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The First Days
The first days after the birth of your baby should be about getting to know your baby. Knowing what is normal and not normal during the first few days will allow you to invest 100% of your energy on your baby, instead of on questioning what is normal and what is not about your baby's feeding and behavior. As a society, one things we tend to worry a lot about is infant feeding and how much babies are getting in terms of ounces in bottle. Because of this focus on bottle feeding volumes, many of us are worry that a baby may not be getting what they need at the breast.
To help us understand what to expect the first few days, let's get started learning about...
Colostrum
Colostrum is the first milk produced by mothers and should be the first food baby receives. Because it is purposefully made in such small amounts, the colostrum-stage is quite possibly one of the most misunderstood stages of breastfeeding. Some families may worry that because colostrum is low in volume, that this means it’s ok to supplement with formula, even though the right milk in the right amount for a newborn is colostrum.
The truth is that, as explained in the Good Breastfeeding Management section, babies are born ready to consume only the drops their mothers produce in the early days of life. Colostrum is concentrated nutrition. In fact, it's a food which contains nutrition, vaccines and vitamins - and it all comes in amounts perfect for a newborn human, something impossible to get from a cow's milk or soy formula.
At birth, babies have the basically sterile intestines, meaning nothing from the "outside world" has been in them. These sterile baby bellies are very vulnerable to germs. Colostrum contains antibodies and proteins that coat the walls of the intestine with a protective barrier. This barrier keeps out germs and proteins that may cause illness or allergy to your baby. Also, incredibly colostrum contains antibodies that serve as vaccines for your baby as mentioned before. It may be hard to believe (but very true) that, in order to protect a baby further, a mother's milk contains antibodies to bacteria which a mother has been exposed over her lifetime. Amazing, right?
Frequency of Feeds
Newborn babies, especially the first few days after birth, should be offered the breast at least every 2 hours. The purpose of offering the breast so frequently is so that baby has increased opportunities to feed frequently, and for parents to be able to understand what their particular baby's feeding needs are. Parents who wait for their babies to cry before offering the breast can expect frustration from the baby as they may not be able to focus on latching and feeding well when they are crying.
How is breastfeeding measured?
In a world in which everything is measured, it is hard to trust something which cannot be seen to be enough for your baby. In infancy, we have to rely on other measures to see if the amount of breast milk a baby receives is what is needed. With breastfeeding, we can measure breastfeeding by looking for wet or dirty diapers.
Watch his diapers closely:
In the early days the diaper "surveillance" has to do with the color (see below) and the quantity of wet and dirty diapers produced by a baby, and we check the count and color closely every new 24 hours of life during the first week.
Wet diapers: Because what goes in must come out, if your baby has at least 5-6 wet diapers per 24 hours, you know they are hydrated and that your colostrum and milk are more than enough for them. Now, if you're sure your baby is not feeding much yet still producing wet diapers, you should contact your the doctor immediately, because that could be a sign of dehydration, which can progress quickly.
Tracking Diapers
Your healthcare providers will likely give you charts on which to note your baby's wet diapers, but here are general goals for baby's poops and pees during the first few days:
Wet Diapers
Dirty Diapers
Because meconium elimination (meconium is the first poop produced by your baby which consists of waste from from what your baby was fed through the placenta) is important to prevent jaundice levels from increasing , it's also important that you look for your baby to make at least 1 dirty (poopy) diaper per day that they're old during their first few days. This can be confusing, if your healthcare provider doesn't offer you one, make sure you ask for a diaper log, or make your own by writing details about the diapers down.
Dirty Diaper Goals
If these goals (below) are achieved by the third day of life (3 soiled diapers on the 3rd day of life), then the surveillance of dirty diapers relaxes unlike with wet diapers. The average baby who is nursing well will dirty about 1-5 diapers a day or more until the first 2 weeks, then they can dirty their diapers once a day or once a week. A diaper is considered dirty if the poop size is bigger than a quarter.
In other words, diapers bigger than a quarter need to happen:
Remember that breastfeeding problems should be fixed, not replaced with other feeding methods. It is rare that breastfeeding problems cannot be overcome.
Infant Weight
Most babies lose weight a few ounces (up to 10% of their birth weight) during the first few weeks. While most return to their birth weight by 14 days, some return to their original weight before, and some after 14 days. If your baby has not returned to his birth weight in two weeks its important you consult your health care provider (your doctor, midwife and a lactation specialist).
To summarize:
To know if a baby is getting what they need, they should be:
If any of those three things are off, breastfeeding needs to be assessed by a professional who can help troubleshoot breastfeeding issues...
The early days for Mom
Breast Fullness
It might come as a surprise to some that breasts transition from producing colostrum to producing transitional milk at around 3-5 days after birth. That fullness means that a mother's breasts are preparing to create the food that will replace the nutrition your baby received from the umbilical cord. Many of us think that this initial swelling is only milk, however, breast tissue swells in preparation to make milk. During this fullness, it is important that the baby is offered the breast frequently to prevent breast engorgement. When milk isn't removed during these days, the breasts can signal to the brain to stop producing the hormones needed to continue to increase supply.
Engorgement
Although many moms DO become engorged, it is not common that the mother who is able to empty the breast frequently the first few days after birth (whether by breastfeeding or pumping) will become severely engorged. If your breasts do become engorged, it may cause difficulty with latching on. If this is your case, you can use towels soaked in warm water over each areola to relax and dilate the milk ducts, then massage the areolas, letting the milk express or drip out. Some moms will also pump for just a bit to soften the breast since baby's can latch better to softer areolas and nipples which protrude more. To help reduce the engorgement, you can nurse or pump, compressing or massaging first the front part of your breasts (the area around the nipple), then middle areas of your chest until it feels softer, then massage the back part of your breasts until you feel relief. Beginning the massage and compressions in the back of your breasts can cause your breasts to become even fuller.
Nipples
Although many sources say that breastfeeding should never hurt, the truth is that it can be uncomfortable at first, especially while learning to breastfeed but with proper attachment (latch) and positioning, it doesn't have to be uncomfortable. And remember that breastfeeding is like a dance...while at first you may step on each other's toes, once you achieve a rhythm the discomfort may go away. If the pain is consistent, or does not go away, it's important that you reach out to a lactation consultant.
Remedies for sore nipples
The most important thing to help prevent sore nipples is achieving a good latch and finding positioning which works for you. Once these are acheived, here are other ways you can help heal sore nipples:
Nipples and areolas are made from the same skin as your lips are made from, which means they heal just as fast. If you don't have an open wound, you can express your own colostrum and milk and apply it to your nipples as "nipple cream". However, if you have an open wound, using colostrum or milk to try to heal them could complicate matters, leading to a thrush (fungal) infection of the nipple since milk contains sugars (which are food for thrush). If you do have an open wound on or around your nipple, it is recommended that you rinse it off with water after feeding, and air dry the breasts/nipples as much as possible (you can even use a hair dryer on a cool setting, or simply blot dry with a clean cloth . Exposing your nipples to fresh air as much as possible will help them heal faster, too. Consult with your lactation specialist regarding remedies or ointments that might help them heal even faster.
What do I need to breastfeed?
All over the world women breastfeed well with four basic things: their breasts, a willing baby, good positioning and a good latch.
Some people use other things like pillows, special bras or shirts for breastfeeding. Although useful, breastfeeding should not depend on whether or not you have these items. If your lactation consultant feels that your breastfeeding could benefit from items such as nipple shields, pumps, etc. she will let you know.
HOMEWORK:
To help us understand what to expect the first few days, let's get started learning about...
Colostrum
Colostrum is the first milk produced by mothers and should be the first food baby receives. Because it is purposefully made in such small amounts, the colostrum-stage is quite possibly one of the most misunderstood stages of breastfeeding. Some families may worry that because colostrum is low in volume, that this means it’s ok to supplement with formula, even though the right milk in the right amount for a newborn is colostrum.
The truth is that, as explained in the Good Breastfeeding Management section, babies are born ready to consume only the drops their mothers produce in the early days of life. Colostrum is concentrated nutrition. In fact, it's a food which contains nutrition, vaccines and vitamins - and it all comes in amounts perfect for a newborn human, something impossible to get from a cow's milk or soy formula.
At birth, babies have the basically sterile intestines, meaning nothing from the "outside world" has been in them. These sterile baby bellies are very vulnerable to germs. Colostrum contains antibodies and proteins that coat the walls of the intestine with a protective barrier. This barrier keeps out germs and proteins that may cause illness or allergy to your baby. Also, incredibly colostrum contains antibodies that serve as vaccines for your baby as mentioned before. It may be hard to believe (but very true) that, in order to protect a baby further, a mother's milk contains antibodies to bacteria which a mother has been exposed over her lifetime. Amazing, right?
Frequency of Feeds
Newborn babies, especially the first few days after birth, should be offered the breast at least every 2 hours. The purpose of offering the breast so frequently is so that baby has increased opportunities to feed frequently, and for parents to be able to understand what their particular baby's feeding needs are. Parents who wait for their babies to cry before offering the breast can expect frustration from the baby as they may not be able to focus on latching and feeding well when they are crying.
How is breastfeeding measured?
In a world in which everything is measured, it is hard to trust something which cannot be seen to be enough for your baby. In infancy, we have to rely on other measures to see if the amount of breast milk a baby receives is what is needed. With breastfeeding, we can measure breastfeeding by looking for wet or dirty diapers.
Watch his diapers closely:
In the early days the diaper "surveillance" has to do with the color (see below) and the quantity of wet and dirty diapers produced by a baby, and we check the count and color closely every new 24 hours of life during the first week.
Wet diapers: Because what goes in must come out, if your baby has at least 5-6 wet diapers per 24 hours, you know they are hydrated and that your colostrum and milk are more than enough for them. Now, if you're sure your baby is not feeding much yet still producing wet diapers, you should contact your the doctor immediately, because that could be a sign of dehydration, which can progress quickly.
- Dehydration signs in diapers are:
- Wet diapers which are dark (like ice-tea colored or darker)
- More than one red or pink tinged diaper in the very early days
- Continued red or pink tinged diapers after the early days
- Consistent diapers with uric acid crystals
- Scant wet diaper counts, or normal diaper counts in a baby who is losing weight and feeding infrequently
- Dehydration signs in baby's appearance are:
- A sunken fontanel (the smushy part on top of a baby's head)
- Dry skin that wrinkles easily
- Dry eyes, tongue and lips
Tracking Diapers
Your healthcare providers will likely give you charts on which to note your baby's wet diapers, but here are general goals for baby's poops and pees during the first few days:
Wet Diapers
- 1 wet diaper during the first 24 hours of life
- 2 wet diapers during the second 24 hrs of life
- 3 wet diapers during the third 24 hrs of life
- 4 wet diaper during the fourth 24 hrs of life
- 5 wet diapers during the fifth 24 hrs of life
- 6 wet diapers during the fifth 24 hrs of life
Dirty Diapers
Because meconium elimination (meconium is the first poop produced by your baby which consists of waste from from what your baby was fed through the placenta) is important to prevent jaundice levels from increasing , it's also important that you look for your baby to make at least 1 dirty (poopy) diaper per day that they're old during their first few days. This can be confusing, if your healthcare provider doesn't offer you one, make sure you ask for a diaper log, or make your own by writing details about the diapers down.
Dirty Diaper Goals
If these goals (below) are achieved by the third day of life (3 soiled diapers on the 3rd day of life), then the surveillance of dirty diapers relaxes unlike with wet diapers. The average baby who is nursing well will dirty about 1-5 diapers a day or more until the first 2 weeks, then they can dirty their diapers once a day or once a week. A diaper is considered dirty if the poop size is bigger than a quarter.
In other words, diapers bigger than a quarter need to happen:
- Once during the 1st 24 hours of life
- Twice during the 2nd 24 hrs of life
- Three times during the 3rd 24 hrs of life
-
Remember that breastfeeding problems should be fixed, not replaced with other feeding methods. It is rare that breastfeeding problems cannot be overcome.
Infant Weight
Most babies lose weight a few ounces (up to 10% of their birth weight) during the first few weeks. While most return to their birth weight by 14 days, some return to their original weight before, and some after 14 days. If your baby has not returned to his birth weight in two weeks its important you consult your health care provider (your doctor, midwife and a lactation specialist).
To summarize:
To know if a baby is getting what they need, they should be:
- Changing posture at the breast (discussed in a previous section)
- Wetting at least 5 diapers per 24 hrs
- Gaining at least 5-7 oz per week
If any of those three things are off, breastfeeding needs to be assessed by a professional who can help troubleshoot breastfeeding issues...
The early days for Mom
Breast Fullness
It might come as a surprise to some that breasts transition from producing colostrum to producing transitional milk at around 3-5 days after birth. That fullness means that a mother's breasts are preparing to create the food that will replace the nutrition your baby received from the umbilical cord. Many of us think that this initial swelling is only milk, however, breast tissue swells in preparation to make milk. During this fullness, it is important that the baby is offered the breast frequently to prevent breast engorgement. When milk isn't removed during these days, the breasts can signal to the brain to stop producing the hormones needed to continue to increase supply.
Engorgement
Although many moms DO become engorged, it is not common that the mother who is able to empty the breast frequently the first few days after birth (whether by breastfeeding or pumping) will become severely engorged. If your breasts do become engorged, it may cause difficulty with latching on. If this is your case, you can use towels soaked in warm water over each areola to relax and dilate the milk ducts, then massage the areolas, letting the milk express or drip out. Some moms will also pump for just a bit to soften the breast since baby's can latch better to softer areolas and nipples which protrude more. To help reduce the engorgement, you can nurse or pump, compressing or massaging first the front part of your breasts (the area around the nipple), then middle areas of your chest until it feels softer, then massage the back part of your breasts until you feel relief. Beginning the massage and compressions in the back of your breasts can cause your breasts to become even fuller.
Nipples
Although many sources say that breastfeeding should never hurt, the truth is that it can be uncomfortable at first, especially while learning to breastfeed but with proper attachment (latch) and positioning, it doesn't have to be uncomfortable. And remember that breastfeeding is like a dance...while at first you may step on each other's toes, once you achieve a rhythm the discomfort may go away. If the pain is consistent, or does not go away, it's important that you reach out to a lactation consultant.
Remedies for sore nipples
The most important thing to help prevent sore nipples is achieving a good latch and finding positioning which works for you. Once these are acheived, here are other ways you can help heal sore nipples:
Nipples and areolas are made from the same skin as your lips are made from, which means they heal just as fast. If you don't have an open wound, you can express your own colostrum and milk and apply it to your nipples as "nipple cream". However, if you have an open wound, using colostrum or milk to try to heal them could complicate matters, leading to a thrush (fungal) infection of the nipple since milk contains sugars (which are food for thrush). If you do have an open wound on or around your nipple, it is recommended that you rinse it off with water after feeding, and air dry the breasts/nipples as much as possible (you can even use a hair dryer on a cool setting, or simply blot dry with a clean cloth . Exposing your nipples to fresh air as much as possible will help them heal faster, too. Consult with your lactation specialist regarding remedies or ointments that might help them heal even faster.
What do I need to breastfeed?
All over the world women breastfeed well with four basic things: their breasts, a willing baby, good positioning and a good latch.
Some people use other things like pillows, special bras or shirts for breastfeeding. Although useful, breastfeeding should not depend on whether or not you have these items. If your lactation consultant feels that your breastfeeding could benefit from items such as nipple shields, pumps, etc. she will let you know.
HOMEWORK:
- Talk to your family about the importance of colostrum
- Save/print this page to know what diaper-count goals should be for your baby
Use of this class by non-parents: This class has been written for parents, and while birth and breastfeeding professionals may share it with their clients, it must be shared as a web-links or printed directly from this site. This class or any portion of it cannot be used a class outline for another breastfeeding professionals' breastfeeding class, nor can any portion of it be copied or pasted. Any dissemination of this class must be in its entire original form (weblink or printed pages) and must cite Breastfeeding Housecalls and Laura Gruber, IBCLC as its author and owner.
