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.

The First Two Weeks

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.
  • Complete emptying of the breasts 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.
  • Complete emptying of the breasts is accomplished by:
    1. At least every 3 hours, or more often if your baby wakes and cries before the 3 hour mark
    2. Both breasts emptied with every feed.
    3. At least 10 minutes, no more than 30 minutes on each breast

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.

Feeding Schedule

  • 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.
    • At least 10 minutes on each side.
    • No more than 30 minutes on either side.
      • After 30 minutes, the baby will have emptied that breast.
      • If baby keeps feeding, she will 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!
  • How Do I Know My Baby is Hungry?
    • In the first 2 weeks of life, if your baby’s eyes are open, he is hungry.
    • If he crying, he is 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 and fussy = 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.
  • What If My Baby Has Fed For 10-30 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.
  • What If the 3 Hour Alarm Goes Off and We Can’t Wake the Baby Up Long Enough to Feed?
    • Unswaddle your baby, use a cold, wet washcloth on the skin, or try taking the diaper off.
    • Many babies will wake when you do this, but fall asleep again before feeding well.
      • If your baby simply won’t wake up long enough to feed, use the breast pump for 10 minutes on each breast.
      • Your breasts need stimulation to bring in the mature milk on time.
      • If your baby won’t do that, use the pump instead.
      • You probably won’t see much milk, if any coming from the pump. This is normal!
      • Remember, you aren’t pumping to get milk now. You’re pumping to bring the mature milk in on time later.
  • What If Baby is Crying So Hard I Can’t Get Him To Latch at My Breast to Eat?
    • Pass him off to another caregiver who will give pumped milk or formula from the bottle until baby passes the hunger test.
    • If this happens, mom should pump for 10 minutes on both breasts to make sure her body knows the baby needed to eat.
    • Somebody (baby!) or something (breast pump!) should stimulate both breasts for at least 10 minutes with every feed.

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.

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 baby to make more.
      • You don't need to do this after every feed, just pick a few feeds 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
    • To thaw your frozen milk:
      • Thaw the bottle or bag in the refrigerator (usually takes around 12 hours)
      • Thaw the bottle or bag by running it under warm water, or placing it in a warm bowl of water.
    • Previously frozen breast milk is safe in the refrigerator for 24 hours after thawing.
    • Never refreeze breast milk after thawing.
    • Warming milk from the refrigerator:
      • Never microwave or warm breast milk on the stove.
      • Most babies will take milk cold from the refrigerator. This is safe and will not cause discomfort.
    • If baby does not finish all the milk you offer in one feeding, return the bottle to the refrigerator and give it at the very next feeding.
      • Separate it in the fridge or use a sticker so everyone knows it must be given at the next feed.