What to Expect in the Early Days of Breastfeeding

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To learn more about getting breastfeeding off to a good start and know what to expect in the first two hours postpartum please see my earlier post in this What to Expect series.  You can also learn more about what to expect that first night home from the hospital (regardless of the timing of that due to a normal vaginal birth, surgical birth, or bringing a preemie home) here.  To learn more about days 2-7 postpartum please see this post.

Now that you’re home from the hospital, your milk has transitioned and is changing to more mature milk, and you’re starting to get to know your baby more you may start to feel a little bit of a groove and your baby may be starting to get more of a routine (or not!).  Your husband or partner may be back to work or may have a little more time off.  You no longer have the call button that you had at the hospital and now is the time to call in those favors that everyone left (“If you need anything let me know.”).  Postpartum is the best time to learn to ask for those favors because taking care of you and your baby are the top priorities, even over dinner. I recommend during pregnancy creating a list of duties, chores, errands, and meal preparation so that when someone is visiting you can encourage them to do a task before getting to see baby.  In many other cultures outside of the United States women have some type of a “laying in” period that other women come and take care of the household chores so mother can feed baby frequently and work on recovering.  A wise midwife, who “caught” my third baby (Lisa Lehrer in Corvallis, Oregon), encouraged me to stay down as much as I was able in the first 2-4 weeks postpartum and promised me that if I did I would feel much better at 6 months postpartum than if I had been running errands, doing chores, etc.  She was absolutely correct.  I felt MUCH better with her at six months postpartum than I did with my first two children.

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Check out my FREE printable helping list!

At this point your baby may begin sleeping up to a 4 hour stretch during the day or night (maybe, it’s totally normal not to have a stretch for a while though).  If baby is gaining well and having enough diapers letting baby sleep is usually ok.  You may need to wake up a sleepy baby though if your baby is not up to birth weight by 10 days or has lost more than 10% of their birth weight, is jaundiced, or was premature or has special circumstances.  If you need to wake baby up, and baby is difficult to arouse, here are some ideas to help:

Ideas to help wake baby up

One other note that is important in the first two weeks.  Babies lose weight after birth.  It should be 7% of their birth weight or less.  It can be up to a 10% weight loss.  More than this and it’s very important to get immediate help from an IBCLC and your doctor to figure out if there is an issue with breastfeeding (even if you aren’t having any pain).  If you received IV fluids during labor baby may lose more weight than if no IV fluids were given.  Baby should be back up to birth weight by 10 days, 2 weeks at the latest.  If baby is not back up to birth weight by 2 weeks it’s important to see an IBCLC right away to assess for any breastfeeding issues.

Who was the biggest help to you postpartum?

If you live in the Oklahoma City, Mustang, or Yukon area and need breastfeeding help or would like to attend breastfeeding classes please see my website for more information.  You may also contact me here.

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What to Expect When Your Baby is 2-7 Days Old

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Whether you are breastfeeding or not your breasts will begin to transition from colostrum to mature milk at about 2-5 days postpartum.  This post is geared toward breastfeeding mothers.  If you choose to feed artificial breast milk (formula) it’s a good idea to manage the swelling in your breasts with expressing your milk to comfort for the first few days and slowly expressing less milk each day after the first couple of days to prevent mastitis (a painful breast infection which can cause you to be very sick).

To learn more about getting breastfeeding off to a good start and know what to expect in the first two hours postpartum please see my earlier post in this What to Expect series.  You can also learn more about what to expect that first night home from the hospital (regardless of the timing of that due to a normal vaginal birth, surgical birth, or bringing a preemie home) here.

In the first 24 hours after birth, your baby is receiving colostrum which is a thick breast milk that is extremely high in antibodies and vitamins because baby has such a small tummy.  The average a baby receives is about 0.35-3.68 oz in the first 24 hours (based on a 7 lb 8 oz baby) (Source: Counseling the Nursing Mother, Fifth Edition).  Your body begins producing this liquid gold breast milk during pregnancy and it protects baby against bacteria and helps jump start baby’s immune system and GI system to living in the world outside of the womb.

Beb mamando

Sometime in the first 2-5 days your body will begin producing more milk as it begins transitioning to mature milk.  I don’t like to use the phrase “milk coming in” because colostrum is also breast milk.  It’s all important and vital to baby’s survival and optimal growth and development.

You may notice some engorgement in your breasts at this time.  Not all mothers experience this and those who do notice varying degrees of this engorgement and time that it lasts.  It typically resolves in about 2 days but it may take about 7 days after milk transitions for it to resolve but it will get better each day.  Not all of this fluid in your breasts is breast milk.  Much of it is lymphatic fluid and blood from which milk is synthesized.  Like if you have an injury, ice packs can be very helpful after a feeding to help take this engorgement down.  The very best way to resolve this is by putting your baby to your breast frequently-a minimum of 8-12 times per day, many babies like to nurse more frequently.

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Your baby’s stomach has increased to the size of a ping pong ball (like in the picture above).  Baby will take an average of 14-19 oz per day of breast milk.  Your milk will slowly transition over the first two weeks postpartum but the components quickly resemble those in mature milk.

Things to Watch For:

  • Baby should be on the breast 8-12 times per 24 hours (or more frequently).  Feedings may last 7 minutes up to an hour or possibly longer.  Expect to spend lots of time feeding your baby and recovering from birth.  Your baby will get more efficient at nursing over time.
  • You should notice your milk increasing in volume and transitioning between day 2-5.  If by day 5 you do not notice your milk increasing in volume or baby has lost more than 10% of birth weight (7% is the number where we really start watching babies closely but if you received IV fluids during labor your baby may lose more) contact your doctor and your baby’s doctor right away and seek help right away from an IBCLC. 
  • Follow the care instructions from the hospital regarding cord care, body temperature for you and baby, and other discharge directions.
  • If you have any breastfeeding questions contact a breastfeeding professional right away.
  • Baby’s stools should become more green in this timeframe as your milk transitions.  Baby should have at least 1 wet diaper in the first 24 hours, 2 the second day, 3 the third day, and so on until baby is having at least 6-8 wet diapers and 3 yellow seedy poopy diapers by the end of the first week. Baby’s stool should be the consistency and color of French’s mustard with sesame seeds in it (the seeds are the curding milk from digestion).
  • Skin-to-skin contact helps babies to breastfeed better.  Many issues can be resolved by making the breast a happy place to be even if baby isn’t latching.  Getting help from a breastfeeding professional is also very important in this process.  If you don’t feel the care plan that you and your professional work out together is working you can always seek extra help or seek a second opinion.  Like doctors, breastfeeding professionals all have different areas of expertise and unfortunately not all are on the same page with evidence-based information because we are continually learning more and more about breastfeeding.

 

What did you find most helpful in the first 7 days postpartum?

If you have breastfeeding questions in the Oklahoma City, Mustang, or Yukon areas I am happy to help.  I offer breastfeeding classes and consultations.  You can find out more on my website or contact me here.

Wearing a Newborn

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Newborn babies are so tiny and precious.  There are a few things we need to watch out for when wearing them.  It’s important to keep in mind that they start out so tiny but grow SO rapidly (doubling their lowest weight by 6 months and tripling by a year).  A carrier that would fit a newborn well will not fit a 6 month old unless it’s a less structured carrier that you have to form to fit the baby.  It’s of special importance to be sure that the carrier supports baby’s legs and hips well, spine, and neck to set baby up for the most optimal circumstances.  While carriers can’t be directly attributed to causing hip dysplasia we do know that baby’s hips are cartilage until they are toddlers and that the femur cartilage is harder and will win in a battle.  Any wear and tear can cause issues down the road-whether this is immediate or when your child is very old or somewhere in between.  I promote best practices so all of my posts reflect this.  Best practices include supporting the spread squat positioning mentioned on the Babywearing Institute’s page here.  And in Dr. Evelin Kirkilionis book A Baby Wants to Be Carried: Everything You Need to Know about Baby Carriers and the Advantages of Babywearing (available on Amazon and through other book suppliers and book stores-link is an affiliate link to Amazon and funds received through the affiliate link helps purchase homeschooling books for my children’s education).

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I have traced my newborn daughter’s legs and bottom in this picture.  This wrap is supporting the spread squat position.  You can see how her body makes a capital M shape.  In this position her femur is sitting in the ball and socket of the hip per the research done by hip dysplasia doctors in Germany.  She does not have hip dysplasia but if she did this would be the position they would keep her in because they have determined that this is the best possible position for baby’s hips to be in to heal if baby does have an issue.  I’m exhausted in the picture and it’s not my favorite of me by a long shot but my daughter is only 2 days old in this and she was enjoying an wonderful nap on me.  She is close enough to kiss and the back of her neck is supported by the carrier being tight and smooth on her neck.  The carrier is smooth across her back and if this shot was taken sideways you could see the c-shape curve that a newborn’s spine is in.  (She should be straight up right but had a tendency to lean-I could have further supported her head and body by pulling one of the sides around the back of her head to support her more).

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This is a stock image.  The mother and baby are beautiful but this wrap is MUCH too loose.  It’s natural to snuggle and cuddle your newborn however I think this mom doesn’t feel very secure and in all images that I saw of this mother and baby she’s pulling her baby closer.  This can easily be adjusted by tightening the carrier by pulling very snuggly when wrapping the carrier (I will demonstrate this in a video in a later post).  The shoulders and arms are also very loose and the wrap is likely to slip down mom’s arms.  This is why in person help with a carrier is very important because once you FEEL and SEE how it’s supposed to be on your body you will always get it right and you are able to apply the feeling to any carry that you do.

This same looseness can occur with other carriers such as a ring sling, mei tai (I don’t recommend most mei tais for newborns though because they have to be adjusted quite a bit and don’t support the spine as well because of this unless they’re specifically made to size down to a newborn), or a soft structure carrier at any age or stage.  This looseness is not recommended no matter how old your baby is.

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My daughter is a week old in this photo. She is in a ring sling.  This picture shows the c-shape curve better (I have traced it to point it out better).  Her chin is off of her chest so she can breathe but the carrier is flexible so that her spine is allowed to do what it needs to do.

Now that we know more about what position baby should be in let’s talk about newborn carriers specifically.  These are my favorite carriers for newborns (with links back to my previous posts about these classes of carriers):

  • Ring Slings (not pouches)
  • Wraps-especially the front wrap cross carry
  • Gauze or hybrid wraps
  • Possibly stretchy wraps if they are wrapped very tightly (I don’t recommend them after 12-15 lbs though because baby’s legs will start to pull down out of the spread squat position and baby will become too heavy to stay in the right position on your body-they should NEVER be worn in a back carry)
  • Mei Tais that are specifically designed to adjust down both vertically and horizontally so that it fits snuggly around a newborn (no fabric going below the knee and fabric emulating the tightness from my first picture above).
  • Some infant soft structure carriers.  There should be absolutely no gapping between the back of your baby’s neck and the carrier.  If there is baby needs to grow larger to fit in the carrier well.  Many manufacturers of soft structure carriers say that baby can fit in the carrier from birth however there’s often not enough support until baby is a couple of months old.

If you are in the Oklahoma City area and would like some hands on help to prepare for wearing your newborn during pregnancy or after your baby has arrived please feel free to contact me or check out my website.

What is/was your favorite carrier for a newborn?

What to Expect The First Two Hours Postpartum

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You prepare for labor, you prepare for delivery.  What happens when your baby arrives though?  You’ve likely created a birth plan that says that you don’t want to be separated from baby in the first hour or two and you want to have delayed cord clamping , a quiet room, etc. (or perhaps you aren’t that far in your preparations and planning yet) but why?  Why are these things important?

Your Amazing Baby’s Reflexes

Your baby is born with an amazing set of reflexes, automatic responses to stimuli.  We once were unsure of what the purpose was of many of these reflexes but in more recent years these reflexes have been studied more and many of them help a baby begin breastfeeding.  Dr. Suzanne Colson has spent a lot of time researching videotaped newborns and babies in the early postpartum months and has recognized many of these assisting baby to breastfeed. Your baby is born READY to breastfeed.  Sometimes, though, things interfere with these reflexes or they can be triggered to make baby not respond the way they are supposed to.  Preparing for these reflexes and recognizing them can help the first two hours postpartum (and beyond) to go more smoothly.

This video is a little bit long (around 9 minutes) but shows these reflexes in action in something called the “Breast Crawl.”  Note that this video is “not safe for work” because it shows mothers and babies totally uninterrupted postpartum (meaning no shirts in the way and very little assistance from everyone else in the room).

What’s especially amazing to me in this video is that there is a woman, with what would normally be classified as having flat and possibly inverted nipples, who is able to breastfeed her baby with no problem because these reflexes were allowed to be triggered and baby was able to find its own way to mother’s breast.  Some believe that the Montgomery glands on mother’s areola (they are more predominant in pregnancy and are raised, almost pimple like) produce a lubricative oil that smells similar to amniotic fluid which helps baby to find the breast.  This oil also helps protect your nipples from bacteria and helps lubricate from the friction that occurs from baby sucking.

Baby’s stepping reflex helps baby to find his or her way to the breast.  When your breast (or something else) touches your newborn’s cheek they will turn toward that stimulus to try and find a nipple (rooting).  Baby will keep trying until he or she can find their way.  They will open their eyes occasionally and try to find the darkened target (your areola) to latch on to.  The sucking reflex is triggered once baby is able to latch which triggers your body to release milk (your milk ejection reflex which is controlled by hormones that are released as a response to your body feeling your baby beginning to suck).  All of these reflexes are helped by having baby’s front whole side to feel supported (a laid-back position helps promote this).  Sucking helps soothe your baby and your milk calms your baby.

What about Interference and Emergencies?

Of course the breast crawl and allowing baby to self latch is potentially the best means for baby to latch on after birth but it doesn’t always happen that way.  Protocols and interference do happen often (this can be minimized by having a doula attend your birth acting as an advocate and helping you and your husband or partner be able to hear all of the pros and cons of a treatment or not allowing a treatment to occur).  Emergencies also happen sometimes as well.  Reflexes can still be triggered and baby can still be allowed to have as natural as possible of a time latching (even after a c-section).  Interference should be minimized to set baby up for the best possible circumstances but know that even without the picturesque birth you can still go on to successfully breastfeed.

So what happens the first minutes to two hours postpartum?

new baby just coming into the world

Your baby is born.  The majority of the hard work of labor is done (or in the case of multiples you will still have another baby or more to deliver).  When baby is delivered he or she can be placed on your stomach to allow the breast crawl to happen.  Baby could be placed on your chest instead.  You may be eager to get baby to latch on sooner to help expel the placenta, patience is important though under normal circumstances.  Baby will still be attached to the placenta via the umbilical cord once he or she is born.  Some practitioners regularly clamp and cut this cord right away but babies are also only born with about 2/3 of their intended blood supply.  Allowing the cord to fully finish pulsating pushes the remaining blood into baby.  Emergencies can occur in which the cord does need to be clamped and cut earlier, however, even with some breathing struggles practitioners can attend to baby while still attached because the oxygen rich blood is still being pumped in to baby.

While the cord is pulsating baby can still be placed on your stomach, the cord is usually long enough, though in some circumstances it may not be.  Baby doesn’t need to be roughly cleaned up but may be patted dry with a soft towel or blanket.  If baby’s hands are left alone this may help baby trying to latch the first time (because of the Montgomery glands that were discussed earlier).  When your baby is placed skin-to-skin with you, your stress levels go down as well as your newborn’s.  Your body will help regulate your baby’s temperature but you may want to place a blanket over the two of you (keeping the room warm is probably a better idea though to allow baby to self attach easier).  A hat and other things are not necessary at this point.

Your uterus will continue contracting after a pause to work on expelling your placenta.  Some placentas come quickly but allowing the placenta to come on its own prevents ripping from pulling which can leave pieces behind that can inhibit your body from transitioning to mature milk.  (Note: If an emergency occurs though keep in mind that pieces aren’t always left behind but if you are struggling with your supply after the first few days this is a possible cause that you and your provider may want to look further in to).  Eventually your baby’s cord will be clamped and your placenta will release.  If your baby is able to latch before the placenta is delivered the first latch will encourage oxytocin to help the uterus push it out.  You will feel a tightening sensation in your uterus for the first few days when your baby is breastfeeding because oxytocin releases smooth muscles of your uterus as well as the smooth muscles in your areola that hold back the milk.  This is what helps your uterus contract down to its pre-pregnancy size.

Childbirth

Baby may self attach as in the breast crawl video or you may assist baby.  Hopefully your care providers are allowing a peaceful and non-rushed atmosphere to allow you to have your time to bond with your baby.  A doula can help facilitate this atmosphere.  As with other mammalian mothers we have a strong need for quiet and privacy postpartum to allow our hormones to work as they were designed.  Skin-to-skin contact without anything in the way helps to promote these hormones to work as well.  If baby is separated from you this can cause stress for you and baby (which can potentially cause unstable vital signs in both of you) and also inhibit your baby’s reflexes and behaviors looking for the breast.  Some of these can be compensated for (especially in emergency situations) but some difficulties can come up with unnecessary separation.

Colorful Marbles

Once baby has been allowed to latch on, let baby determine when he or she is done breastfeeding.  Newborns have very small stomachs (about the size of a shooter marble) that can only hold a little over a teaspoon of milk at a time.

You and your new baby may be very tired after this.  You may both with to go in to a period of rest.  You may want to see visitors and show your new baby off.  Keep in mind that your newborn may want to nurse frequently because they have such small stomachs and need a lot of colostrum (this will help build your supply when your milk transitions as well).  You have done a lot of work and it’s perfectly OK to tell visitors to wait for a few hours or longer to visit you.  It’s also OK to limit the time that they are visiting because these early days are especially important to get breastfeeding off to a good start.  Babies that are kept skin-to-skin for the first two hours are able to use your body to help regulate their temperature and are able attach and breastfeed as often as he or she would like.  After this time your baby may be weighed and vital signs can be taken (some can be taken after the first breastfeeding has occurred).  Some caregivers may be antsy to get these done quickly so be sure to talk about your wishes well in advance to be sure you are all on the same page with what needs to be done and when.

Mother feeding newborn baby

If you tore or an episiotomy was performed that will be repaired, hopefully after baby was allowed to breastfeed for the first time.  Your newborn may be allowed to remain skin-to-skin while the repair is made.  You can hold your infant on your body while on your back.  You may also be transferred to a postpartum room after the first two hours as well.  Your newborn may be allowed to remain skin to skin with you during this transition but some hospitals have policies that babies must be transported separately.  You can learn about the protocols in advance so you are able to know and prepare beforehand.

If you’re in the Oklahoma City area be sure to check out my class details and register here.

For More Information Please See:

References:

Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Nancy Mohrbacher, 2010.
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers
, Second Edition. Nancy Mohrbacher and Kathleen Kendall-Tackett, 2010.
Counseling the Nursing Mother: A Lactation Consultant’s Guide, Fifth Edition.  Judith Lauwers and Anna Swisher, 2011.
The Womanly Art of Breastfeeding, Eighth Edition.  La Leche League International.  Diane Wiessinger, Diana West, and Teresa Pitman, 2010.
Your Amazing Newborn. Marshall H. Klaus and Phyllis H. Klaus, 1998.

(As always please remember that the information and opinions provided on this website and blog are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time.  Please see my disclosures here.)

 

What was most helpful to you in the first two hours postpartum to get breastfeeding off to an excellent start?