10 tips for Breastfeeding during the first few days of life

Congrats, Mama!  Welcome to the club! Your baby was just born and you’re wondering what to do next?  This post will help set you up for success!

The morning my first daughter was born, I was filled with so many emotions.  I had spent 20 hours laboring, pushed for an hour, hemorrhaged, and then got to hold over 9 pounds of perfection. My body felt like it was hit by a bus, sleep deprivation was starting to kick in, and here was this little miracle that I would do anything for.  Nurses helped me latch her to the breast within the first hour. I immediately had this sense that I had no clue what I was doing.  What I thought would be natural was suddenly causing me to question every little decision.  What she latched properly?  Is she sleeping too much? Should I wake her to nurse? Feed on-demand or on a schedule? Oh, my word, what is this black tar poo all about?  I wanted to be so perfect for my tiny, but before I knew it I was told she had lost greater than 10% of her body weight and would need to be supplemented.  My mommy instincts kicked in and I asked for a pump and begged for some time to collect some colostrum to supplement her with.  I worried about her feedings and output even after we got home from the hospital. I wished I were more prepared for what to expect in the hospital and how to pivot when things didn’t go as planned.  

That moment was 6 years ago.  Since then I’ve navigated breastfeeding with 2 children, counseled moms with breastfeeding support, and became a board-certified Lactation Consultant.  Here is what I wish I would have known to do immediately postpartum.

1. Skin to Skin

Skin-to-Skin and getting the baby to the breast during the “The golden hour” is the most important time for a mother and baby to have uninterrupted skin-to-skin time.  Skin-to- skin refers to mom undressed on her chest, baby in just a diaper and hat, and a blanket placed over the top of them. This helps stimulate oxytocin also known as the love hormone and helps elicit the letdown reflex that enables milk to be pushed out of the ducts. Research shows that babies placed skin to skin immediately after birth can better maintain their body temperature, better absorb and digest nutrients, cry less often, exhibit improved weight gain, higher blood oxygen levels, increased brain development and parental attachment, more successful at breastfeeding immediately after birth, have stronger immune systems, and spend more time in appropriate sleep and alert states. For mother’s it improves breast milk production, reduces postpartum bleeding, and risk for postpartum depression.  This time together promotes bonding and regulation of both mom and baby.  When we interrupt this time for a bath, testing, or visitors, we can make it more difficult for breastfeeding success to occur.  In a perfect world, the baby will attempt the breast crawl, smell their mother’s montgomery glands, and suckle at the breast for the first time during this golden hour.  Be open and honest with your support team about how you would ideally like this time to go.  Putting baby to the breast early and often is one of the biggest contributors to breastfeeding outcomes.  If the health of mom or baby is at risk this time may be delayed, but it should be initiated as soon as possible.  Skin-to-skin should be done as much as possible in the first few weeks, your partner can do it too.  Having the baby room in with you also promotes responsive feedings and in turn helps bring in your supply. 

2. Hand expressing

during the early postpartum time increases breastfeeding rates and durations. You can hand express a little bit after each feeding and offer by spoon, cup, or syringe to avoid nipple confusion.  This helps to make sure the baby is getting enough milk and sends signals to your body to increase your milk production.  This helps transition baby’s poop from meconium to yellow-seedy poop sooner.  Hand expression is preferred over the pump for removing colostrum because colostrum is thick like syrup.

Press, compress, release: 

• Start with moist heat and gentle massage to relax and help elicit the letdown reflex.
• Hold your breast with your fingers and thumb cupped around your breast in a C shape, near but not touching your areola.
• PRESS your fingers and thumb back towards your chest.
• COMPRESS your breast between your fingers and thumb, moving them slightly towards your nipple without lifting them from your breast.
• RELEASE without moving your hand from your breast.
• REPEAT, moving your hand to a different place around your breast after every few compressions or whenever milk flow stops so that you compress all of your milk ducts. Releasing and repeating rhythmically helps to mimic the action of a baby breastfeeding.
• You can ask your nurse for a clean collection container or a spoon if feeding directly.
• Hand expression should feel comfortable. If it’s not adjust what you’re doing until it feels ok.

3.  How often should you feed your baby?

Those first few days after birth you want to follow your babies feeding cues and put them to the breast with the earliest cues

-Early cues: Stirring, mouth opening, head-turning

-Mid cues: Stretching, increased movement, hands to mouth

-Late cues: Crying, lots of movement, color turning red

While feeding based on feeding cues is important, some babies are very sleepy and need to be woken to feed every 2-3 hours until they regain their birth weight.  If your baby loses a lot of concerning amount of weight during the first few days, nurse frequently as well as offer them expressed colostrum.  Ideally, we want to avoid offering a bottle or pacifier until breastfeeding is well established.  You can offer hand expressed colostrum by cup, spoon, or syringe.

4.  Ask For Help

Ask to see the lactation consultant for help getting comfortable with latching, especially if there were complications during or after the birth. 

5.  How to get a deep latch

-Start skin-to-skin with baby in a diaper with hands-free 

-Get yourself comfortable and then bring the baby to your breast

-The babies chin should be the first thing that touches your breast

-Hold your breast in a boob sandwich 

-Aim your nipple towards the top of the babies nose

-Wait for a big gape then bring the baby on your breast

-Babies belly should be facing towards your belly

-Check to see if both lips are flanged out

-The nose should be free

-Check to see if babies ears, shoulders, and hips are in alignment and pulled in close to you

-Listen for audible sucks and swallows

-If this is painful, stick your finger in the babies mouth like a fish hook to un-latch and try again

-Play around with different positions

-Pay attention to the shape of your nipple when the baby unlatches.  We want our nipples to maintain their shape. 

6.  What goes in must come out

-Diaper output is a great way to know that your baby is getting enough.  Track output for the first few weeks to ensure the baby is getting plenty to eat.

-A wet diaper feels like 3 tablespoons of liquid

-A Poop diaper is about the size of a quarter

Typical patterns for wet diapers are 1 wet diaper on day one
2 wet diapers on day two
3 wet diapers on day three 

4 wet diapers on day four
5 wet diapers on day five
6 wet diapers on day six and from then on. 

Look for light yellow to clear urine. 

Typical patterns for Poop 

Day 1-as least 1 Meconium (dark & tarry)
Day 2-at least 2 Brownish
Day 3-at least 3 Brownish yellow 

Day 4-at least 4 Dark yellow, soft
Day 5-at least 5 Yellow, semi-liquid
Some newborns stool after every feeding

7.  Supplementing

If your baby needs to be supplemented in the hospital, ask your nurse to guide you in latching followed by expressing and giving colostrum/transitional milk baby.  Follow the below table for appropriate supplementation amounts.  If for some reason you need to be separated from your baby, request a hospital grade pump and pump every 2-3 hours followed by hand expression.

Time(hours) Intake (mL/Feed)

First 24 2-10 Colostrum

24-48 5-15 Transitional Milk

48-72 15-30 Transitional Milk

72-96 30-60 Mature Milk

*table from the Academy of Breastfeeding Medicine Supplementation protocol

8.  Birth Plan

While in the hospital be clear of your desire to breastfeed and don’t hesitate to ask how certain interventions can impact your breastfeeding relationship. Specify on your birth plan that no artificial nipples, pacifiers, sugar water, or formula be given to your baby unless medically indicated, prescribed by your pediatrician, and approved by you.

9.  Ask lots of questions

in the hospital and have an appointment set up with a board-certified lactation consultant the week you get home from the hospital.  

10.  Home life after baby

Once home you may be challenged with figuring out breastfeeding and all of the visitors that want to meet your bundle of joy.  Spacing out feedings can cause engorgement and a decrease in supply.  It’s okay to be a mama bear and verbalize what’s best for you and your baby. 

This is your breastfeeding experience. Give yourself grace, slow down, heal, and bond with your new baby.  Everyday may have its own challenges, but each day you and your nursling are learning and will get a little bit better at all of the things.  I want you to know that you’re not alone.  You’re not failing when things are hard, you’re doing great.  Please reach out if I can be of any further assistance in helping you reach your breastfeeding goals.