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Breastfeeding Basics

Breastmilk Production

Colostrum is a special milk that a mother produces for the baby's early feedings. Colostrum is a thick, yellowish fluid consisting of protein, antibodies, essential electrolytes, nutrients and just what your baby needs for the first few days of life. Colostrum is the perfect first food for your baby. During the first 3-4 days your breasts will begin to feel fuller before feedings. The milk glands are changing from making colostrum to making milk. People say the milk is "coming in." The truth is that mothers have colostrum available immediately after giving birth. After a few days, the milk changes consistency and the breasts start making MORE milk, because your baby is ready for more. Colostrum is replaced by transitional milk, which is thinner, lighter in color, and more plentiful. Within about two weeks of the baby's birth, early milk is replaced by bluish-white mature milk.

As the milk comes in, your breasts may become engorged (swollen). Most mothers feel heavier or fuller before feedings but do not get engorged. Breastfeeding at least every 2 - 3 hours during the day and at least once at night will help keep your breasts comfortable as your milk comes in. If you feel engorged and your baby is sleeping but due for a feeding wake the baby up and feed to help relieve your engorgement.

When your baby is about two-three weeks, your breasts will get a little softer and smaller. This does NOT mean you have less milk. Your breasts are now regulating to the supply that the baby needs and are less swollen.

After the first days of life your newborn will become more and more alert and feed more frequently about every 2 to 3 hours and about 8 to 12 times in 24 hours. You may notice your baby "cluster feeding" which is feeding every hour for two to three feeding sessions and than sleeping for 4-5 hours. These cluster feeds are normal and help the baby deal with the inability to digest large meals and this frequent breastfeeding stimulates the mother's hormonal system to increase milk production. Lactation Consultants advise mothers to breastfeed the baby on demand rather than by an hourly schedule. This practice not only ensures that the baby receives the proper nutrition, but also that the mother's milk supply is maintained.

Milk at the beginning of a feeding session is different in composition than milk at the end-the hindmilk, or later milk, is much richer in fats. At Westside Pediatrics, we recommend that a breastfeeding session begin and continue on one breast until the baby spontaneously stops feeding; then the mother should offer the other breast, allowing the baby to feed until completely satisfied. Halting feedings after a predetermined time may prevent the infant from obtaining the extra fat calories in the hindmilk necessary for proper growth.

For the first few weeks of life your baby should have about 6 wet diapers and 2-3 stools in 24 hour period. Breastmilk stools are yellow (sometimes green or brown), loose, liquidy, seedy and sweet smelling. Keep a written log to track the numbers of feeding sessions and the number of urine and stool diapers for the first few weeks.

During the first two weeks of life your baby will come with you to Westside Pediatrics and have a newborn exam and a weight check. Once your baby has gained weight and established a good breastfeeding routine you no longer need to keep a log and you can allow your baby to sleep longer periods at night (5-6 hours). We recommend allowing your baby to sleep longer periods at night but no longer than 4 hours during the day to coincide with a mother's prolactin level which is highest in the morning/daytime and slightly lower in the evening time. Prolactin is a hormone that stimulates the lobules, or milk-producing cells, in the breast to secrete milk.

The Let-Down Reflex

As your baby starts to breastfeed, your milk starts to flow. During a feeding your milk glands release more milk. This is called let-down or often referred to as the milk ejection reflex. The same hormone that causes the let-down makes your uterus contract (tighten). As your milk lets down, you may also feel your uterus cramp and have heavier vaginal bleeding. After the first few days, the uterus is smaller and you do not feel that cramping anymore. Some mothers feel a tingling or tightening in their breasts with the let-down at the start of each feeding. Some mothers do not feel the let-down but see their babies start to gulp as the milk comes faster.

Making Enough Milk

When you nurse as long and as often as your baby wants, you are telling your breasts how much milk to make. This is often called supply meets demand. Supply meets demand as long as you breastfeed, even when your baby is bigger. Your body makes as much milk as your baby is taking.

The First Weeks of Breastfeeding

Stages of Breastfeeding

The process of breastfeeding and your milk change as your baby grows and develops. A newborn's feeding routine may be different than that of a breastfeeding 6-month-old.

Early Breastfeeding

The first weeks of breastfeeding should be considered a learning period for both you and your baby. Early feedings take time and patience. Privacy, support, and realistic expectations can help them to go more smoothly. Do not expect to work as a coordinated team immediately. Give yourselves plenty of time to recuperate from labor and birth, develop a daily routine, and overcome any initial breastfeeding difficulties. Gather your advice from someone who has experience and is both calm and therapeutic.

Day 1

Most full-term, healthy babies are ready and eager to begin breastfeeding within the first half hour to two hours of birth. Then many sleep or act drowsy for the next two to 20 hours. Expect to change only a couple of wet and dirty diapers during the first 24 hours.

Days 2 to 4

By the second day your baby should begin to wake and cue (show readiness) for feedings every 1 1/2 to 4 hours for a total of 3 to 5 breastfeedings in 24 hours. These feedings provide your baby with antibody-rich first colostrums milk and tell your breasts to make more milk. Your baby should suckle for at least 10 minutes and may continue for about 30 minutes on the first breast before stopping without help from you. When your baby finishes at one breast, you can burp and change his/her diaper before offering the second breast.

As with Day 1, you probably will change only a few wet and dirty diapers on baby's second and third days, and do not be surprised if your baby loses weight during the first week. The number of diaper changes and baby's weight will increase when your feeding sessions increase.

You may feel uterine cramping when breastfeeding the first two or three days, especially if this is a second or subsequent baby. This is a positive sign that the baby's sucking has triggered a milk let-down, also called the milk-ejection reflex (MER). It also means your uterus is contracting, which helps minimize bleeding. A nurse can give you something to take before feeding if needed for the discomfort.

Because your baby still is learning, you may experience nipple tenderness when he/she latches on or during a breastfeeding. Other factors also may contribute to this tenderness, but usually it is mild and disappears by the end of the first week. If tenderness persists, develops into pain, or nipple cracking is noted, contact Suzanne Bussetti, a certified lactation consultant, at our office or any certified lactation consultant (IBCLE).

Days 3 to 5

The volume of breast milk produced increases dramatically at about 3 or 4 days after birth, and the milk is said to have "come in." Your baby probably will drift off after his/her 8 to 12, 10 to 30-minute feedings and act more satisfied after a meal. Within 12 to 24 hours, you should be changing a lot more wet diapers. The number of dirty diapers also increases, and the stools should be changing in color and consistency. From the dark, tarry meconium stool, they should progress to softer and brown color before becoming a mustard-yellow and loose and seedy. Weight gain should also pick up within 24 hours of this increase in milk production, so your baby begins to gain at least half an ounce (15 g) a day.

You may notice that your breasts feel fuller, heavier, or warmer when your milk comes in. Some mothers find their breasts become uncomfortably engorged due to increased milk volume and tissue swelling. Then the breasts feel hard and tight; the areola and nipple may seem stretched and flat, making it difficult for a baby to latch-on. The most important thing to do when your milk first comes in is to move the milk out of your breasts by feeding your baby frequently. If your baby has difficulty latching on because of severe engorgement:

  • Soften the nipple and areola by expressing some milk and then let baby latch on.
  • Breastfeed or express milk by hand to relieve engorgement or discomfort. Try not to pump your breast empty. This will only signal your body to produce more milk. Pump to soften your breast so that they are more comfortably and easier for the baby to latch onto.
  • Apply cold packs or sandwich bags filled with ice or frozen vegetables to the breasts for 20 to 30 minutes after a feeding or pumping session. The application of cold packs MAY relieve the swelling. Some women do report improved milk flow if they also apply warm compresses to the breasts for a few minutes immediately before breastfeeding or milk expression, but there are no studies that support that either cold or warm are more effective. In some women using heat for more than a few minutes could increase the amount of swelling. Experiment and see what relieves your engorgement and discomfort.

Days 5 to 30

Your baby will become more proficient at breastfeeding as the first month progresses. Expect to feed your baby about 8 to 12 times in 24 hours and for approximately 10 to 30 minutes at the first breast before he/she lets go of the breast without your help. You can then burp the baby, change his/her diaper, and switch to the second breast. Usually, a baby will breastfeed for a shorter period at the second breast, and sometimes he/she may not want to feed on the second breast at all. Simply offer the second breast first at the next feeding.

Babies that guzzle their food nonstop may self-detach in 10 to 15 minutes; babies preferring to savor their meals often take 20 to 35 minutes on the first breast, because they tend to take a few several-minute breaks between "courses." Whichever type your baby is, it is important to let him/her choose when to let go of the breast, as this self-detachment will increase the amount of higher fat/higher calorie milk (hindmilk) your baby takes in.

Your baby should continue to:

  • Soak six or more wet diapers.
  • Pass three or more loose, seedy, yellow stools.
  • Gain more than one half ounce (15 g) a day, more than four to five ounces (120 to 150 g) a week, or one pound (454 g) a month (from lowest weight), regaining birth weight by 2 weeks.

Growth Spurts

Your baby probably will go through several two to four day "growth spurt" periods when he/she seems to want to eat almost around the clock. Babies commonly experience a growth spurt between 2 to 3 weeks, 4 to 6 weeks, and again at about 3 months. It is important to let a baby feed more often during these spurts. Within a few days, your baby will have returned to a more typical pattern.

Let your baby set the pace for breastfeeding. Pay attention to his/her feeding cues. The number of feedings each baby needs and the length of time each feeding lasts will vary from baby to baby and from day to day. Trying to force a breastfed baby to wait longer between feedings, or fit a particular feeding schedule, can result in poor weight gain.

The Scoop on Poop and Urine

You can tell your baby is getting enough milk by keeping track of the number of wet diapers. In the first few days, when your milk is lower in volume and high in nutrients, your baby will have only 1 or 2 wet diapers a day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day. In the first weeks, your baby may pass a small, loose, sometimes explosive unformed stool. The color of the stools range from greenish yellow to mustard yellow; and the odor is characteristic sweet odor.

A healthy, thriving exclusively breastfed baby over 5 weeks old may stool only a few times a week or even less. As long as the stools are soft, your baby is gaining weight and content that pattern is not unusual. Consult our office if you are having any concerns about the number of wet diapers and your baby's weight gain. This chart shows the minimum number of diapers for healthy, full term babies. It is fine if your baby has more.

Baby's Age Wet Diapers Dirty Diapers and Texture
Day 1 Birth 1 Thick, Tarry and Black
Day 2 2 Thick, tarry and black
Day 3 3 Greenish yellow
Day 4 4 - 6 Greenish yellow
Day 5 5 - 6 Seedy,Watery, Mustard Color
Day 6 5 - 6 Seedy,Watery, Mustard Color
Day 7 5 - 6 Seedy,Watery, Mustard Color

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.


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