The First Weeks of Breastfeeding: What to Expect and When to Get Help

While no two mother-baby pairs are alike, the following typical breastfeeding routines will help prepare you for what to expect during your first weeks at home. Beginning when your milk comes in, the following guidelines describe expected breastfeeding patterns, and offer guidance about when to seek help. If you have any breastfeeding concerns, contact the hospital where you gave birth and ask to be referred to a lactation consultant (ideally one who is credentialed as an IBCLC). Many hospitals now offer follow-up breastfeeding services—including support groups and individualized help–for their new mothers. Remember that breastfeeding problems are easier to remedy when you get help early.

 

Infant Latch on and Suckling

What to Expect:  By the time you go home from the hospital, your baby should be able to latch on to both breasts without much difficulty and suck actively for at least 10 minutes per breast at each feeding. When her pattern of sucking slows down at the first breast or she becomes drowsy, burp her and help rouse her to take the second side.

 

When to Get Help:  If your baby is unable to latch on to one or both breasts, or latches briefly but does not suck effectively, seek assistance right away. If your baby is not able to latch and nurse well, she will not get enough milk, and your supply will decrease. Early assistance to overcome a latch problem will ensure your baby is well-fed and your milk supply remains plentiful.

Infant Swallowing While Feeding

What to Expect:  By the time your milk comes in (usually on the 2nd to 4th day), you should hear your baby swallow often while breastfeeding – a soft “cuh, cuh, cuh” sound when she exhales. When her rate of swallowing slows, switch her to the second side.

When to Get Help:  If you do not hear frequent swallowing when your baby nurses – and suspect that she is not drinking much milk – contact her doctor. Infrequent swallowing may mean she is not getting enough milk.

Nursing Frequency

What to Expect:  Typically, your baby will give feeding cues (rousing from sleep, squirming or grimacing, moving her tongue or mouth, trying to suck on her fingers or hands) every 2 to 3 hours. Feedings are timed from the beginning of one nursing to the beginning of the next. Since the first breast nursed gets better drained, you should alternate the side on which you start feedings. Expect your newborn to nurse at least 8 times every 24 hours. In fact, 10 or 12 feedings a day are not uncommon during the first two weeks. Babies often cluster several feedings close together, especially in the late afternoons or evenings, and then sleep for a longer stretch at other times.

 

When to Get Help:  If your baby often sleeps through feeding times, seldom demands to be fed, or frequently needs to be awakened to nurse, contact her physician and have her weighed and checked. You also should seek help if your baby nurses more than 12 times each day or frequently acts hungry after breastfeeding.

 

Infant Bowel Movements

What to Expect:  Expect your newborn’s bowel movements to turn yellow by the 4th or 5th day after birth (or within 24 hours after your milk comes in). Her stools will be loose, about the consistency of yogurt, with little seedy curds (resembling a mixture of cottage cheese and mustard). Your baby should pass 4 or more sizeable (at least a tablespoon in amount) bowel movements each day for at least the first 4 to 6 weeks of life. After the first month or two, the number of daily bowel movements gradually declines.

When to Get Help:  If your baby is still passing dark meconium or greenish brown “transition” stools by 5 days of age and has not yet had a yellow bowel movement, or if she has fewer than 4 stools each day, or her bowel movements are very small, contact your baby’s doctor to have her checked and weighed to see if she is getting enough milk.

Infant Urination

What to Expect:  In the first 2 days, your baby may wet only a few times in 24 hours. As your milk production surges, the number of wet diapers steadily increases. By the 4th or 5th day, your baby should urinate after most, if not all, feedings (at least 6 to 8 wet diapers every 24 hours). The urine should be colorless (dilute), not yellow (concentrated).

When to Get Help:  If your breastfed baby has a pinkish or orange-colored “brick dust” appearance in her diaper (a sign of concentrated urine) after the 3rd day of life, contact her doctor and have her checked to make sure she is getting enough milk. Also notify her doctor if your baby has fewer than 6 wet diapers each day after the 4th day or if her urine is dark yellow or scant in quantity.

Infant Weight

What to Expect:  All babies lose some weight in the first days after birth. Peak weight loss typically occurs on the 3rd day, just as your milk starts to be produced in abundance. By 4 to 5 days of age, most breastfed babies begin gaining weight (usually about 1 ounce each day between birth and 3 months) and will regain their lost weight and surpass their birth weight by 10 to 14 days of age (often sooner). After the first several months, your baby’s rate of weight gain gradually tapers off.

When to Get Help:  If your baby loses more than 8 to 10% of her original birth weight, continues to lose weight beyond 4 days of age, still weighs less than her birth weight by 2 weeks, or has not started to gain at least 5 to 7 ounces each week after your milk has come in, she probably is not drinking enough milk and may not be breastfeeding effectively. Contact your baby’s doctor who can evaluate her, decide whether she needs supplemental milk, and refer you to a lactation consultant to help you increase your milk supply and your baby’s breastfeeding effectiveness.

Your Breast Changes

What to Expect:  The small amount of colostrum your breasts produce in the first few days of breastfeeding is the perfect first food for your baby. Typically, as your milk production surges within 2 to 4 days after your baby’s birth, your breasts become firmer, heavier, warmer, and may feel tender. These breast changes, known as postpartum breast engorgement, are more dramatic in some women than others. After your milk has come in, your breasts should feel full before each feeding and softer after your baby has nursed.

 

When to Get Help:  If your breasts become severely engorged and you are having difficulty latching your baby or getting your milk to flow, or if your full breasts do not soften when your baby nurses, contact her doctor or a lactation consultant. The lactation consultant can help you use an electric breast pump to express your milk, soften your breasts, improve your baby’s latch, and help her drink more milk. If normal postpartum breast engorgement has not occurred by 4 days and your baby acts hungry after most feedings, you should also seek help to make sure your baby is getting enough milk.

Nipple Tenderness

What to Expect:  Your nipples may be mildly tender for the first several days of nursing – usually at the beginning of feedings and subsiding as the feeding progresses. This mild, temporary nipple tenderness generally does not interfere with feedings and dramatically improves once your milk has come in. Severe or persistent nipple pain usually is caused by incorrect infant latch-on or suckling. Severe pain can impair milk letdown, cause you to postpone feedings, and limit the amount of milk your baby takes. 

When to Get Help:  If your have severe nipple pain that causes you to dread nursing your baby, pain that lasts throughout a feeding or persists beyond a week, your baby may not be latched to your breast correctly, causing nipple trauma. A lactation consultant can help you latch your infant comfortably for effective breastfeeding and give you tips for healing damaged nipples.

Letdown Reflex

What to Expect:  You may notice the sensations of milk letdown within 2 to 3 weeks of giving birth. Letdown usually occurs shortly after you begin nursing, and it also can be triggered by the sight, sound, or smell of your baby. Once your milk supply is well established, letdown causes noticeable, brief breast sensations in many women – such as a slight tingling or pins-and-needles feeling, tightening or heaviness, or slight burning. The rapid flow of milk during letdown may cause milk to drip or spray from both breasts. Your baby may start gulping milk, and her rate of swallowing will increase.

When to Get Help:  Although women vary in the way they experience milk letdown, most are aware of the reflex by 3 weeks postpartum. Typically, the signs of letdown are dramatic with an abundant supply. If you are concerned about your milk supply, contact your baby’s doctor and arrange to have your infant weighed.

Adapted from Great Expectations: The Essential Guide to Breastfeeding by Marianne Neifert, MD (Sterling Publishing Co., 2009). 

Copyright ©  2011  Marianne Neifert, MD, MTS     May be duplicated if authorship is cited.     www.dr-mom.com