Breast feeding is, obviously, very natural and the way mom’s and baby’s bodies were made; however, this does not mean that it is always easy, especially the first time you do it! It is very natural, but you should not feel bad or inadequate if there are challenges or difficulties, particularly in the first few days. Many babies and moms take several days to weeks to establish a comfortable breast feeding routine. With support, persistence and sometimes assistance, almost all mothers and babies are able to establish successful breast feeding.
There are two main hurdles to overcome, or two main determinants of successful breastfeeding: proper latching on, and adequate milk supply. These are the two main and most essential ingredients; everything else you need (proper schedule, dealing with minor problems, etc.) you can overcome through knowledge.
Positioning
Proper positioning of the baby for breastfeeding is important both for your own comfort and for proper latch-on. The baby should be positioned so that her head is facing the breast directly. There are several positions you can use to hold the baby.
The cradle hold: The most common position is with your baby’s head on your forearm near the elbow and her bottom near your hand. The baby will be lying across your body with her mouth facing your breast. Using this position, it is sometimes difficult to control your baby’s head, especially when you are first breastfeeding. It may be more useful once you are more used to breastfeeding. In this position, you also have to use your free hand to position the opposite breast and nipple.
The cross-over hold: This is very similar to the cradle hold, but gives you more control of your baby’s head. Here you also hold the baby across your body, but with her head in your hand and her bottom near your elbow. This allows you to position the baby’s head exactly, using your other hand to position your breast and nipple nearest to your free hand. This is generally a more comfortable position.
The clutch or football hold: Position the baby at your side, at a slight angle towards your body, using your hand to hold his head and your arm to support his body. This position is sometimes more comfortable for mothers who have had a c-section because the baby is not lying across your body.
Lying down: You can also lie down with your baby lying next to you, facing you and lying in the same direction. Position your breast into her mouth. You can use either breast in this position.
In any of the seated positions, a pillow can be used to support your arm and the baby’s weight. This is usually very helpful, especially since the baby may nurse up to 45 minutes per side!
Latching on
Proper latch-on is the key to successful breastfeeding. The main thing you want to do is to get your entire nipple and part of the areola (the darker skin around your nipple) into the baby’s mouth. A proper latch-on should not usually be painful.
Rub or tickle the baby’s lips with your finger or nipple. This will cause the baby’s mouth to open wide (a reflex called the rooting reflex). When the baby’s mouth is open wide, pull the baby straight forward and place your entire nipple and part of your areola into the baby’s mouth. Her lips should be around the areola, not the nipple. You may find it helpful to hold your breast with your free hand as the baby is latching on. Hold the breast away from the areola, with the thumb on top and several fingers below on the breast. Your hand basically forms a C around your breast, which helps the nipple and areola to protrude if you squeeze your breast gently. It also helps to lift your breast which will be heavier due to milk production.
When the baby first latches on and starts feeding, there will be a strong tugging sensation which may cause some discomfort or mild pain. If it causes a pinching sensation or is very painful, then the baby is probably not latched on properly. Use your fingers to break the baby’s suction and reposition the baby. It can take several attempts each time you nurse to get the baby latched on correctly. You should always use your fingers to break the baby’s suction when removing the baby from your breast. After you nurse, let your nipples air-dry. This will help prevent soreness and cracking. You may also rub some breast milk on your nipple and areola just after nursing and allow this to air-dry. This is the most care most women need to keep their nipples healthy while nursing.
First feedings
Your baby can nurse anywhere between 5 and 45 minutes per side, especially during the first week. She may at times nurse only on one side per feeding. Some feedings during the first few days she may not nurse at all; you should attempt to nurse her every 2-3 hours and in between if she seems hungry during the first week or two. During the first week or two, most babies will breastfeed between 8 and 12 times a day (per 24 hours), or every 2 to 3 hours. Until your milk is in and the baby has established a good pattern of breastfeeding, you should wake your baby to feed at least every 3 hours if she has not woken up on her own.
Babies can be sleepy or lazy during the first week or two and may need some stimulation to continue nursing. Undressing them, rubbing their backs with something cool like a wipe, and changing their diapers between sides can help. This problem usually goes away by the time the baby is two weeks old.
At first you will probably feel your uterus contract or cramp when the baby nurses. This is actually a sign that the baby is nursing well and properly stimulating your breasts. The uterus contracts because nursing causes a hormone, oxytocin, to be released. It helps your uterus stop bleeding and return to a normal size. These uterine contractions usually stop after about a week of nursing.
At first, your breasts will produce a thick liquid called colostrum. This liquid is rich in sugars and antibodies and is the perfect food for a newborn infant. It provides necessary sugar and fluid, and both protect the baby from infection and stimulate her immune system. Your baby is born with extra fluid in her body, and she will lose a little weight (up to 10% of her birthweight) during the first week of life. This is both natural and normal, and breastfeeding colostrum is all the fluid most babies need. She will take only a few teaspoons of colostrum per breast per feeding; the rest of the time she is sucking she is comforting herself and stimulating you to make milk.
You should try to nurse as soon after delivery as possible and definitely within the first two hours of life unless this is impossible for a medical reason. You should also have the baby room-in with you, and have the nursing staff avoid giving a bottle of formula unless your doctor orders it for a medical reason. Almost all babies will get enough fluid and sugar from colostrum by nursing 5 minutes per side at least every 3 hours. Many breastfeeding experts also feel that pacifiers should be avoided, but honestly I have not seen many babies have a problem nursing due to pacifier use; I have seen many lazy nursers due to bottle feeding during the first 2 weeks of life. You should probably avoid pacifiers if possible (they can have other negative side effects), but it is acceptable to one if necessary.
Your milk will come in usually about the third or fourth day (or a day sooner if you have breastfed before). Most women produce a lot of milk at first, and then the breasts adjust to the amount of milk the baby is taking. Throughout all of breastfeeding, the breasts will adjust both the amount and composition of the milk to match the baby’s needs.
Ensuring adequate milk supply
The main thing you can do to ensure that you have enough milk is to have the baby latching on properly and nursing every 2-3 hours on average. If you feel your uterus contracting when you nurse, that is a good sign that the hormonal system responsible for milk production is being stimulated; however, not all women feel this and it is not necessary. Once you start making milk, feeling a let-down response, where your breast starts ejecting milk shortly after the baby begins sucking, is another good sign. Other signs of good latch on are a lack of nipple pain while nursing, hearing the baby suck and swallow, having part of your areola in the baby’s mouth, and the baby’s chin and nose resting against your breast while you nurse.
There are several other things you can do to ensure an adequate milk supply. One is to drink plenty of fluid; aim for about a full glass of water for each feeding. It may be helpful to start drinking it about 30 minutes before each feeding. Also, you need to be sure you are getting adequate rest and eating a healthy diet. It takes about 500 extra calories a day to breastfeed, and only 300 to be pregnant, so you need to be sure you are eating well. Your body will use stored fat to produce milk, so most nursing mothers eat a lot and lose weight, which is a great thing.
How to tell if baby is getting enough
Moms often worry that their baby is getting enough to eat, which is understandable since you cannot really tell how much your baby is taking from your breasts. Healthy babies are born with extra water and sugar stored in their bodies, and they do not need much to eat during the first 24 hours of life. Your baby will take only 1-5 teaspoons of colostrum per breast per feeding, which is not much fluid! She can get all of this in about 5 minutes of feeding, and needs to eat every 2-3 hours or so, but may go a little longer at times during the first few days. Your baby should urinate at least once and have at least one bowel movement before you leave the hospital.
The following table may be helpful; of course, when you are nursing you will not be sure how much your baby is getting.
Expected intake and output
| Day | Milk intake per day | Output per day |
| 1 | 5 ml (1 tsp.) to 90 ml (3 oz) of colostrum | 1 meconium (black tarry) stool
1 wet diaper |
| 2 | 10 ml (2 tsp.) to 120 ml (4 oz) of colostrum | 2 wet diapers
Stool, if any, still black |
| 3 | 90 ml (3 oz) to 180 ml (6 oz) colostrum + early milk | 3 wet diapers
1 stool black-green |
| 4 | 240 ml (8 oz) to 360 ml (12 oz) milk | 4 wet diapers
Several green-yellow stools |
| 5 | 360 ml (12 oz) to 600+ ml (20+ oz) milk | 6+ wet diapers
3-4 yellow stools |
Congratulations
Congratulations! Those are the basics of breastfeeding – how to get the baby to latch on, how to hold the baby, when to feed her, and what to expect over the first few days. There are other things for you to learn and problems you may encounter, but the biggest hurdle by far is getting started, and you should feel great about accomplishing the first few feedings.
