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In The Beginning

You’ve just brought your new baby home from birth center or hospital. Suddenly, everything is overwhelming. Where do you begin? How do you know that all is well with your newborn?

The First Week

  • HOW OFTEN?  Aim for 10-12 feedings per 24 hours for the first two weeks of life.  You CAN”T nurse too much, you CAN nurse too little.
  • WHEN? At first signs of hunger (stirring, rooting, sucking, etc). Crying is too late, easier to nurse before crying. You can change baby before switching to next breast for a more peaceful changing.
  • HOW LONG? Watch the baby, not the clock. Keep him/her actively sucking/swallowing by cuing if he stops (breast compression*). When he/she comes off, offer burp and/or change and then offer second breast. Baby should be feeding every 2-3 hours in day with a possibly longer stretch at night.

(*Breast compression)To keep baby actively sucking/swallowing at breast, squeeze breast when he slows down.

  • WEIGHT GAIN? Normal weight loss= 7-8% in first few days. Once mature milk is in, normal weight gain is 6 or more ounces weekly.
  • PEES and POOPS? 1 on day 1, 2 on day 2, 3 on day 3, from day 4 on – 4 or more seedy, yellow poops and 6-8 pees every 24 hours.
  • BREAST CHANGES? Mature milk typically “comes in” between day 2 & 5. Minimize engorgement with frequent feedings, finishing one breast before switching to the next, ensuring good latch. Can use cold compress, cabbage leaves, reverse pressure softening, pumping to relieve softness.

CALL YOUR DOCTOR OR LACTATION CONSULTANT if insufficient pees or poops, dark colored urine after day 3, dark colored stools after day 4, or mom has mastitis symptoms (chills, fever, inflamed breast, flu feeling).

Helpful Tips

  • Laid back breastfeeding – Leaning back, baby on chest, he will seek out breasttlc1
  • You can support his neck and shoulders/back, but try not to push on head.  Chin hits breast first, nose free, head is slightly tilted back, throat is open.

Difficulty Latching?

  • Aiming nipple to nose can be helpful. Baby takes in more breast near his lower lip. It is not usually possible to get entire areola in baby’s mouth. You will still see top of areola and little or none of bottom. Baby comes UP onto breast.tlc2
  • If baby is struggling to latch due to tongue tie, prematurity, flat or inverted nipples, then, nipple shield may help him stay on and help supply issues.
  • Patience, patience, patience.

Confusing Baby

  • New baby has a lot to learn at once. Allow parent and baby to “master” breastfeeding before introducing other things (unless medically indicated)
  • Pacifiers: Routine use linked to early weaning, confusion, lower milk intake, increased thrush, oral development problems, lower weight gain, & fewer smiles! No calories going in, but burning calories. Use sparingly if you must, but newborns should be fed when they want to suck, rather than being offered a pacifier.
  • If supplementation is necessary-Can use Supplemental nursing system or Paced Bottle Feeding. Preferable to use expressed breastmilk or donor milk before formula.
  • THE BABY MUST BE FED/THE MILK SUPPLY MUST BE PROTECTED –If necessary to use a bottle, use Paced Bottle Feeding with baby sitting upright, tickling the upper lip eliciting a wide open latch, bottle at about a 90 degree angle, so baby must suck and swallow to keep milk coming. Use traditional nipple shape, slow flow.

Sore Nipples

  • Your nipples should not be abraded, cracked or bleeding, though they may feel tender. If so, see lactation to resolve, typically, improper latch or oral anomaly.
  • Try varying position, remembering you are BREASTfeeding, not NIPPLE feeding.
  • Start on least sore side first.
  • If you need to remove baby from breast, release suction first.
  • Hydrogel dressings are helpful for moist wound healing. Use medical grade (ie Ameda Comfortgels). or nipple Cream (olive oil base) is helpful. Coconut oil is helpful. Medihoney (Amazon) is really helpful for severe wounds.  Lanolin is NOT particularly helpful. Nipple shields are not helpful for soreness, but can help latch.
  • If nipples are cracked or bleeding, prevent infection with Bactroban (Rx), Polysporin, or Bacitracin (not Neosporin). Keep area clean (can use saline.)
  • If pain continuing, consider tongue tie, Vasospasm, All Purpose Nipple Ointment

BE PATIENT WITH YOU, WITH YOUR BABY…. Most parents are deeply grateful that they stuck it out through the first challenging weeks for the rewards. Those who give up, often have deep regrets.  Let me know if I can help you further!