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June 28, 2018
Women in the U.S. need all the help we can get when it comes to breastfeeding success. We live in a nation whose relationship with lactation is highly paradoxical —the societal pressures are high to exclusively breastfeed but real, practical information on how to make it go right and how to tell if things aren’t going right is spotty, to say the least. When I meet new moms in the hospital, I’m always trying to educate fledgling nursers on the most important rule of all: babies need to eat.
You’re probably thinking that sounds pretty basic. Obviously, babies require nutrition. But, exactly how much they need to eat and when they need it often gets significantly more convoluted. Thankfully, we can set ourselves up for breastfeeding success by understanding a few basic principles around newborn nursing needs (for more free resources for new moms, click here). Let me break it down for you:
In the first few days to weeks, babies need to have a feeding attempt at least every three hours. We call it “three hours start to start” in my office – that is, it should be no longer than three hours from the start of one feeding to the start of another. Babies will often want to feed way more often than that, which is great and perfectly okay, but at the very least they need that every three-hour cueing. That means, set a timer when you start feeding your infant in the first few days. Three hours later, you need to start feeding again, even if your last feeding session only ended two hours ago.
Breastfeeding is a two-way feedback loop. The first feedback loop is for the mom; the more a baby’s suckling stimulates the breast, the more milk the mom’s body makes.
The second feedback loop is for the baby: the more the baby eats, the more food it takes in, the more alert and hydrated the baby, driving hunger and allowing the baby to eventually regulate its own feeding needs.
People are constantly talking about letting newborns breastfeed “on demand” – that they should drive their own hunger and can do so. That breastfeeding should be natural.
That’s totally true…eventually. But, in the beginning, a baby needs help to get her system going. Breastfeeding IS natural, but it’s not usually easy in the beginning for a new baby or a new mom – both have to learn new skills and how to “rev up the system.”
There’s also a ton of talk in the new mommy world about how a baby’s stomach is really small at first and they don’t need much milk. About how they really only need tiny bits of colostrum in the first few days.
That is absolutely true. Babies are often sleepy in the first 24 hours after they are born, mom’s milk hasn’t come in yet, the system is set up so that there’s a little grace period.
But here’s the catch – that is the time to prime the pump(s) by nursing frequently so that the milk actually does come in and so that baby is alert enough at day three to four so they can take the milk mom starts making.
In some cases, if that doesn’t happen, blood sugar levels can drop, making babies lethargic and harder to feed. Babies can get dehydrated, contributing to jaundice (the yellow color that can develop in a baby’s skin).
Breastfeeding success isn’t quite that simple (believe me, I wish it was—it would have saved me a lot of time and money in lactation services with my first baby). Consider these factors as well.
Keep your baby active at the breast. You may need to stimulate your baby (tickling baby’s feet, using a cool washcloth at the forehead, getting baby undressed down to the diaper, rotating her arm gently) to get your baby to feed effectively (otherwise, they may burn energy on sucking without getting much back in return).
Of all the advice I offer, this is the most important. Get help from the get-go with latch. Ask your nurse at the hospital to position correctly the first day. Ask for a lactation consultation right away (not day two or three) if you have any concerns at all (this is pretty much every new mom I meet, so don’t feel like you have to have major worries in this area to justify getting extra assistance. Sometimes, you don’t realize the questions or issues you have until an expert helps you out).
Like I’ve said before, if you lived in a home with all of your breastfeeding friends and experienced breastfeeder family members, you wouldn’t need all this outside help but, the reality is, you probably don’t. Lots of moms worried about they are a bother if they ask for help but that is not true at all!
When a baby is born, we expect that they will lose up to 10% of her initial weight at birth. This occurs because, in the beginning, they don’t get much milk because their moms’ bodies haven’t gotten the message that there is a baby yet and the baby has minimal needs in the first few days. When the milk comes in (at about 72 hours), the weight starts to come back up again. If your baby loses more than 10% of her birthweight, you need assistance.
By about day 3-4 of life, we expect milk to come in for most moms. You’ll know your milk is in because the poop will be changing, you’ll start to see your baby really swallowing when he is eating, and you may see milk at the corner of his mouth. If that isn’t happening, again, it means you need help.
All babies have a very floppy connection between their feeding tube or esophagus and their stomachs. This is called the pylorus. While for some babies, this connection valve can be too tight, causing something caused pyloric stenosis (a very serious condition that needs to be treated right away—projectile vomiting is the hallmark sign of this issue), for most babies, the valve is loose for awhile before the muscles firm up and it causes them to spit up.
This is normal and, (as long as the spit-up looks like digested milk, not bright yellow/green or bloody) although it creates a huge laundry problem, it’s not a problem for the baby. Sometimes, though, if your milk is coming out super fast (called overactive letdown) or if your baby is spitting up all day very day, it can make it uncomfortable for your baby to eat. A lactation specialist can help you assess this and give you tips for positioning and for decreasing the flow to your baby, if necessary.
Breastfeeding success, even if you follow every single piece of good advice you hear, is hard work. Sometimes, despite doing everything “right,” it’s still a huge struggle for new moms, contributing to a sinking feeling that they’re “lesser than” other first-time mamas out there and setting the stage, for some, for postpartum depression and anxiety. The truth is, breastfeeding is only a small part of motherhood—a part that is easier to approach and problem-solve when you have credible resources and knowledgeable support at your fingertips.
We want to help you build your confidence and set realistic expectations for breastfeeding and beyond when it comes to your new infant and your new mommy role.
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