Breastfeeding- The First Month

The ins and outs of feeding baby is such a huge focus during the postpartum period for many new parents, and can be a major source of stress. For those who plan to breastfeed, having an idea of what you can expect during the first month can help a lot in getting off to a good start.

First Latch

The beginning of the postpartum time is marked by the birth of your baby, and often the sweet, hard earned skin to skin time that immediately follows. Research shows that this undisturbed skin to skin time is an important time for both bonding and breastfeeding initiation. It is known that babies that are left undisturbed during this time, after being placed tummy to tummy with their mothers, their arms and legs splayed out will go through 9 instinctive stages, using all 5 senses to locate and then self attach to the breast within roughly the first hour. It is thought that the laid back positions that allow babies to rest on their bellies on their mothers activates inborn feeding instincts and helps them to better organize their reflexes.

In the research these babies did have a little better long term breastfeeding outcomes than those who were assisted by outside support (i.e. nursing staff). IBCLC Nancy Mohrbacher states that this approach is about “Promoting continuity from womb to world by keeping mothers and babies together and comfortable, it features close body contact where mother-baby interactions work in harmony with gravity.  These important factors are all related and interact to release an amazing cocktail of instinctive behaviors that help mothers and babies get started with breastfeeding.”

That said, there is no right or wrong way to initiate breastfeeding and you know yourself and your baby best. There is nothing wrong with trying a more active breastfeeding hold, or with asking for some hands on assistance, especially if you are in a hospital bed with a blood pressure cuff and an IV that may restrict your dexterity.

If baby hasn’t yet latched around the hour mark, that may be a good time to provide some assistance as you want to capitalize on baby's alert time post birth, which usually lasts about 2 hours. This video is a great resource to learn the basics of getting a comfortable, effective latch.

Colostrum

Also known as liquid gold, this magical mama made elixir is what your body produces for the first couple of days before your mature milk comes in— baby’s first super food. Actually, your body begins producing this thicker, yellowish milk from about 16-22 weeks of pregnancy, though you may not know it as it may not leak or be easy to express. This sticky, viscous substance is chock full of nutrients and disease fighting properties, containing 70% leucocytes (white blood cells that fight infection) compared to < 10% in mature milk. It contains the perfect balance of protein, vitamins, minerals, prebiotics and probiotics. Colostrum also has a laxative effect, stimulating bowel function and helping the newborn to begin passing tarry meconium (first bowel movements), and stave off jaundice. In addition, it is an important influence on gut health and bacterial composition, essentially laying the ground work for the emerging immune system. Colostrum helps establish beneficial bacteria in the digestive tract, and research shows that beneficial bacteria in our microbiome may help us fight infection anywhere in the body! What a magical potion in which to coat your baby’s digestive system!

Feeding Frequency

Breastfeeding goes best when babies are fed on cue, or at least every 2-3 hours. This means watching for signs of hunger, such as stirring, rooting, bringing their hands to their face— bringing baby to the breast whenever these signs are present, and even in the absence of feeding cues if baby has been sleeping longer than 3 hours in the early days.

Feeding frequently encourages good milk supply, and helps reduce engorgement. After breastfeeding is off to a good start and baby is gaining weight well, you may be able to let baby sleep a bit longer during the night. This amounts to shooting for around 10-12 feedings per 24 hours. It will feel like you are feeding the baby all the time, and you are. This is normal, and over time as baby grows and gets more efficient at transferring milk the feedings may get shorter and space out a bit.

Engorgement

When the mature milk comes in, anywhere from day 2-5, sometimes it can result in the breasts feeling painfully full, heavy, and sometimes warm. This is normal, and temporary— usually only lasting about 24-48 hours until your body regulates your production— but can be very uncomfortable. Some find that cool cabbage leaves or other cool compresses placed in the bra are soothing. Breast massage and hand expression can help a lot, as well as using compression during feeds. If baby is having trouble latching due to engorgement, you may find that reverse pressure softening helps to move some of the edema away from the nipple so that baby can latch on. If you decide to use a pump to relieve pressure, do so only for a minute or two for comfort, as you don’t want to send your body the message that more milk is needed at this time.

Latch Troubleshooting

Sometimes even when you think breastfeeding is going well, and yes, even if a lactation consultant told you everything “looks good”, you may start to notice some red flags that something is up with your latch after getting into your first weeks together. These flags can include pain with the latch, visible damage to your nipples, poor weight gain or your baby losing suction/ making clicking noises while nursing. There are lots of positions and ways to approach breastfeeding, but the only two requirements for a good latch is 1) your comfort, and 2) good milk transfer. If you are having pain, particularly after two weeks, showing any visible signs of nipple trauma, or baby isn’t gaining well, then most likely there is something going on with your latch. Don’t be a hero here and try to suffer through it as you work on it on your own! If there is a latch issue, the sooner you get some qualified help from a lactation professional the better! You aren’t doing baby any favors if you continue on with a latch that is painful, as it most likely isn’t very effective at transferring milk either, and sometimes the cure is as simple as a few subtle changes in positioning that someone can help walk you through.

Nursing in Public

As of 2018, it is now legal to breastfeed in public in all 50 states. The US is now officially up to speed with the UK, Australia and other countries all over the world that protect nursing mothers.

 

You don’t need to find a nursing room, or use a cover. That said, I know different people have different comfort levels when it comes to breastfeeding in public. If you prefer to minimize exposure, but don’t like traditional covers or want to breastfeed in a separate space, you could always try your hand at the tried and true double shirt technique, or breastfeeding with baby in a carrier.

Whatever you do, don’t let anyone make you feel wrong or weird about needing to feed your baby when your baby is hungry! If they have a problem with that, they are the one with the problem.

Pumping and Bottle Feeding

If all is going well with breastfeeding, it is best to hold off on pumping and bottle feeding until around 4-6 weeks if your schedule and lifestyle allows. Some parents need to be separated from baby before then, but if not, holding off on pumping not only allows you to focus on getting into a groove and enjoying your breastfeeding relationship, but also minimizes the possibility of unintentionally boosting your milk supply too high (which can lead to other problems such as mastitis) or baby developing a bottle preference. When getting started with pumping, make sure you understand how to use the settings on your pump, and don’t be discouraged if you don’t pump a huge amount as it is normal to get about 1.5 to 2 ounces per session (both sides) if you are also feeding baby. Still, that bonus milk adds up, and pump output may increase over time as your body recognizes the increased demand. When you do introduce a bottle to baby, using paced bottle feeding techniques can help to ensure your breastfeeding relationship will not be affected. Try not to stress if baby doesn’t take to the bottle immediately, as sometimes it takes a little repetition or trying a few different bottles/nipples until you find one baby likes. You may also find that baby will take the bottle more readily from someone other than the breastfeeding parent, and it’s good to practice this regularly if you anticipate needing baby to feed frequently from a bottle when you return to work/school.

What’s Next?

If you have made it one month into your breastfeeding journey CONGRATS!! Often the beginning is the hardest part. Now that your your supply is beginning to calm down, your breasts probably won’t leak as much, or at all. This doesn’t mean you are losing your supply, just that it is now regulated and your breasts are getting more efficient. Hopefully any latch issues you may have had will now be resolved, and soon you’ll be seeing baby’s first smiles in appreciation of the wonderful gift you are providing them!

Guest post by Angie Traska, CLC, Director of Childbirth Education at Haumea and Birth Doula/ Lactation Counselor supporting clients in Madison, WI at Align Doula Services.

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