Breastfeeding Basics - Part II: The First Few Days

In the previous post, I discussed briefly some of the basic details about how breastfeeding works and what you need to know before the baby is born. If you haven't yet given birth, or if you've recently given birth but haven't read that post yet, it'd be a good place to start.

(This post is written with the assumption that you gave birth to a normal, healthy, full-term baby. Most of the advice in this series - especially the early posts - simply does not apply if you have an extraordinary circumstance such as a premature baby, a baby in the NICU, a baby with a cleft palate or other physical impediment to breastfeeding, etc.)

Now that you actually have a baby to feed, let's talk about what's going to happen in the first few days postpartum.

Hunger Cues


How will you know when your baby is hungry? Well, your best bet to start with is to offer the breast whenever the baby fusses. Even if he's not hungry, it's a great way to comfort him. If he doesn't want to suck, he won't. If he does, you'll be giving him what he needs. Pretty soon, you'll start learning his hunger cues. A hunger cue is a young baby's way of letting you know he needs to nurse. A fairly typical cue is fussing accompanied by "rooting," which is when the baby turns his head toward anything brushing his cheek and tries to suck on it. This may be your finger, a blanket, or, of course, your nipple. The rooting reflex is how the baby looks for the breast and is an excellent clue to look for if you think he may be hungry. Some babies may also open and close their mouths, wave their arms, or stick out their tongues. You'll start to recognize your own baby's cues. Remember that crying is a late sign of hunger, and by the time he starts crying, he's already been hungry for a while and is getting desperate.


Nurse That Baby!


In the first few days of life, it may seem like all you're doing is nursing. This can be frustrating, as it seems like you barely put the baby down to change his diaper, only to have him start fussing to eat again. And feedings seem to take forever. Your arms get tired. You can't find time to pee or eat. And he'll only sleep if you're holding him.

I know this is an adjustment, but I hope that you're also enjoying your new baby, taking this time to bond with him and get to know him a little, memorizing his face and his little ears, the cute little noises he makes when he sucks, and the random waving of his arms. If you're in a hospital, enjoy the fact that someone else is taking care of you. If you're at home, let your loved ones care for you while you focus on your baby.

All of this constant nursing is very, very good for both you and baby. I mentioned in the previous post that breastfeeding takes practice. Just like any other skill, the more you do it, the more you work at it, the better at it you get. The frequent nursing gives you and your baby lots of opportunities to practice various positions and holds and that all-important latch.

The most important benefit is that nursing is stimulating your breasts and your brain to produce milk, and all the colostrum and milk your baby is taking in will help him grow, pass along antibodies and beneficial bacteria, and protect him.


Avoiding Bottles


I also mentioned in the previous post that it's generally recommended to avoid any kind of artificial nipples (pacifiers and bottles) before about the fourth week of life. Sometimes you can get so overwhelmed with the constant nursing that the idea of giving just one bottle, or of offering a pacifier, so you can have an hour or two without baby attached to you is very attractive. Keep in mind that this period is only a few weeks, and that as overwhelming as it is, you are doing yourself and your baby a world of good by letting him nurse as often and for as long as he wants. This intense period will end, and things will get easier.

If you do need a break, sometimes passing the baby to Daddy or Grandma or some other caregiver for an hour will allow you to rest, go to the bathroom, eat something, or just doze for a bit. Sometimes the baby will go longer between feedings if someone else is holding him, because he doesn't smell or sense the milk nearby. Don't deny the baby a feeding, and make sure he's satisfied before handing him off, but it's perfectly okay (and healthy) for you to take an hour for yourself when you need it.

As a side note, if you are in a situation where you must supplement your baby with expressed breastmilk or formula, there are ways to feed him without using a bottle. These include a Supplemental Nursing System, finger feeding, syringe feeding, or cup feeding. You should talk with a lactation consultant about which method will work best for you and how to do it.


When Your Milk "Comes In"


For the first two to six days postpartum, your baby will be subsisting off of the miraculous substance called "colostrum," which is produced by your body before you start making mature milk. If this is your first baby, your milk may take as long as six days to fully appear. If you have had a baby before, and especially if you nursed a baby before even for a little while, your milk may come in as quickly as 48 hours after giving birth.

You can tell your milk has come in because your breasts will suddenly feel very full, very large, possibly hard to the touch, and possibly painful. This is called "engorgement," and engorgement happens when you have more milk in your breasts than you need or that your breasts can comfortably hold. Some babies have difficulty latching when you are engorged. You can relieve engorgement by squeezing out some of the milk with your hands, using a breast pump to remove some of the milk, using warm compresses or standing in the hot stream of water from the shower to encourage milk flow, and, of course, nursing the baby. Be careful not to remove more than enough milk to be comfortable, or you will stimulate more milk production and continue the cycle of engorgement.

You can also tell your milk has come in because instead of the thicker, golden substance you've been seeing, you'll see a thinner, white liquid.


Pain


The first few days or weeks of breastfeeding may be painful. While you'll hear over and over again that if your technique is good, if the baby's latch is good, then you won't feel pain, some women may have a baby with a perfect latch and yet still experience some pain. It's important to know "good" pain from "bad" pain.

First of all, engorgement itself can be painful. If the pain localizes to a "lump" or "bruised" spot on your breast, this may be a plugged duct or the beginnings of mastitis, which you want to make sure to treat right away. If it's just a general breast soreness, relieving the engorgement should also relieve the pain.

Secondly, some women experience nipple pain with nursing during times of hormonal changes, such as the first few days or weeks postpartum. Your nipples may feel sore, or you may experience some pain when the baby latches. If a lactation consultant has evaluated the baby's latch and it seems to be fine, you may be experiencing normal-for-you pain that will pass once your hormones settle down. However, if your nipples become bruised or cracked and bleeding, or if your nipple looks like the tip of a new tube of lipstick after nursing your baby, then the baby's latch is likely in need of adjustment, and you should see a lactation consultant immediately.

Some women experience let-down as a painful sensation. Let-down is when the milk is released into the milk ducts and flows down toward the nipple. While some women don't feel any sensation at let-down, for others it can be very noticeable. As your supply adjusts to meet your baby's demand, the intensity of the let-down often also decreases.

Finally, nursing your baby releases the hormone oxytocin, which is the same hormone that stimulates uterine contractions during labor. The oxytocin released while nursing will also stimulate your postpartum uterus to contract, helping to bring it back down to its normal size and limit your postpartum bleeding. While these contractions are good things, they can be quite painful for some women. Your doctor likely recommended or prescribed a pain reliever such as ibuprofen. Take it as directed to help with this pain, as there is certainly no need to suffer.

I don't want to scare you away with all this talk about pain. The pain of nursing should not be excruciating, it should not last more than a few days or weeks, and it should not make you dread nursing your baby. If the pain is unbearable or causes you to avoid allowing your baby to nurse, or if your nipples are showing signs of damage, please see a lactation consultant.

Positions


There are many comfortable ways to hold your baby while nursing. One popular way is the "cradle hold," in which you hold the baby along your forearm, supporting his head in the crook of your elbow, with your hand supporting his back, bottom, or thigh (depending on how big your baby is). Another common one is the "football hold," or clutch hold, where you hold the baby face-up on your arm, against your side, much the way a football player holds a football (hence the name). This position is popular for women who have had a c-section or who are nursing twins, as it keeps the baby off your stomach. There are several other ways to hold your baby in order to nurse him comfortably. Usually there will be someone in the hospital to help you with these different positions. You can also see illustrations online, such as here. It is helpful to find a few that work well for you and practice with them. The most important thing to remember is that the baby should not have to turn his head or strain to find the nipple.

Keep it up! The first few days and weeks can be difficult, but the hard work pays off. I hope you'll join me for Part III, which will discuss the next few weeks up to what I call the "magical six-week mark."