweight, and she will get back to birthweight by the end of the second week.

Vitamins

  • Mom should continue her daily prenatal vitamin for as long as she is breastfeeding.
    • Whichever option you took during pregnancy will be just fine
  • Babies need a daily supplement of vitamin D (not well-transmitted in the breast milk) for bone growth and development.

Pumping, Storing, and Preparing Your Breast Milk

Pumping

    • In order to develop breast milk stores, you may need to increase your supply, so there is some left over after your baby is full.
    • The very best and simplest way to increase your supply is to pump your breasts when they're empty.
      • Do this for 5 minutes, after a feed, to send a strong signal to your body to make more.
      • You don't need to do this after every feed, just pick 2 or 3 feeds per day when you have the energy to do so.
      • If milk comes out, you can store it of course, but don't be discouraged if you don't see milk for the first few days.
      • After a few days of this, you will have extra milk at the end of the feed, which your baby did not need.
      • You can store this milk for a later time.

Storage

  • The amount of time stored breast milk will stay fresh and safe for your baby depends on where it is stored.
  • Follow the rule of 6s:
    • 6 hours in room temperature (68-72ºF)
    • 6 days in the refrigerator (32-39ºF)
    • 6 months in the freezer

Preparing Stored Milk for Baby

  • You can take breast milk from a colder to warmer environment (eg. freezer to fridge), but not back and forth (freezer to fridge back to freezer).
  • Think of this like leftover food you bring home from a restaurant.
    • It's not safe to warm the food, then return to the fridge, and then warm again.

Milk in the Freezer

  • Take frozen milk from the freezer to the fridge to let it thaw.
    • This will take 10-12 hours.
  • Don't warm it to room temperature directly from the fridge.
    • If you don't use it all, you can't put it back in the fridge (warm to cold environment).

Milk in the Fridge

  • Take cold milk from the fridge and bring it directly to the baby.
    • If baby doesn't finish what's in the bottle, you can return it to the fridge to be used at the very next feeding.
  • Skip the bottle warmers.
    • Babies do great with cold milk, so save the money, space, and time it takes to mess with a bottle warmer.