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Answers to Common Questions
Let the nursing staff know you want to breastfeed your baby immediately after birth, if possible, and request to room-in with your baby. In the first moments after birth, practice skin-to-skin care with your newborn right on your chest, both of you covered with a blanket for at least 30 minutes. This closeness comforts and warms your baby – and helps you get to know your baby’s early hunger cues. Immediate skin-to-skin contact after birth is shown to help a baby breastfeed well and often. If you have a cesarean delivery, ask to begin breastfeeding as soon as possible after birth.
For the first month after birth, your baby needs to nurse every two to four hours, or eight to 12 times per day. Breastfeeding should be “on demand” as your milk flow is getting established. Allow your baby to set the pace and keep in mind that during the evening hours, it’s normal for baby to “cluster feed” every 30 to 45 minutes. It is also normal for a newborn to seek the comfort and closeness of lying at the breast to adjust to being out of the womb. At first, it may feel like you are nursing around the clock, which is completely normal. Soon you and your baby will settle into a more predictable schedule.
Sleepy babies need to be awakened to feed every two to three hours during the early weeks of life. As babies get older they may go longer between feedings since their stomach size grows and mother’s milk supply and production increases. Newborns shouldn’t go more than about four hours without a feeding, even during the night. If baby doesn’t awaken for feeding, place them skin-to-skin and usually they will begin to search for the breast within 30 minutes.
Babies give cues such as smacking or pursing their lips, putting their fists or fingers to their mouth, moving and flexing their arms, or nuzzling against your breast to let you know they are getting ready to feed. Crying is a late hunger cue, so these signals can help you read your baby’s needs better than the clock.
A good latch is essential to a comfortable and successful breastfeeding experience. It helps prevent sore nipples and will help your baby receive more milk and swallow less air. When you are nursing, check your baby and your breast for the following:baby’s mouth is wide open about 140 degrees; lips are curled out with nose slightly touching the breast; most of the areola is inside the baby’s mouth; the lower lip covers more of the areola than the upper lip; baby’s chin is pressed deeply into the underside of the breast; the tongue is under the nipple and extends outward over the gum line forming a “trough”through which the milk flows; baby’s jaws compress the areola rhythmically; you will hear swallowing; and when baby comes off the breast, the nipple will look like the flat top of a pencil eraser, flat on the tip, not pinched.
Although you can’t measure the volume of breast milk your baby consumes, you can see the evidence of good intake by what is coming out. Your baby should be making plenty of wet and dirty diapers after the first week – six to eight wet diapers, and two or three dirty diapers each day. There are other clues your baby is getting enough: your breasts feel less full after a feeding; your baby drifts off to sleep for a couple of hours after feeding; and your baby falls away from the breast satisfied and content between feedings. Weight gain is how your physician determines whether your baby is getting enough to eat. Most babies will lose 7 percent to 10 percent of their birth weight during Week 1 and regain it by the end of the Week 2. Extreme sleepiness is a warning sign. A baby who is not getting enough to eat over a few days becomes very sleepy. In the first weeks, if your newborn wants to sleep four or more hours at a time, you should contact your doctor immediately.
Exclusive breastfeeding means that your baby is taking your breast milk and only your breast milk, not even formula. Breastfeeding exclusively helps your body establish a great supply of breast milk. Breastfeeding is a demand-supply cycle – the more time the baby nurses, the more milk your body produces. If you skip a feeding or supplement with formula, especially in the first weeks, your body will not know to make the proper amount of breast milk for your baby. The American Academy of Pediatrics recommends that infants be breast fed exclusively for the first six months.
During the first week after birth, the number of wet and dirty diapers usually matches the number of days of life. On Day 1, expect to see one wet diaper and one blackish stool diaper; on Day 2, two wet and two brownish dirty diapers; on Day 3, three wet and three greenish dirty diapers, and so on for the next five to six days. After that, stools of an exclusively breastfed baby are seedy or curd-like liquid and mustard yellow in color.
Dads can help a lot by being reassuring, knowledgeable and enthusiastic. Being close during feedings helps your baby bond to you, as you touch, stroke, make eye contact and talk to your baby. After feedings, place your baby in just a diaper, skin-to-skin on your bare chest. Cover both of you with a blanket and let your newborn be comforted by your warmth, learn your smell and enjoy the deep resonant vibrations of your voice through your chest. Dads can also help with crowd control in the first few weeks when everyone wants to visit and welcome baby. Controlling visitors gives mom time to rest and recover from giving birth. Give mom water or juice when she is feeding the baby and help her get comfortable as she does the important job of breastfeeding and establishing a good milk supply.
When your milk first comes in, you may be making more milk than baby will take. If you are uncomfortable with engorgement or baby has trouble latching on, use a pump or manually express your breast milk to relieve the pressure. After the first few weeks, you can begin to pump and store milk by massaging the breasts after a feeding. As with the use of a pacifier, it is best to wait three to four weeks before introducing a bottle to your newborn. Refrigerate or freeze the expressed breast milk right away; it should not stay at room temperature for more than four hours. Studies show that breast milk keeps in the refrigerator for up to eight days and in the freezer for three to six months, depending on the actual temperatures in the refrigerator or freezer. Never heat expressed breast milk in a microwave oven.
Babies naturally breathe through their noses. It is nature’s way of ensuring newborns can suck, swallow and breathe in rhythm as they nurse. Baby is breathing freely when chin is tucked deep into your breast, latched on tight, and the nose is tipped away or only slightly touching the breast.
Most babies find their fingers or hands and began to suck on them while still in the womb. Some babies continue to find contentment with the stimulation of “non-nutritive” sucking. After three or four weeks of breastfeeding, you can evaluate your experience. Is baby latching on well and showing good signs of intake? Is your milk supply well established? If you are satisfied with how things are going and baby wants to suck longer than needed for feeding, a pacifier will fulfill that need.