Surviving Growth Spurts

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Growth spurts happen a lot with your baby.  I get a lot of questions about growth spurts and what to expect or symptoms that baby is showing that are very common with growth spurts.  Often, breastfeeding professionals and mother-to-mother support group leaders will refer to these times as “frequency days” or sometimes even “fussy days.”

While a growth spurt can occur at any time they typically occur at about 7-10 days, 2-3 weeks, 4 weeks, 6 weeks, 3 months, 4 months, 6 months, 9 months, and really any other time.  They continue to happen about every 2-3 months through toddlerhood and periodically through to teenage years.  Your baby’s only way to communicate is through crying and baby will often communicate that something is wrong.  Growth spurts can be painful for baby (breast milk has pain relieving properties for babies and the oxytocin released when you breastfeed helps calm you both).  They can just be a confusing time or a time that baby’s brain is growing and not necessarily their body as much.  One nice thing about a growth spurt is if baby is having a fussy day and you’d rather stay home and relax together you can always blame a growth spurt!

Quite often mom will recognize something is different about baby but not quite pin point it to being a growth spurt.  Here are some signs that baby may be having a growth spurt:

  • Baby is nursing more frequently than usual (Do note though that it’s common to have a growth spurt at around 4-6 weeks and this is around the time that mothers will notice their breasts feeling much less full.  This is usually not an indicator that you’re not producing enough milk but this is a concern many mothers have).
  • Baby is fussy even after nursing.
  • Baby seems inconsolable.

While all of these can be signs of other issues, if your baby is gaining weight and has plenty of wet and poopy diapers it is very often a growth spurt.  Another possibility is over-stimulation if the crankiness is happening after being around a lot of new people or things, in the evening, or after being outside for a while.  If baby is about 3-4 months or older it could be teething causing these issues.  More on this in a later post.

Please also remember that your breast milk is usually enough.  If you have any doubts about your supply please be sure to check out this post.  Baby will start nursing more frequently on these days because baby is putting in an order for more milk later.  Imagine that it’s a Friday night and you know you want to have a pizza delivered at 6 PM.  Friday nights are really busy at the pizza delivery restaurant.  If you wait until 5:30 to order they might not be able to deliver or even have a pizza ready for you to pick up until 7 or 8!  Since you’ve probably had that experience before you know that you need to call in earlier so your food arrives when you’re ready for it (and hungry!).  When baby starts nursing more frequently they are phoning in their order for more milk later.

So how do you survive when baby can’t seem to get enough?  Here are some ideas to try:

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A little more about the “nest.”  I help mothers that attend my breastfeeding classes prepare what I call their “nest” before baby arrives so that they can have everything easily at hand whenever baby wants to nurse.  Many mothers find that having everything close at hand (and having a little box or container to carry everything room to room as needed) helps to be able to sit down and nurse comfortably whenever baby shows early cues rather than going through the house to hurry and grab a snack, the remote, water bottle, etc.  By the time all of those items are gathered baby may be crying and harder to get to latch well and begin nursing.

Something else that you may find helpful is to have a good breastfeeding book.  I really love the Womanly Art of Breastfeeding and Breastfeeding Made Simple.  A lot of parents also enjoy The Wonder Weeks because it helps predict when baby may be going through a growth spurt or another developmental leap.  Remember that babies haven’t read the instruction manuals so not every baby follows the books exactly as they’re written but they can be reassuring even still.

One last thing I want to note is on dinner and snacks.  It’s so important to take care of YOU during a growth spurt.  Having easy snacks and maybe an easy meal that you can eat one handed while nursing can be very helpful.  It’s very common for babies to be crankier at night during growth spurts so having dinner taken care of is helpful.  You can always call in a favor to a friend that offered help, have some freezer meals on hand that just need to be heated up or baked, or have some crockpot meals on hand that you just need to throw in the crock pot the day of.  We really enjoyed having a couple of whole chickens in the freezer so we could throw one in our crock pot all day with some baby carrots and some other veggies we had on hand with salt and pepper, garlic powder, onion powder, and whatever other seasonings we had on hand that we like.  It would take me about 5 minutes to throw it all in and I didn’t have to worry about dinner.

I offer breastfeeding and babywearing consultations and classes in Oklahoma City, Yukon, and Mustang.  If you’re interested in learning more, you can visit my website, or contact me.

What do you do to survive growth spurts?

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Watch the Baby, Not the Clock

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After my last post, you may wonder if it’s better to watch baby or the clock.  A sleeping baby usually only needs to be woken up if there is special circumstances once they have gained back to birth weight.  Breastfeeding is so very intuitive.  We are very procedural and scientific as a society and we are very concerned about numbers.  This is helpful in some ways, especially to make sure that baby is thriving and not having breastfeeding struggles.  In other ways it sometimes gets in the way of what is normal and natural about the ART that is breastfeeding.

Healthy, full-term babies can tell YOU when they’re hungry.

You should expect that baby will continue to want to nurse 8-12 times per day approximately in the first six months.  Unlike with formula, baby will continue to get approximately the same amount of milk at the breast until baby begins eating solid food.

Feedings will eventually become shorter but still work on supply and demand.  Many mechanisms in our bodies work in cycles.  Breastfeeding is no different.  It’s very normal for milk supply to be higher in the morning and lower in the evenings.  It’s very normal for baby to want to nurse more frequently in the evenings and even to be fussy (more on this in a later post).

Scheduled feedings based on a certain time came because someone took the average of 8-12 feedings per day and decided to break that up on a clock.  Because our bodies (baby’s as well as mom’s) don’t work on a strict schedule but more of a routine, this can cause breastfeeding issues when you limit feedings based on certain times.  Certain baby programs meant to train and discipline babies highly discourage feeding more often than a set amount of time (usually more often than every 2 or 4 hours) and also discourage feedings longer than a specified amount of time (usually 15 or 20 minutes).  All babies are different in their efficiency, breasts are different in how often let-downs occur (where baby gets the majority of the milk in a feeding), and some babies have a stronger sucking need than others.  All people are different.  We all have different appetites.  We all expect meals at a certain time to some degree but if we get hungry most people will have a snack when they start to feel hungry.  If you wake up thirsty during the night you will get up and drink some water rather than say “Only 2 more hours until I’m allowed another sip of water.”  Babies are the same in that regard.  Babies will fall in to a routine eventually and following baby’s cues helps keep breastfeeding going in the most optimal way.

Because we don’t have graduations like a bottle on our breasts and can’t see how much milk baby is actually getting in there are some good indicators to help you know that baby is getting enough.  The most important keys to watch for to be sure that baby is nursing frequently enough and getting enough milk are:

  • Watch for early feeding cues: rooting, smacking/sucking noises, bringing hand to mouth, and in the early days just waking up.  Don’t wait for baby to cry-it will be harder for baby  to latch on and baby may become so tired that they may not nurse as effectively.
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Early feeding cues include bringing hands to mouth and making smacking noises.  This is my daughter when she was just a couple of weeks old.

  • Diaper counts: by the end of the first week expect to see at least 6-8 wet diapers and 3 poopy diapers.  At about 6 weeks baby may have less stools and this is normal.  Some babies may go less than once a day at about 6 weeks and may go as infrequently as once a week or up to 2 weeks and be healthy.  If you have concerns, talk to your baby’s doctor and see a breastfeeding professional.
  • Weight gain: Baby should gain at least 5-7 oz per week after getting back to birth weight.  Baby should be back to birth weight by 10 days, 2 weeks at the latest.
  • When baby finishes a feeding (baby should usually be allowed to finish the feeding by coming off when he/she is finished) his/her hands and body will be more relaxed.  Babies often have fists at the beginning of the feeding and relax as their stomachs are filled.

If you have supply concerns some helpful ideas are to:

  • Check latch-if it’s painful an assessment by an IBCLC is important.
  • Let baby finish a breast, burp, then offer the other breast.  Following babies cues is important as is getting enough breast stimulation so that you continue having a good supply.
  • Nurse baby on cue as long as baby wishes.
  • Take away pacifiers and extra bottles, if baby needs a supplement consider an at-breast supplementer or work on paced bottle feeding to simulate how your breast delivers milk.  If you have supply concerns, all suckling should be at the breast.
  • Skin-to-skin contact as long and as much as possible during the day.
  • RELAX!  Stress can inhibit your let-down and make you not feel the best.
  • And above all, get professional help and support.  Mother-to-mother support groups and volunteers can be extremely helpful as well.
  • A very helpful book is Breastfeeding Mother’s Guide to Making More Milk.

 

For further reading see:

What cues does your baby give to let you know that he/she is hungry?

I offer breastfeeding and babywearing classes and consultations in Oklahoma City, Yukon, and Mustang.  If you would like more information please contact me or visit my website.

What to Expect in the Early Days of Breastfeeding

earlydays

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.

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.

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?