Breastfeeding: Getting Started

The First 24 Hours

• Uninterrupted skin-to-skin with mom right after birth is very important to help baby start off with a good latch. All non-necessary procedures (weight, bath, shots) should wait until after the first breastfeeding session. There can be skin-to-skin even after a C-section.
• • Skin-to-skin will keep baby warmer, calmer, and they can hear mom’s heartbeat. 
• Your milk will appear yellow or golden…the amount will be small, but it is made in the right amount and has what your baby needs! Remember, your baby’s tummy is tiny, so he/she will only eat about 1 tsp of your milk at each feeding! 
• Your breasts may be a little tender, but breastfeeding should not hurt! 
• Your baby will probably be awake the first hour after birth, so this is a good time for him/her to breastfeed. It may be more nuzzling than nursing the first couple of times, but these are good starts!
• If you have a lot of visitors after delivery, try to keep your room calm and quiet for the first hour to allow time for your baby to breastfeed. 
• It’s normal for babies to sleep heavily after their initial alert period. Labor and delivery is hard work for you and your baby! Some babies may be too sleepy to latch on well and feedings may be short and irregular. Let your baby feed as he/she demands. This may result in a 3-minute feeding or a feeding that lasts 15 minutes. As your baby wakes up, he/she will have a strong instinct to suck and feed often. 

Keep your baby skin to skin as much as possible as this will help alert them to go to the breast more often. Your baby— and your breasts—need at least 10 feedings in 24 hours. 

Baby’s First Milk (Colostrum)

Babies are born with TINY bellies (about the size of a cherry)!

Colostrum is made during the last months of pregnancy and the first days after birth. Because babies have such small stomachs, they cannot hold much in the early days. Colostrum is the perfect first food because it is small in quantity and helps your baby get used to breastfeeding before the faster flow of milk arrives. It also helps your baby poop, protects your baby from illness, and satisfies your baby’s hunger and thirst. 

Once baby is born, it is important to feed baby at the breast or use hand expression by massaging your breast and collecting the milk.

Small feedings often also create a healthy eating pattern right from the start. 

Colostrum is the only food your baby needs!

Days 2–5

Do NOT give your baby a bottle or a pacifier until your milk supply is established and a good sucking pattern is set! Allow 3-4 weeks.

• During this time, colostrum transitions to mature milk. It will look bluish white but may still look a little yellow or golden for about 2 weeks. 
• Your breasts may swell when your mature milk comes in. Your breasts may feel full and may leak.  Tenderness is normal but pain is not! This swelling should go away around the second week. You are not losing your milk when the swelling goes away. Your body is just adjusting to your baby’s feeding demands. Breastfeeding often will help reduce swelling. 
• Your baby will feed a lot! Ten to twelve times in 24 hours is normal. Your baby’s stomach is little and breast milk is easily digestible, so frequent feedings are normal! 
• Breastfed babies don’t eat on a schedule. It is okay to feed whenever baby shows signs of hunger! Watch your baby, not the clock. 
• Feedings will vary as all babies are different. Your baby may only take one breast at a time or seem to prefer one side. 
• After delivery, it is common for babies to lose some weight. Your baby should regain his/her birth weight by 10-14 days of age. If you are worried your baby is losing too much weight, ask your doctor or WIC staff to weigh your baby. 
• Skin-to-skin is not just for the hospital and not just for mom. When at home both mom and dad can do skin-to-skin to bond and calm baby. Think of it as a “reboot” any time there is trouble with latching, and it can help improve your milk supply. 
• You need to take care of yourself to take care of your baby. You do not need to follow a special diet but try to rest, eat nutritious foods, and drink fluids when thirsty.

Breastfeeding can be difficult during the first 5 days. There is a lot to learn. If you have questions or concerns, contact your local WIC office or Breastfeeding Peer Counselor for help.

First 4–6 Weeks

• Your milk may vary during a feeding from a bluish white at the beginning of a feeding to a creamy white toward the end of a feeding. The color may vary a little from day-to-day and may be affected by some foods you eat, but this won’t harm your baby. 
• As your body adjusts to breastfeeding, your breasts will be softer, and leaking will slow down. Don’t worry. Your milk is still there! 
• As your baby grows, he or she will become better at breastfeeding and will have a larger stomach to hold more milk. Feedings may take less time and be further apart. By now, you will have learned his or her hunger cues. 

Growth Spurts

• Most babies will have growth spurts at 2-3 weeks, 6 weeks, 3 months, and 6 months. However, growth spurts can happen at any time. During these growth spurts, your baby may be fussy and want to nurse more often. When the baby feeds frequently, your breasts will respond by making more milk.

Many breastfed babies like to nurse often because it is comforting and keeps you close to them! 

Signs of Hunger & Fullness

Baby’s Signs of Hunger

• Roots around on the chest of whoever is carrying them 
• Opens and closes mouth
• Brings hands to face
• Flexes arms and legs
• Makes sucking noises and motions
• Sucks on lips, hands, fingers, toes, toys, or clothing
• Crying* is a late sign of hunger! It can be hard to latch when baby is crying. If baby has already reached the crying stage, try skin-to-skin. This may calm baby to get a better latch. 

Baby’s Signs of Fullness

• Slows or decreases sucking
• Extends/relaxes legs, arms, and/or fingers
• Pushes away or arches back
• Turns head away from nipple
• Decreases rate of suck or stops sucking when full

The best time to breastfeed is when baby is in a light sleep or “quiet alert” state. Babies will often be sleeping, but have eye movement under their eyelids, opening their mouth or make sucking sounds. They may also be awake but very still. These are all clues that baby is in a good state for breastfeeding. It’s important to have baby WITH you (and on your skin) to see these signs. 

*Crying may also be your baby’s way of saying “I need something!” It may be a clean diaper, a burp, some rocking and loving, a nap, or perhaps he or she is too hot or cold. If you have just breastfed, try giving baby these things first. If nothing else helps, your baby may still be hungry. Remember… try to not watch the clock! 

Latch (Starting and Ending Breastfeeding)

Positioning

• Make yourself comfortable. A pillow or folded blanket placed on your lap can support your arm and baby. (Many mothers feel clumsy doing this the first time, so be patient with yourself!) 
• Baby’s tummy and chest should be touching mom’s tummy. 
• Baby’s arms and hands should be around the breast (baby “hugging” the breast). 
• To make sure baby is positioned correctly, you should be able to draw a straight line from baby’s ear, to shoulder, to hip. 
• Baby’s nose should be lined up at mom’s nipple. 
• Support but don’t force baby’s head to breast. 

Getting A Good Latch

Position baby so it is comfortable for baby and YOU. Baby’s tummy and chest should be touching mom’s tummy. Before latching, hold baby nose to nipple.

Hold your breast in a ‘C’ hold. Curve your hand like a ‘C’ with thumb on top, supporting your breast behind the areola. Wait for baby to open mouth WIDE. You can lightly stroke baby’s upper lip with the nipple to get a wide gape. Nipple should be pointed at the roof of baby’s mouth.

Pull baby quickly on to the breast so that chin and lower jaw make first contact, not the nose. Baby should take in more of the lower breast than the upper breast. If baby only latches to the nipple, simply remove baby from breast and try again. Use your smallest finger in the corner of baby’s mouth to break the latch. 

Baby’s lips are spread open to create a good seal on the breast. Look for both of your baby’s lips to be turned out (not tucked in or under) and relaxed—you should see the pink of the lips. If needed, press gently on the chin to pull the lower lip out. The tongue should be cupped under your nipple. 

When your baby is ready to end the feeding, he/she will release the breast and be relaxed. Keep track of the breast last used. Start with it at the next feeding. 

Watch this video on how to get a deep latch!

Baby Belly Size

Day One: Baby’s belly is the size of a cherry.

1 tsp per feeding

Day Three: Baby’s belly is the size of a ping pong ball.

3–6 tsp per feeding

Day Ten: Baby’s belly is the size of an apricot.

12 tsp per feeding

Image from Le Leche League - Canada. 

Successful breastfeeding is a baby who is thriving, growing well, and having several wet and dirty diapers. 

Dirty Diaper Schedule

The ideal way to know if baby is getting enough milk is frequent weight checks. The number and color of dirty diapers can be useful as a rough gauge between weight checks in the early weeks. Contact your local WIC office if you would like to do a weight check. 

The first 24 hours: At least one meconium stool.

At least one meconium stool. Meconium is the baby’s first stool and should be black, thick, and sticky. Meconium is the baby’s first stool and should be black, thick, and sticky. Meconium is made by ingesting mucus, amniotic fluid, and other materials in the womb.

Day 2: At least two dirty diapers.

Day 3–5: At least three dirty diapers each day.

The number of dirty diapers should increase day by day, through the first 7 days. A dirty diaper is a stain about the size of a quarter or larger. 

Watch for gradual color changes:

• Day 1 & 2—black, thick and sticky
• Day 3 & 4—green and pasty
• Day 5+—yellow and seedy

When changes are happening in the baby’s diaper, they are happening in mother’s breasts too. Mom’s colostrum gradually becomes transitional milk, and then mature milk. For the first 7-10 days, changes in the diaper tell moms that everything is going according to plan. 

Once a baby’s diaper pattern seems consistent you can stop watching so closely. More changes will come as your baby continues to grow and gain weight. After 4-6 weeks, some babies will continue to have three or more stools a day. Others will have fewer and larger stools every 1-5 days. 

Image from: WICbreastfeeding.fns.usda.gov

Sources: La Leche League International & Breastfeeding: Keep It Simple Amy Spangler, MN, RN, IBCLC