This article includes tips and facts that will help you through this wonderful (and sometimes difficult) time.
What happens directly after the birth?
After the delivery of your baby, a breastfeeding consultant, your midwife or a maternity ward nurse will guide you slowly through the steps of breastfeeding.
Feeding your baby can take 7 – 40 minutes, every 3 hours. Most newborns want to feed 10 – 15 times a day after the first 3 – 4 days of life and then settle down to 6 – 8 times a day by the end of the first week. Your baby will lose 5-10% of her birth weight in the first 3 days, but will start to regain weight after that.
For the first few days after birth, your breasts will secrete watery, yellow fluid known as colostrum. This precedes the onset of breast milk. Colostrum contains antibodies and has all the proteins, vitamins and minerals your newborn needs. It also acts as a gentle laxative, helping to clear out the sticky, brown-black meconium from your baby’s intestines.
You’ve probably heard people say that breast milk “comes in on the third day”. This means that the production of mature milk will start any time between the second and fifth day and it is quite normal for your breasts to increase in size when this happens.
When do you start breastfeeding?
A nurse will help you to get used to breastfeeding, giving you advice on latching, the different positions and how long to breastfeed on each breast. This can be a very stressful experience for new mothers as breastfeeding is not as easy as it looks.
Your newborn’s sucking reflex (urge) is the strongest in the first hours directly after birth. Breastfeeding as soon as possible is important – whether you had a C-section or vaginal delivery. The benefits are:
- It promotes bonding.
- It provides stimulation to bring the milk in sooner.
- It releases the hormone oxytocin to help the uterus contract.
- It provides the baby with the immunological advantages of colostrum.
If you can’t breastfeed in the first few hours, this doesn't mean you're a failure.
Some women never get the hang of breastfeeding or might decide that they won’t be breastfeeding and go onto formula directly after the birth. It is your choice. Know the facts and make the best decision you can to ensure your good health and a healthy, happy baby.
If you're not breastfeeding, you should know that:
- Your body will not know that you're not planning to breastfeed.
- Your milk will still come in on day two or three.
- Your breasts will swell and may be painful and possibly engorged.
- Avoid stimulating your breasts in any way, like pumping or standing under a running shower for relief – this will just cause further engorgement.
It's important to understand that you and your baby should be comfortable and relaxed. There is no one position that is better than another and a different position can be adopted with each feed as you and your baby experiment and get to know one another.
The different positions include:
1. The Madonna position: This is the most commonly used position. You can sit in a comfortable chair with your baby positioned across her lap.
2. The football position. This is an adaptation of the Madonna position. You can sit in a comfortable chair with your baby positioned under your arm and lying against the side of your body.
3. Lie on your side. You can also lie on your side with your baby on this side as well, facing you.
4. Lie on your back. You can also lie on your back with two to three cushions behind her head and allow your baby to lie on his tummy across your tummy. This position is often used when the flow of milk is too fast for the baby to cope with.
General points to remember are:
- You should be comfortable.
- Your baby should be positioned against you so that his chin, chest and knees are against your body.
- There should be as much skin contact as possible between you and your baby.
Tips on latching baby to the breast
To properly latch on a baby, a mother should:
- Support the breast with her hand by positioning her thumb on top, and her other four fingers on the bottom.
- The fingers should be kept far back enough so that it leaves enough of the nipple and areola (the darker skin around the nipple) for the baby to latch onto.
- The mother may need to support her breast for the entire feeding.
- Gently slide the nipple from the middle of the baby’s bottom lip, down to the chin.
- This will encourage the baby to open his or her mouth. The baby’s mouth should be opened wide with the tongue down. Then, quickly bring the baby to the breast, chin-first.
- The baby should be brought to the breast rather than vice versa.
- Make sure the baby has taken in as much of the areola as possible, with more areola showing at the top lip than at the bottom lip.
- The baby should not be latched on solely to the nipple. Instead, the baby must latch on to the areola as well in order to stimulate milk production.
- Latching on solely to the nipple only also causes pain to the mother.
- Make sure the baby’s nose is nearly touching the breast and not pressed against it. The baby’s lips should be turned out (flanged), not tucked in or under.
- If the positioning of the baby’s lips is unclear, gently press on the lower chin to pull the lower lip out.
- The baby’s tongue should be cupped under the breast.
- Then, listen for sounds of swallowing and look for movement along the baby’s lower jaw. There may also be visible movement at the junction of the baby’s temples and ears.
Signs of a hungry baby
If you're breastfeeding it can be hard to tell if your baby is getting enough milk as it can’t be measured in millimetres.
Possible signs that your baby isn't getting enough milk, and might still be hungry, include:
- Your baby doesn't begin to regain his birth weight after the first few days.
- Your breasts don't feel softer after feeds.
- Your baby is wetting fewer than six to eight nappies in a 24-hour period after the five days following birth.
- Your baby doesn't have a bowel movement at least once a day or is having small, dark stools five days or more after birth.
- Your baby becomes more yellow, instead of less yellow, after the first week.
Worried that you have too little milk?
Many new moms worry that their milk will be too weak or that they won't be able to produce enough milk.
The good news is that breast milk cannot be “too weak” – it is naturally perfectly balanced. But there is a possibility that you may not produce enough milk. This is not a physical problem (except in very rare circumstances) as your body has the ability to make enough milk, but is often due to external influences.
Some tips to ensure that you produce enough milk include:
- Drink plenty of fluid, even while feeding – the more fluid, the more milk. Try avoiding drinks with caffeine or high citrus levels as these can affect the baby.
- A lack of rest could also affect milk production – so if your baby is asleep, you need to sleep.
- Feed frequently and let your baby drink as long as he needs to.
- Make sure your baby is latched onto the breast properly. This is one of the main causes of low milk supply and of sore and cracked nipples. Your baby needs to have a large portion of the breast in her mouth and her jaw actions need to be strong.
- A good way to “understand” how latching and milk flow should feel is to try express with a breast pump as this imitates the sucking action.
Worried that you have too much milk?
If your breasts feel full and tender and aren't relieved when your baby starts feeding, you may have too much milk in your ducts, which needs to be relieved to avoid engorgement or mastitis.
The simplest way to relieve or avoid the problem is to:
- Let your baby empty the one breast completely before offering the second breast.
- Feed frequently and on demand as this stimulates the flow of milk.
- Don’t “skip” a feed in the hope that production will slow down. This will result in engorgement.
- Express a little after he has finished feeding, but only to a level of comfort.
- Massage your breast while under a hot shower and allow some milk to flow out. You must not pull on or near the nipples, but rather rub downwards from your armpit to your nipple.
- Always wear a supportive bra – even when you are sleeping.
More on engorgement
Engorgement can appear directly after your milk “comes in” or any time in the weeks to come if you are breastfeeding at the moment.
Signs of engorgement include:
- Breast skin that is shiny looking
- Swelling of the breasts
- Breasts that feel heavy
- Breasts that are tender (and even painful)
Follow these steps to treat engorgement:
- Express enough breast milk prior to a feed to soften the areola and enable your baby to attach properly.
- Once your baby is latched onto the first breast, allow your other breast to flow with the 'let-down' reflex.
- Always make sure that the first breast is well drained before you attach your baby to the other breast.
- If you have extreme engorgement, heat will not relieve discomfort but may actually further aggravate the situation. If this is the case, try using a liquid ice-pack or cool water as you express milk.
- Engorgement should be treated immediately. If left untreated, it can lead to a blocked duct or a breast infection called “mastitis”.
- Important: Consult your doctor before taking any medication as medication can affect your baby.
Is breast milk all my baby needs?
Yes, breast milk equals the perfectly balanced meal. It contains the following:
- Breast milk has a very high fat content. This isn't bad for your baby in the way a high-fat diet might be bad for you. The fat is important for the healthy growth (weight gain) of your baby.
- An enzyme in breast milk called “lipase” helps to break down the fat into smaller molecules which your baby can digest easily.
- Your newborn needs more protein now than he/she will ever need again.
- Breast milk contains “lactalbumin”, a simple, highly nutritious protein. Lactalbumin is found in the milk of many mammals.
- The carbohydrates found in breast milk are mainly lactose (milk sugar). Some babies are lactose intolerant.
- Your breast milk contains all the vitamins your baby needs.
- But if your baby isn't getting enough sunlight (and this doesn't mean sun exposure every day or a suntan), you might have to give him/her a vitamin D supplement. Speak to the clinic sister or your doctor before giving your baby any supplements.
- Newborns also don’t make their own vitamin K until a few days after birth. For this reason, your baby might get a vitamin K injection directly after birth.
- A healthy baby is born with a very good reserve of iron. Iron levels in breast milk are quite low, but the combination of vitamin C and lactose in your breast milk will help your baby to make the most of the iron that is available.
- Breast milk consists of 87% water. Therefore, you don’t have to give your baby additional water.
- The antibodies are the most amazing of all the ingredients. These are natural antibiotics to protect your baby and build his/her immune system.
Can breast milk be stored?
Expressing milk and storing it have its benefits.
By expressing milk you can give your partner the chance to feed your baby with a bottle, which creates special bonding time for dad and baby.
Other caregivers can also easily make sure that your baby is fed on time. And it also prepares your baby to be fed by others when you have to go back to work.
How to store your breast milk
You can store your breast milk in the fridge or the freezer, providing that you use sterilised containers such as glass bottles or the breast milk cups that you can get from baby stores.
Make sure to write on the container the day that you expressed the milk.
How long can you store breast milk?
- You can store it in the fridge for up to 8 days at 0 to 3.9 degrees Celsius.
- You can store it in a freezer (separate from the fridge, with its own door, and not a compartment within the fridge) for 3 – 4 months.
- Leave space at the top of the storage container to allow for expansion of the milk when it freezes.
Dos and don’ts:
- Don't refreeze breast milk after you have taken it out to thaw.
- Don’t freeze a bottle of milk that your baby has drunk from.
- If you thaw frozen milk, you can refrigerate it and use it within 24 hours.
- Thawed breast milk will look different from “fresh” breast milk (it might look a little blue, yellow or brown and it can also separate in layers). Don’t be concerned – this is normal.
- It's very important that you sterilise your breast pump every time you've used it.
How to express breast milk
Always work with extreme care and optimal hygiene when expressing milk:
- Your hands must be thoroughly washed beforehand.
- Any utensils, e.g. breast pumps or bottles that are used, must be adequately washed and sterilised.
- The containers in which the milk is to be stored should also be washed and sterilised. All breast pumps are for individual use only.
- Never borrow a breast pump from a friend or buy a second-hand breast pump.
- Express milk only for use when mom and baby are separated.
With the very best intentions you will usually only manage to express about one quarter of the quantity that your baby would have been able to drink if he were on the breast.
To express by hand:
- Wash your hands.
- Use a sterilised wide-neck bottle in which to express.
- Gently massage your breast in the direction of the nipple.
- Support your breast with a cupped hand and gently squeeze the areola area (the brown area behind the nipple) between thumb and forefinger. It helps to lean forward slightly.
- Warming your breasts with warm water or cloths will help milk to flow.
Bringing up wind
Far too much emphasis is placed on winding. It's not imperative for a baby to be winded after a feed. If you do it, keep it short – two to three minutes will do. If your baby falls asleep after a feed, don’t disturb him and leave him to sleep.
Here are a few methods:
- Put your baby onto your shoulder and gently tap his back.
- Lie him face down across your lap and rub his back in a circular motion.
- Sit your baby on your knee, with your hand under his chin and gently bounce him up and down.
- Put him in a semi-raised position after a feed.
- Gently rub the bones behind his ears.
- Give him a dummy.
Coughing up / choking
Choking is the coughing spasm and sputtering that happens when liquids or solids get into the windpipe. A newborn’s cough reflex should clear the windpipe of liquid within 10 to 30 seconds.
Choking in newborns is particularly common in the first day after birth, especially if the baby has swallowed any blood or meconium. It is also common when the milk flow is excessive, especially around 3-4 days of age.
Most babies cope with these episodes quite well, and either swallow the regurgitated contents or cough them out.
To prevent choking, make sure that nothing enters your newborn’s mouth besides your breast, a bottle and his own fingers (or a dummy and chewable toy if necessary). Do a regular scan of the area within your baby’s reach and remove small objects.
Babies cannot tell us if they're choking, so be alert for the signs:
- A baby turning blue or dusky or visibly struggling to breathe.
- If you see tears and arm and leg movements, but you hear no crying, also suspect choking.
The stool of a breastfed baby
If you breastfeed your baby, you can expect the stool to be a yellowy, mustard colour, green, brown and even orange. It will also be loose, unformed and probably a semi-liquid. This doesn't mean that your baby has diarrhoea.
Your baby will probably have 2 – 5 dirty nappies per day in the first 6 weeks. However, there could be a lot more. Remember that your baby is an individual and that his/her intestinal system is developing at its own pace. There are no rights or wrongs – as long as the stools are soft, yellow, brown, green or orange and not red or black, your baby is healthy.
After 6 weeks your baby will have fewer dirty nappies. Don’t be alarmed – this is normal and your baby might even skip a day or two, or maybe a week.
If you have an average-sized baby, you can expect her to double her birth weight by five months of age, triple it by one year, and quadruple it by two years.
The average gain in length or height is 25cm in the first year. Note, however, that these are estimates for the average-sized baby and could be different if your baby was born prematurely or has been ill.
Common times for growth spurts are during the first few days at home (around day 7 – 10), then again at 2 – 3 weeks, 4 – 6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). It may vary from baby to baby.
Growth spurts usually last 2-3 days, but sometimes last a week or so.
Here are a few tips on how to handle a growth spurt:
- Follow your child's lead. Your baby will automatically get more milk by nursing more frequently, and your milk supply will increase due to the increased nursing.
- It is not necessary (or advised) to supplement your baby with formula or expressed milk during a growth spurt.
- Supplementing (and/or scheduling feeds) interferes with the natural supply and demand of milk production and will prevent your body from getting the message to make more milk during the growth spurt.
- Some nursing moms feel more hungry or thirsty when their baby is going through a growth spurt. Listen to your body – you may need to eat or drink more during the time that your baby is nursing more often.
Sore, cracked nipples
You cannot “prepare” your nipples for breastfeeding, but by taking the right precautions during feeding you can try to avoid sore, cracked nipples. This is one of the most common problems associated with breastfeeding, especially in the early days.
Some of the causes of sore nipples include:
- Incorrect latching.
- The position of feeding.
- Taking your baby off the breast incorrectly.
- A very strong sucking action by your baby, especially in the beginning.
- Not allowing your breasts to dry out between feeds.
- In extreme cases, a thrush infection.
If these problems aren't resolved early, your nipples may become cracked and they may even bleed. This is exceptionally sore and makes breastfeeding very difficult.
Follow these guidelines:
- Always ensure that your baby is correctly latched when feeding and not just pulling at the nipple. If you are unsure, show your clinic sister your feeding technique so that she can advise you.
- Change the feeding position in the first few weeks every third or fourth feed. This will also help you work out which position works best for you and your baby.
- To take your baby off the breast properly without hurting your nipples, you need to break the suction by putting your finger in the corner of her mouth. Don’t pull the nipple out.
- Try to feed more frequently so that she doesn’t suck too hard when put to your breast. When you've finished feeding, rub a little of the breast milk onto the nipple area and leave the area open for a few minutes to dry out.
- Breast pads or bras with plastic linings keep the moisture in, so try not to use them too often. Always change them when they're wet and try to give your breasts some air.
- You don’t have to use creams on your breasts, but if they are very tender choose a cream that is light and which doesn't need to be removed to feed.
- If you have thrush, you will need to see your doctor. He or she will prescribe a breast gel that will also help treat your baby’s thrush.
Contraception and breastfeeding
Breastfeeding is NOT a contraceptive. In fact, your body may be very fertile from the hormones released during pregnancy and child birth.
Although your periods may not return while you're breastfeeding, you could still ovulate, so unless you really want to have a small gap between babies, it is recommended that you take contraceptives after the birth and while you're breastfeeding.
The mini-pill, which doesn't contain oestrogen and which has lower progesterone, shouldn't affect your breastfeeding. The normal combination pill is not recommended during breastfeeding as it can decrease your milk supply. The contraceptive injection can be used during breastfeeding, as can most other forms of contraception such as the diaphragm, an intra-uterine device and condoms.
Painkillers and breastfeeding
There are many reasons why you may need to take painkillers while you're breastfeeding, from stress-induced headaches to a cold to soreness from a C-section, an episiotomy or even tender breasts.
Since everything you consume is transferred to your breast milk, you need to be aware of what is safe and what is not. Always speak to your doctor before taking any medication.
What can breastfeeding mothers eat and drink?
Here are a few important guidelines:
- DO NOT smoke, drink alcohol or use any recreational drugs.
- If you are on medication for a chronic condition, you should consult your doctor before you take it.
- You don’t have to avoid certain foodstuffs during breastfeeding.
- You should have a balanced intake of foods. Variety in the diet is important.
- Strong flavours are inclined to flavour the milk, but even this is very acceptable to the baby.
- If, however, the baby shows signs of intolerance, consult a professional lactation consultant for advice.
- It is VERY seldom that a mother is placed on an exclusion diet during lactation.
- A baby’s restlessness can be ascribed to many things other than a mother’s food intake.
- You should avoid dieting while you are breastfeeding.
Caring for your breasts
Many people make a great fuss over breast care and recommend all sorts of potions and lotions. If your baby is latched correctly, you shouldn’t have any problems and breastfeeding will be painless.
Here are a few things to bear in mind:
- A daily shower with warm water is all the cleaning a mother needs.
- Wash the breasts, not the nipples.
- Avoid soap as this has a drying effect on the skin and also washes off the natural softeners.
- Nipples should be kept dry.
- Avoid soggy or wet breast pads.
- Prevent cracked nipples by correctly latching and fixing the baby onto the breast.
- Wear a comfortable bra.
When to call a lactation consultant
A lactation consultant is there to help you in any situation which causes you stress or anxiety concerning your own health or the health, feeding and behaviour of your baby.
Such a consultant is someone who has herself breastfed a baby, who can identify with your anxieties, listen to you and offer constructive suggestions to overcome your problems. No question is a stupid question when it comes to your most precious possession.
Call a lactation consultant whenever you need reassurance.