10 breastfeeding basics mothers should know to start breastfeeding off on the right foot. According to the CDC 2018 breastfeeding report card, 83% of babies start out breastfeeding while less than 50% are exclusively breastfed by 3 months. Early postpartum is a critical time for initiating and establishing a breastfeeding relationship. Starting off on the right foot with a support network is a integral to longterm breastfeeding duration. Here are 10 tips from me, a postpartum nurse and IBCLC, to help you start your breastfeeding relationship off right!
1. Spend one hour of uninterrupted time skin to skin after delivery
Right after delivery is prime breastfeeding time aptly dubbed “The Golden Hour.” Baby is alert and led by instinctive behaviors to find the breast and intimate feeding. By delaying routine care for the newborn until after breastfeeding has been initiated, we are giving the infant the opportunity to let biology aid in the process of initiating breastfeeding. When an infant is immediately removed from mother to be weighed, foot printed, vaccinated, and assessed there is an inevitable amount of stress endured by the infant. The heightened corticosteroid response wears the baby out and can sometimes lead to missing the window of opportunity when baby is alert and ready to feed.
As you will see in the next bullet point, many babies have a sleepy period during the first few days of life. Babies that miss the “golden hour” to nurse will often move into the “sleepy” phase without ever nursing successfully.
Not all hospitals have started making uninterrupted skin to skin standard practice. Inquire with your provider about your delivering hospital’s protocols. There are clearly scenarios when this is not possible (such as medical emergencies, NICU admissions, or for some hospitals during routine c-sections). If this is the case, do not despair. Initiate skin to skin with your infant as soon as it is medically or logistically possible.
2. Be prepared for your baby to get sleepy
After the lovely alert period, many babies go into prolonged sleepy spell. They are difficult to rouse for feeds and are seemingly willing to sleep their life away. This is why first bullet point is so important.
Many well intentioned parents attempt to rouse their newborn every 2-3 hours to feed and find their once willing infant not longer interested. A baby that previously fed for an hour straight may feed less than 10 minutes if at all. This is completely normal. For the first 24 hours many babies are catching up on sleep after the trials of an exhausting labor and delivery experience. It rocked their little world and now they need to catch up on some shuteye.
What do we do? We continue like it is business as usual and offer that baby the breast every 2-3 hours. When it is time to breastfeed, it is essential we take some time to rouse the baby before putting it to the breast. This means getting the baby naked, changing it’s diaper, rubbing it’s back, and generally stimulating the infant until they seem alert with their eyes open. If all these interventions fail to rouse baby, try offering a finger to stimulate the infant’s suck reflex. Most infants will rouse enough to get an adequate feed (I like to see at least 10 minutes of active sucking).
When a baby refuses to be roused after all this harassing, put the infant skin to skin and try again in an hour. Continue this cycle until baby decides to wake up and eat. Many hospital policies will require a blood sugar check if the infant has fasted for too long. Do not fret. Most term healthy infants will wake up when they are ready and decided to eat. I promise.
The majority of term newborns usually get one or two good feeds in before they get sleepy. Make the most of this time! Don’t postpone feedings for visitors. Use this time to bond with your new infant and let the baby feed for as long as they are willing.
3. Understand the role of colostrum
Colostrum is the antibody rich milk your body produces throughout pregnancy and early lactation. Colostrum is a thick sticky consistency with a yellow to orange hue. It is low in fat but high in carbohydrates and protein, namely antibodies. The well known benefit of colostrum is the passive immunity passed from mother to baby via IgA antibodies in the milk. But colostrum has numerous other benefits that are just beginning to be understood.
One of the less known functions of colostrum is it’s ability to seal the infant gut protecting it from the penetration of foreign substances (such as viruses and bacteria) and aiding in the colonization of a healthy gut flora.
A newborn infant’s stomach is the size of a marble, which equates to around 10-15mls of milk. Because colostrum is thick and sticky, it often takes some work for the infant to draw it out of the breast for a feed. I describe it to parents as drinking a milkshake with a coffee straw. Infants need to nurse for an adequate length time to draw out the small but vital dose of colostrum. Colostrum is easy to digest and a natural laxative. This is important for priming the infant’s new and fragile gut and expelling all the built up meconium.
Colostrum is truly tailor made to fit an individual baby’s need. It comes in a small package but delivers a big punch.
4. Understand what normal newborn feeding behaviors look like
The most common concern expressed by parents in the hospital is, “How do I know my baby is getting enough?” Let me set the stage:
Small colostrum feedings are appropriate for the size of the newborn’s stomach and are sufficient to prevent hypoglycemia [low blood sugar] in the healthy, term, AGA [normal sized] infant. Healthy term infants also have sufficient body water to meet their metabolic needs.Academy of Breastfeeding Medicine
What this means is that small amounts of colostrum combined with a healthy term baby’s physiology are enough to sustain him without any supplementation. Babies are meant to subsist off their brown fat for the first few days of life. Infants are expected to loose up to 7% of their birth weight in the first few days of life. This is as nature intended it.
Parents often misread cues from their infant and interpret them to mean the baby is hungry. When do we worry an infant is not getting enough to sustain his needs?
- When there is no enough wet and dirty diapers in a day
- If there is blood sugar instability
- Baby develops jaundice
- When there is a weight drop greater than 10%
A baby who is meeting these milestones is getting adequate intake. Take a deep breath and allow nature to take its course. Your infant may seem hungry and want to feed more than the recommended 2-3 hr guideline. Go for it! You cannot feed too much. The more your infant feeds the quicker your body will transition from colostrum to mature milk.
6. Get your baby evaluated for a tongue tie
I cannot emphasize this enough. Have someone who knows what they are doing look for ankyloglossia (aka tongue tie). It is estimated that 4.2-10.7% of infants are affected by tongue tie. What is significant is the consequences associated with tongue tie. 60-80% of mothers with tongue tied infants report nipple pain or breakdown. One study estimated that “for every day of maternal pain during the first 3 weeks of breastfeeding, there is 10-26% risk of cessation of breastfeeding.” Clearly this a problem for breastfeeding moms. Also included in the laundry list of issues is failure to thrive infant, poor milk supply, infant reflux, breast engorgement, and infant refusal to feed.
Many providers are not properly trained to assess for tongue tie and just as many do not believe it is truly an issue. Keep in mind, very few pediatricians have any formal breastfeeding training. This is not a dig at doctors, just a fact. Their training is specialized elsewhere and there is little motivation for them to seek training in this field. One study found that 90% of pediatricians did not believe ankyloglossia caused breastfeeding disfunction while 69% of lactation consultants did. Hmmm. As a lactation consultant and mother of two tongue tied children, I can vouch that it is definitely a problem. If you don’t believe me, check out tongue tie guru Dr. Ghahari’s webpage.
7. Recognize when your baby swallows
Recognizing a baby’s swallow can give parents peace of mind. It is visual and auditory proof that baby is eating. Part of the mental block related to breastfeeding for many parents is that you cannot SEE how much baby is eating. You just have to take your baby’s word for it. A baby who is nursing well will begin with a fast burst of sucks to stimulate the milk ejection reflex followed by slow sustained sucks. This will be followed by a gulping sound and a breath. Clicking and smacking noises are not normal and tend to be associated with a poor latch. Being able to recognize a swallow, allows parents to feel some assurance baby is eating.
8. Don’t be surprised when your baby wakes up.
This tends to be the point when most new parents are freaking out. Their sweet little bundle of joy has already been dubbed a “good baby” because he is so quiet and seems to sleep through anything. What many parents mistake as a positive character trait is really just the sleepy phase we previously spoke about. Generally at about 20 hrs of life, or somewhere into the second night, baby wakes up and wonders, “Where the heck am I?” All his little fetal life he has been in the warm, dark, tightly snuggled womb, surround in the near deafening cacophony of blood whooshing arteries and gurgling visceral organs. Now he is out in the world. He is cold and exposed to a whole world of stimuli that are completely foreign to him. The only place he knows is safe is with his momma.
This period is affectionately dubbed, Second Night Syndrome. It generally is heralded by a more alert baby who seems to be only happy when he is breastfeeding. This is baby’s safe place. With his mother at the breast, past experience and instincts are telling him this is the place to be. Some babies handle this period with very little complaint while others are down right cantankerous until it passes.
This can FREAK parents out. What is wrong with my baby? He was so calm and now he seems like he is STARVING! Any experienced postpartum nurse will sagely nod and explain this is totally normal AND IT IS. Baby is simply adjusting to his new surrounds the only way he knows how. The added biological benefit is that frequent nursing helps bring in mature milk AND control post partum bleeding. What a elegant design. 🙂 Just remember everything from bullet point number 4. If your baby is meeting milestones he is not hungry, he is normal and adjusting. Breastfeed on demand, lots of skin to skin time with mom and this too shall pass.
9. Have a list of resources when you leave the hospital
Ask the hospital staff for outpatient support resources if they do not already provide it to you. Many insurers cover in home lactation visits. If you simply need some good internet breastfeeding informational sites, check out my resource page.
10. Leave mommy guilt at the door
Women come into the L&D until with all kinds of expectations. Expectations about the birth experience, expectations about the moment they meet their baby, and expectations about breastfeeding. I have seen so many women consumed by the anxiety of living up to strict set of axioms that they use to define a good mother.
Having a baby and the early post partum period is a grueling exhausting experience. We are completely at the mercy of our bodies and we can not control many of the variables at play leaving many women feeling frustrated and impotent. My advice is to leave expectation at the door. Come in with an open heart ready to experience all that comes. Be prepared to shuffle as they need to accommodate the cards you are dealt.
In regards to breastfeeding, just take a deep breath and let it happen. I am not saying it won’t take work. I am not saying there will be no difficulties to overcome. Simply, be prepared to let yourself experience the evolution of becoming a mother and make decisions as they come. You can do anything you set your mind to. If your heart is centered on making decisions that are good for YOU and your BABY, then you have absolutely nothing to feel guilty about.
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Baby’s Second Night • KellyMom.com. (2016, November 17). Retrieved November 04, 2017, from https://kellymom.com/ages/newborn/bf-basics/second-night/
“Breastfeeding.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Aug. 2018, www.cdc.gov/breastfeeding/data/reportcard.htm.
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Segal, L. M., MD, Stevenson, R., PhD, Dawes, M., MB BS MD FRCGP, & Feldman, P., MD FCFP . (2007). Prevalence, diagnosis, and treatment of ankyloglossia; A Methodical Review. The College of Family Physicians of Canada, 53(6), 1027-1033. Retrieved November 4, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/17872781.
The Sounds of Breastfeeding. (n.d.). Retrieved November 04, 2017, from https://www.lllc.ca/sounds-breastfeeding
What is colostrum? How does it benefit my baby? (n.d.). Retrieved November 04, 2017, from http://www.lalecheleague.org/faq/colostrum.html