How to Begin Well in the First Weeks of Breastfeeding

The first days and weeks of frequent breastfeeding are critical for establishing a healthy milk supply, and having lactation support from the start of your journey, can make a significant difference to your success.

Early frequent breastfeeding and hand expression from birth forward is key to practice for you and baby, and to establishing your milk supply. Baby may not cooperate with your initial breastfeeding plans, so be flexible, and just follow baby’s lead. Breastfeed on demand, whenever baby is showing hunger cues. Allow baby to nurse as long as he wants and to get a full feeding. Do breast compressions periodically throughout the feeding to keep baby suckling, especially when baby stops or falls asleep. The more baby nurses and the breast drains of milk, the more milk your body will produce to feed your baby. Hand express if baby doesn’t want to nurse and it’s been 3-4 hours from last breastfeeding. Also if baby has difficulties latching at the start, hand expression is recommended to obtain the colostrum and feed your baby. Massage your breasts beforehand to stimulate milk let-down. In the first few days after delivery, you will only be obtaining small amounts of colostrum. Feed the expressed colostrum to baby immediately after collection. Remember the small amounts of colostrum, 5-7 milliliters per feeding, at least 8 times per 24 hours, is all baby needs to fill his small stomach, which is the size of a cherry, in the first few days after birth. Baby will consume more colostrum/milk per feeding and his stomach will grow as your frequent breastfeeding continues day by day. Average amount of breast milk baby needs per feeding, at least 8 times per 24 hours in the first week of life: Day 1: 5-7 mL, Day 3: 25-50 mL, Day 7: 45-70 mL. Follow baby’s lead, and breastfeed on demand whenever you observe hunger cues, or it has been at least 3 hours since last feeding. It’s normal for baby to eat frequently. More breastfeeding yields increased milk supply! Your incredible body will produce breast milk to fulfill your baby’s needs.

Evidence supports that skin to skin contact in the first hour after birth, significantly improves outcomes for both mother and baby. Research by Dr. Ann-Marie Widstrom provided an understanding of the timing of the newborn’s progression through nine observable stages after birth when placed skin to skin. Dr. Widstrom, working with Dr. Kajsa Brimdyr (Healthy Children Project) called this newborn progression in the first hour of birth, “The Magical Hour.” The nine instinctive stages after birth generally occurs within 1.5 to 2 hours after delivery, but the process may take longer. Holding baby skin to skin as long as possible after birth and through the postpartum period at the hospital is essential to establish breastfeeding for mother and baby. However, holding baby skin to skin even beyond the hospital stay, at home in the first 4-6 weeks continues to enhance breastfeeding and help baby transition from life in-utero to the outside world. Moreover, even Dad or other family members may hold baby skin to skin for positive effect.

Baby will eventually latch onto the breast during this skin to skin time after delivery, but for encouragement if baby is too sleepy or just won’t latch, hand express colostrum to your nipple. Either put the colostrum directly on baby’s lips which may entice baby to latch, or collect your colostrum in a baby feeding cup or via a colostrum collector kit and feed the colostrum to baby.

Check out Lactation Education Resources for detailed instructions with photos about hand expression: handouts-parents (lactationtraining.com)
Also here’s a video from Stanford Medicine to watch the technique of hand expression: Hand Expressing Milk | Newborn Nursery | Stanford Medicine

Human colostrum is the first form of milk produced by mother during the late stages of pregnancy and in days 1-3 after birth. Often referred to as “liquid gold” because of its yellowish color, colostrum’s composition is uniquely tailored to meet the needs of the newborn, with high concentration of proteins, antibodies, vitamins, and minerals, but has lower fat than the mature milk to follow. Colostrom’s critical components such as immunoglobulins, growth factors, lactoferrin, and leukocytes play a role in protecting newborns against infections and supporting their developing immune system. Moreover, colostrum is easier to metabolize by baby’s digestive system, and acts as a natural laxative promoting the passage of meconium (baby’s black, tarry initial stools) in the first few days. Colostrum transitions in composition around days 3-5, and becomes mature milk around days 10–14.

The composition of mature milk differs significantly from colostrum. “Excluding the water, which comprises about 87–88%, the most basic components in human breast milk are macronutrients: carbohydrates, proteins, and fats. These macronutrients provide essential nutritional support for infant growth and development, supplying 65~70 kcal of energy per 100 mL. Human breast milk components change dynamically according to lactation periods and nursing sessions within a single feeding and become suitable for various needs according to the state of lactation or the child’s growth. Fat, which accounts for almost 50% of the nutritional supply of the infant, is the second most prevalent macromolecule in human breast milk and is the most important for infant growth and development of the central nervous system.” (Yi, D.Y. and Kim, S.Y., 2021)

If baby is breastfeeding on cue or demand, 8-12 times per 24 hours, at least 15 minutes and as long as baby desires, and having 6-8 voids and up to 3 stools per day (from day 5-7 of life onward), then you are off to a good start! If on the other hand, baby does not breastfeed consistently, and seems uninterested in nursing, then pumping is highly recommended. Hand expression to entice baby to latch is still encouraged, but additional stimulation through pumping is needed to help boost your milk production. The earlier pumping begins, the better for stimulation and milk production, especially if baby is not providing the stimulation needed. A hospital-grade double electric pump is best to stimulate the breasts. Pump both breasts at the same time (double pump) for 15 minutes. While pumping, do breast compressions periodically to help drain all areas of the breast, and to induce release of fat into the milk. The breasts never empty, so if baby shows hunger cues while pumping or afterward, stop pumping, and put your baby to breast. If possible though, have a rest between breastfeeding or pumping: a 1.5 hour break between sessions is encouraged to boost milk production.

Periodic visits with a lactation consultant after going home from the hospital is highly recommended. It cannot be overstated that the first days and weeks of frequent breastfeeding are critical for establishing a healthy milk supply, but having lactation support from the start is also essential. Both can significantly affect your breastfeeding success. Having a lactation consultant is encouraged early on, to check baby’s latch, do a weigh and feed assessment to check baby’s transfer of milk, address your concerns or questions, and especially to get help, if you’re having breastfeeding problems. Often breastfeeding issues may be resolved using lactation tools/aids on the market, after you receive recommendations during a visit with a lactation consultant. An IBCLC has a wealth of knowledge to share and encouragement to cheer you on!

Check your insurance policy for coverage of breastfeeding counseling, and schedule an initial visit to a lactation consultant (IBCLC) within 1-2 weeks or sooner after you and baby are discharged from the hospital, especially if you are having breastfeeding difficulties. Depending on your insurance policy, you may be allowed one to six lactation consultant visits. Schedule an appointment as soon as possible, especially if you are having problems.

For help, contact The Lactation Network, a national company who works to verify insurance benefits and connect families with International Board-Certified Lactation Consultants (IBCLC) across the United States. To verify insurance coverage: https://go.lactationnetwork.com/MommaAndBabeLactationConsulting

In addition to lactation consultant support, one last recommendation is to consider joining your peers in a breastfeeding support group like La Leche League, Breastfeeding Cafe, or your local community breastfeeding or mothers’ group. You’ll be glad you did!

KEEP CALM & BREASTFEED ON!!!

REFERENCES

Durbin, K. Protecting Your Potential for Breastfeeding. Amarillo, TX: Praeclarus Press, 2023. 
https://amzn.to/3MzVcz8

Spencer B, Hetzel Campbell S, Chamberlain K. Interdisciplinary Lactation Care, 2nd ed. Burlington, MA: Jones & Bartlett Learning, 2024.

Walker, M. Core Curriculum for Lactation Consultant Practice. Sudbury, MA: Jones & Bartlett Publishers, 2002

Wambach K, Riordan J. Breastfeeding and Human Lactation, enhanced 5th ed. Sudbury, MA: Jones & Bartlett Learning, 2015.

Yi, D.Y., Kim, S.Y. Human Breast Milk Composition and Function in Human Health: From Nutritional Components to Microbiome and MicroRNAs. Nutrients 202113(9), 3094; https://doi.org/10.3390/nu13093094

VIDEO- “The Magical Hour: Holding Your Baby Skin to Skin in the First Hour After Birth” produced by Dr. Brimdyr, Dr. Widstrom, and Kristin Svensson is a good resource as well: https://amzn.to/4c8o9wP

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