The First 6 Weeks

At The Hospital

Babies must also learn how to nurse, just as they will later learn how to crawl and walk. There are several things you can do right from the beginning to encourage a positive breastfeeding relationship. Don't let bottle-feeding thwart your plans to breastfeed. If you expect to give birth in a hospital setting, consider the following:

(Also see our What will happen to you, baby, and your milk supply)

• Plan as natural a birth as possible. Intervention during labor and delivery normally results in a delay in breastfeeding. Medication can cause your newborn to be sleepy, and to not be interested in nursing early and often. However, even if you end up having a cesarean birth breastfeeding can still be established successfully.

• Tell the hospital staff frequently that you do not want your newborn to receive any formula, water or pacifier, and have your doctor record this on your baby's chart. Some mothers have also found it to be helpful in adding this information to their birth plan. In order for breastfeeding to properly established it is important to avoid these items. Pacifiers tend to cut down a mother's milk production and using water of any kind is unnecessary until your baby reaches the age of 12 months. The more natural you begin breastfeeding the fewer problems you may have later.

• Begin nursing as soon as possible. Babies have a period of alertness during the first hour after birth, and display a strong sucking reflex that is not as strong again until approximately 40 hours later.  Nursing soon after birth with help your uterus contract by stimulating the release of oxytocin.  This first time at the breast is a time to introduce your baby to the breast.  Don 't force things or try to practice everything you've read or learned.  Some babies will just nuzzle and lick the breast at first, and others will latch right on.  Sucking in frequent bursts and pauses is the typical pattern for the first few hours and often the first few days

• Arrange for rooming-in so your baby can be with you at all times. If that is not possible have your baby brought to you often. Newborns need to be nursed at least every two hours during the day and whenever they awaken at night.

• Turn down any offers of formula samples to take home with you. Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula.  It is very effective, and very unethical, marketing.  If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding.  "But I need formula because the baby is not getting enough!".  Maybe, but, more likely, you weren’t given good help and the baby is simply not getting your milk well.  Get good help.  Formula samples are not help.

• Speak with the hospital's lactation consultant. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast.. Unfortunately, that are still many hospitals that are not breastfeeding friendly. It is important that you look into this when touring the hospital where you plan to give birth.

Your First 6 Weeks

The first six weeks will be a learning experience for the entire family. There will be wonderful times as well as difficult challenges. Even for those parents who have older children. However, regardless of the type of day you have the best part of breastfeeding will always be the bonding between mother and baby. Here are some tips that will help you in not only establishing a good milk supply, but help you enjoy this special time with your newborn:

• Nurse as soon as possible after birth.

• Establish the proper latch on. This will eliminate much of the pain and soreness often associated with breastfeeding, and it will allow the baby to get milk more easily.

• Avoid artificial nipples.

• Do not restrict the length or frequency of breastfeeding.

• Sleep when your baby sleeps!

• Wear your baby! Carry your baby in a sling for easy nursing. Also see About Nursing In Public

• Have a glass of water every time you sit down to nurse - this will help make sure you're drinking enough fluids.

• Avoid bras and tight-fitting clothing in the first few weeks after birth to allow sore nipples to heal.

• Use pillows to support you and your baby while breastfeeding.

• If you experience pain during breastfeeding or other difficulties, seek help from your doctor or a Lactation Consultant.

Also see our What will happen to you, baby, and your milk supply.

Indicators of low supply

From my experience as a regular on breastfeeding support boards, I would say that this is the number one concern of all moms. However, despite this great concern, true low milk supply affects less than 5% of breastfeeding women. Because of this I have researched and put together a list they you might find helpful in determining whether you are in that 5% of breastfeeding women.

1. These are ABSOLUTELY POSITIVELY not indicators of low supply:

   1. A baby nurses frequently (every hour or more.)

   2. The baby is fussy.

   3. Your baby guzzles down a bottle of formula or expressed breastmilk after being fed. Many babies will willingly take a bottle even after they have a full feeding at the breast. Read more here from board-certified lactation consultant Kathy Kuhn about why baby may do this and how this can affect milk supply. Of course, if you regularly supplement baby after nursing, your milk supply will drop.

   4. Your breasts don't leak milk, or only leak a little, or stop leaking.

   5. You never feel "full" or never become engorged. Your breasts do not increase in size during pregnancy.

   6. Your breasts feel "softer."

   7. You never feel let down.

   8. You get very little or no milk when you pump.

   9. Your milk hasn't come in by day 4. Milk can come in anywhere between days 2-5. Before then, you are producing colostrum and your baby can thrive on that, but may need to feed quite frequently (cluster feeding every hour or more.)

    

   1. These CAN BE (but are not necessarily) indicators of low supply. These are the only indicators of possible low milk supply.
      1. Weight loss or slow weight gain. Now it is important to know that babies generally lose 5-7% of their body weight in the first week or so of life. So, it would be perfectly fine for an 8 pound baby to lose about 9 oz (dropping to 7 lbs. 5 oz.). Even a 10% weight loss can be normal (loss of about 13 oz. dropping to 7 lbs. 3 oz. for an 8 lb. baby) can be considered normal, but at that point you should be sure to be evaluated by a pediatrician and going in for regular weight checks. I also can't urge you enough to seek out a GOOD LC. What is bfing friendly expectations for weight gain? Most pediatricians will look for a return to birth weight by the age of two weeks. The AVERAGE weight gain per week for a nursing infant is 6 oz, but anywhere between 4-7 oz per week is acceptable.
      2. Low wet/poopy diaper counts. In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often--this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy. In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once mom's milk comes in, expect 5-6+ wet diaper every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 ml) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet

How do I know my baby is getting enough milk?

You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, when your milk is low in volume and high in nutrients, your baby will have only 1 or 2 wet diapers per day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day.  Consult your pediatrician if you are concerned about your baby's weight gain.

The chart below shows the minimum number of diapers for healthy, full-term babies. It is fine if your baby has more.

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