Breastfeeding – The first few days

Babies have very different personalities when it comes to how they approach breastfeeding and it can take time to get to know your baby and to learn together. In the early days, some situations may arise which result in breastfeeding taking a bit longer to get established. Being aware of what might happen and having some helpful suggestions to hand can make all the difference. Many women have found that going along to breastfeeding support meetings, such as those held by La Leche League, before the baby is born helps them to be prepared for any challenges they may encounter.

Did you know?

• If things haven’t got off to the best start and you are tempted to stop, it can help to take one day at a time. Every day you breastfeed counts towards creating healthy building blocks for the future for both you and your baby.
• Breastmilk is meant for our babies and contains living cells, hormones, active enzymes, antibodies and compounds with unique structures that can never be replicated in formula. The composition of human milk changes to meet the changing needs of the baby as he matures, as well as from feed to feed.
• Breastmilk adapts to suit our own baby’s specific needs and if a baby is born prematurely it will adjust so that it is ideal for the continued growth that baby needs.
• Colostrum (the milk produced in the first few days after birth) contains especially high concentrations of antibodies to help a baby’s immune system to mature after birth.
• Mature milk continues to provide this protection to help the baby remain healthy, creating specific antibodies aimed at fighting germs to which either the mother or baby have been exposed.
• There is evidence that the longer a baby is breastfed, the greater his protection from ill health will be, leading to a more positive impact on both short and long-term health. A breastfed baby is five times less likely to be hospitalised with gastroenteritis and on average will visit the doctor 15% less.[i]

Sleepy Baby

Birth can have an impact on the way breastfeeding gets started. A baby may be sleepy from the effects of analgesics the mother has had, or may have a headache due to a forceps delivery. You may need to take the initiative in offering to feed, rather than waiting for the baby to ask, as babies who are not feeding enough tend to sleep to conserve energy. You can watch for rapid eye movements under closed eyelids, and other cues indicating that he will be receptive to feeding, such as arm and leg movements, sucking noises and facial expressions. You can lift his arm and see if it offers some resistance, rather than being floppy.

If he is not latching at all, or is not feeding well, hand expressing some milk and giving it to the baby by spoon, feeding cup or syringe will provide him with the energy needed to breastfeed, and help your milk supply.

Skin-to-skin contact, gentle rubbing of the baby’s back, hands or feet, and unwrapping him from blankets, perhaps wiping his forehead with a cool damp cloth, can help to arouse him enough to instinctively latch. Swapping sides and trying breast compression can keep him interested.

For further information on sleepy babies and breast compression go to:

Sleepy Babies – Why And What To Do (https://www.laleche.org.uk/sleepy-baby-why-and-what-to-do/)

Engorgement

Many mothers experience some engorgement in the first days, in some cases weeks, after birth. This enlargement and hardening of the breasts is not exclusively due to milk “coming in”, but also to extra blood and fluids which can cause congestion and swelling. You won’t be like this forever, as the body gradually adjusts, but engorgement can be painful. It can make it harder for a baby to latch on deeply and it might lead to nipple soreness.

Things you can try to relieve engorgement include: expressing a small amount of milk before you feed (this can be easier in the bath or shower); feeding the baby frequently to prevent breasts from getting too full; massaging your breasts gently, or applying moist warmth just before a feed.

For further information on engorgement and reverse pressure softening go to:

Engorged Breasts – avoiding and treating (https://www.laleche.org.uk/engorged-breasts-avoiding-and-treating/)

After a Caesarean

Mothers who have had a caesarean birth may need a bit more help getting a baby comfortably to the breast. Having your IV drip inserted into your forearm, rather than in the back of your hand, can allow more movement when holding and feeding the baby. Extra fluid from an IV drip can increase engorgement, and the anaesthetic received during birth may make your baby sleepy (see section on Sleepy Baby for more information).

Having the baby skin-to-skin can encourage him to latch on and birthing partners can help by holding him close to you. You may need to try out a few breastfeeding positions to see what feels most comfortable, making sure that the baby is effectively attached to the breast. Lying down or using the underarm position may be most comfortable for breastfeeding at first, perhaps using a rolled-up towel or small pillow to protect your incision. If your nipples are squashed or flattened after feeds, or look sore or damaged, ask for help with positioning.

For further information on this go to:

Caesarean Birth and Breastfeeding (https://www.laleche.org.uk/caesarean-birth-and-breastfeeding/)

My Baby Won’t Breastfeed

One of the most distressing situations for a new mother can be when a baby refuses to breastfeed. There are various reasons why this may happen, often connected to a difficult birth. Having the baby skin-to-skin and letting him find the breast naturally can help. Although it can be hard to keep calm, singing, talking and walking with your baby, or taking a relaxing bath together can help his natural instincts to kick in. Once a baby is distressed, it becomes hard to get him to latch, so watching for early feeding cues such as stirring in his sleep, rooting and fist sucking can help to get him calmly latched onto the breast before he becomes upset (see section on Sleepy Babies for other useful tips).

For further information on this go to:

My Baby Won’t Breastfeed (https://www.laleche.org.uk/my-baby-wont-breastfeed/)

Positioning and attachment

Identifying a comfortable breastfeeding position can cause mothers a lot of anxiety, but there is not a fixed way to breastfeed a baby. All mothers and babies are different in shape and size and what suits one may not be right for another. Ensuring that the baby has a deep latch is the key to comfortable breastfeeding. If your baby is not latched on well at the breast, it is much more difficult for him to get your milk. A small adjustment to the way the baby comes to the breast can make all the difference.

The key things to remember to get started are: babies need to be calm; babies need good support; babies’ lower jaws need room; babies need a big mouthful; babies need to choose their own timing to latch on.

Milk is mostly in the ducts in your breast, so the baby who just chews on a nipple won’t remove milk effectively and it will hurt. For his lower jaw to get a big mouthful of breast, the baby needs to lift his chin so that his head tips back slightly. This keeps the chin in firm contact with the breast, with his nose lifted free or nearly free of the breast. Tipping his head back a bit also helps with swallowing.

If the baby is properly latched, you will see both his top and bottom lips fully flanged outward and his cheeks full and rounded, you will see and hear his swallowing, and your nipple will be elongated and rounded when he comes off the breast.

For information and suggestions on different positions and help with latching go to:

Positioning & Attachment (https://www.laleche.org.uk/positioning-attachment/)

Is my baby getting enough milk?

Babies have very small stomachs and it is perfectly normal for them to feed frequently. Small frequent feeds provide them with the milk they need, and help to increase milk production: the more you feed, the more milk you will produce. Babies also nurse for comfort.

Wet and dirty nappies can give you reassurance that your baby is taking in enough milk. These will gradually increase in the early days from 1-2 wet and tarry meconium nappies a day in the first couple of days, to 5-6 heavy disposables (6-8 cloth nappies) and at least 3-5 yellow, unformed stools at least the size of a 2p coin at 5 days. Loose yellow stools are normal and do not mean the baby has an upset stomach.

A baby’s weight gain needs to be measured from his lowest weight, not from his birth weight. It is normal for a newborn to lose up to 7% of his birth weight during the first few days. Most babies regain birth weight by 10-14 days and from 0-3 months usually gain about 4-7 ounces a week. Length and head circumference can also be useful indicators of how a baby is growing.

For more information go to:

Is My Baby Getting Enough Milk? (https://www.laleche.org.uk/is-my-baby-getting-enough-milk/)

Too much milk?

In the early days a mother may have a very forceful milk flow at the beginning of a feed which causes a baby to gulp, choke or splutter. Some babies become distressed and pull away from the breast, potentially causing soreness, and they can become reluctant to nurse because they can’t cope with the flow of milk.

Frequent feeding can help as the flow of milk will be slower. More “upright” positions, or nursing while you are reclining and the baby’s head and throat are higher than your nipple, can help him control the flow. If the baby wants to nurse frequently but is distressed by the flow, offering the same breast over a four-hour period can also help. However, this is generally not indicated in the early days when offering both sides serves the purpose of establishing a good milk supply.

For more information go to:

Too Much Milk and Oversupply (https://www.laleche.org.uk/too-much-milk-and-oversupply/)

Feeling tired

Night feeds are important as they help to establish and maintain your milk supply and help to avoid engorgement, blocked ducts and mastitis. Breastfeeding is sometimes blamed for a mother’s tiredness, but caring for a new baby is often tiring, independent of the way a baby is fed. It can help to try to sleep or rest when the baby does, even if it’s not a time when you would normally nap. Sitting down to breastfeed means you get a chance to relax and put your feet up.

Studies have shown that when mothers stop breastfeeding their fatigue level does not change. One US study also found that breastfeeding mothers averaged 40-45 minutes more sleep at night during the first three months than those formula feeding, even when fathers helped out with giving bottles.[ii] [iii]

The hormones released when breastfeeding, prolactin and oxytocin, promote feelings of relaxation, helping women to feel calmer during the time months they are nursing their babies. In addition, lactation suppresses the nervous system’s hormonal response to stress for both mothers and babies.

For more information go to:

Adjusting to Motherhood (https://www.laleche.org.uk/adjusting-to-motherhood/)

Nipple/breast difficulties

Cracked and sore nipples can be a major challenge in the early days of breastfeeding. This can be a sign that the baby is not well positioned at the breast, which can be addressed by adjusting the way the baby is latching. You can use the healing properties of breastmilk by expressing a few drops and rubbing them gently onto the nipples, allowing them to dry naturally. Allowing air to get to your nipples by avoiding tight bras and soggy breast pads, and making sure there are no rough seams which can rub, can speed up healing. If you need to remove your baby from the breast, you can break the suction by gently inserting your finger between your baby’s gums to avoid damage to your nipple.

Blocked ducts and mastitis can be caused by not having the baby well positioned, too long a gap between nursing sessions, giving bottles or over-using a dummy, and wearing a bra which is too tight. Applying gentle heat to the sore area, resting as much as you can and keeping the breast as empty as possible by feeding the baby frequently or by expressing, are all helpful tips. Cold, raw, washed cabbage leaves worn inside a bra can be soothing for engorgement, blocked ducts and mastitis. They should be changed when they wilt or after about two hours. If you continue to feel unwell, you may want to contact your doctor. If he/she prescribes antibiotics, you can ask for one compatible with breastfeeding

Using artificial nipples such as bottles and dummies in the first few weeks can lead to nipple soreness, as they require a set of jaw, tongue and mouth movements very different from those used to breastfeed. Some babies become confused and refuse the breast. If you wish to give some bottles of expressed breast milk it is usually better to wait until breastfeeding is well established. When a breastfed baby also receives bottles of formula the mother’s body gets the message to make less milk, resulting in a reduced supply.

For more information go to:

Nipple Pain (https://www.laleche.org.uk/nipple-pain/)

Mastitis (https://www.laleche.org.uk/mastitis/)

Nipple Confusion? (https://www.laleche.org.uk/nipple-confusion/)

Dummies and Breastfeeding (https://www.laleche.org.uk/dummies-and-breastfeeding/)

Inverted Nipples

Nipples vary widely in size and shape between women and usually don’t affect the ability to breastfeed. If one or both nipples are inverted – that is they don’t stand out when compressed or stimulated – then breastfeeding can take a bit more time and patience to start with. Inverted nipples are different to those which are flattened by full or engorged breasts.

As babies breastfeed, not nipple feed, using effective positioning and attachment techniques means that the baby can usually feed well despite the shape of the nipples. This also applies to nipples which seem too big or wide for a baby’s mouth: finding an effective breastfeeding position helps, and as a baby grows this difficulty passes.

For more information go to:

Inverted nipples (https://www.laleche.org.uk/inverted-nipples/)

Tongue Tie

Whilst the majority of early breastfeeding difficulties can be sorted out by looking at positioning and attachment, as well as improving breastfeeding management, tongue-tie can sometimes cause challenges. Tongue tie (ankyloglossia) can be described as a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth) which may restrict tongue mobility.

A baby needs to be able to move his tongue freely and extend it over the lower gum with his mouth open wide to be able to breastfeed effectively. Some babies with tongue tie breastfeed well from the start; others do so when positioning and attachment are improved; some require a tongue-tie division (frenotomy).

Some of the symptoms associated with poor attachment that may be caused by tongue tie include: baby being unable to latch onto the breast at all; being unable to latch deeply causing nipple pain and damage; difficulties staying on the breast; making a clicking sound as he loses suction; breastfeeding constantly; poor weight gain; and developing colic. A mother may experience pain during feeds, her nipples may be distorted into a wedge shape immediately after feeding, often with a stripe at the tip, and ineffective milk removal may result in engorgement, blocked ducts, mastitis and low milk production. This can make a mother feel frustrated and discouraged.

Tongue-tie treatment options are available and effective, especially if treatment is prompt.

For further information go to:

Tongue Tie (https://www.laleche.org.uk/tongue-tie/)

Jaundice in Healthy Newborns

More than half of all newborns become jaundiced during the first week of life and, in most cases, this is a normal part of adjusting to life outside the womb. A baby who feeds well and often, around 10-12 times a day in the early days, is less likely to have a problem with jaundice. Frequent breastfeeds help to clear bilirubin, formed from the breakdown of excess red blood cells, from a baby’s intestines more quickly. If your baby is sleepy and not waking often, you can express your milk to help establish milk production and you can offer it to your baby by cup or syringe. Giving water or breast milk substitutes can make things worse as the baby will nurse less often. If further treatment is considered necessary, breastfeeding can continue and will comfort your baby.

For further information go to:

Jaundice in Healthy Newborns (https://www.laleche.org.uk/jaundice/)

Premature baby

Whether you knew that your baby was going to be premature or not, it can still be quite a shock to see your precious newborn in a Special Care Unit. You may feel overwhelmed and unable to do anything for your baby. Providing your breastmilk for your baby is one thing which only you can do for him and it can really help you feel how important you are to him.

When a baby is born prematurely, his mother’s milk is different from that of a full-term baby. It contains more of the nutrients your premature baby needs and is ideally suited to his immature digestive system.

Hospital policies can vary, but more and more Maternity Units are aiming to let parents have as much skin-to-skin contact with their baby as possible. Even if your baby can’t feed directly from you, he can have your milk via a tube or other means. Pumping and expressing regularly will help to build your supply, and prepare you for the time when you can feed your baby directly. Breastfeeding is less tiring for a baby than bottle feeding and helps to relax and comfort him, but he may not feed for long at any one time to start with.

It has been shown that a mother’s breastmilk can prevent infections and illness, especially something called necrotising enterocolitis (NEC). This is a very serious condition that premature babies are at high risk of developing when being fed formula milk.[iv]

Sometimes, premature babies have milk fortifiers added to their mother’s breastmilk. If possible, it is preferable to have a fortifier which is human-milk based rather than cow-milk based.

For further information go to:

Breastfeeding Premature Infants (http://www.llli.org/nb/nbpremature.html)

If in doubt ask for support

If you are having difficulties and doubts, ask your healthcare provider where you can get help and support. It is much easier to address challenges before any problems escalate.

The early days of breastfeeding can be intensive and sometimes challenging, but as babies and mothers get to know each other better and start learning and growing together, breastfeeding usually becomes a very enjoyable and important part of their relationship.