The first few weeks of nursing will be a time of learning for you and your baby. They might be tough, but if you make it through the first few weeks, it WILL get easier! Neither of you may accomplish a lot on your first few tries, but that is all right. Breast milk usually does not even come in until day four of life. Until then, a clear or yellowish fluid called colostrum, which is extra rich in nutrients and immunity enhancers, will come from your breasts. At first, your new baby will nurse often (eight or more times in twenty-four hours). As the breast milk comes in, your baby will get more and more each feed and will gradually space out the feeds. You know your baby is getting milk if you can see it in their mouth during the feed and if you can hear them swallowing after every few sucks. Also, look for the “Signs of a well-fed baby” listed above. Most newborn babies will automatically consume what their body needs within a twenty-four hour period.
During the first couple of weeks, one of the most common issues with breastfeeding is keeping your baby awake during feeds. Gently arousing your baby by moving them, burping them, tickling their feet or chin, and changing their diaper can help stimulate your baby to feed while on the breast. Some babies feed better if they are naked except for their diaper. However, even with the best effort, some children will choose to sleep rather than feed. Some babies would just sleep and snack all day if we let them, using you as a human pacifier. In general, keep feeds to less than 45 minutes to prevent maternal exhaustion. Most babies get the largest amount of milk per feed during the first ten minutes on each breast.
This is a common problem. You may use nipple creams (such as Lanolin) and salt water soaks as needed. But, more importantly, keep the nipples as dry as possible between feeds. They need air in order to heal. Do not sleep with bras or tight clothing. Try to wear a loose fitting t-shirt during the day and avoid wearing a bra if possible. Try not to use breast pads when you have dry, cracked, or sore nipples. In addition, be certain that the pain is not being caused by your baby “latching on” incorrectly. If intense pain persists beyond the first minute or so after latching on, you might need some help. Contact us for more pointers or for lactation consultant telephone numbers if you are having difficulties.
Decreased Milk Supply
This is another cause of breastfeeding frustration. Breastfeeding is a “use it or lose it” endeavor. The breasts must be emptied thoroughly and often enough to build and sustain milk supply (at least every three to four hours). Try to alternate which breast you offer first at each feed. Some breastfeeding mothers put a safety pin on their bra to remind themselves where to start the next time. In this way, the breasts will be emptied more evenly and completely.
If your baby cannot effectively empty both breasts, then consider using a pump. Some moms will need to use the pump until their baby is old enough to take large, efficient feeds. A few babies will need supplementation with pumped breast milk or formula given in a bottle. If it becomes necessary to supplement to maintain growth, urine output, or to completely satisfy your baby while you are pumping to boost milk supply, always breastfeed first, then you may offer the bottle. As your milk supply increases, your baby should be taking less and less of the bottle and eventually you can drop the bottle supply altogether. Feeding on demand will usually stimulate milk production effectively, but it can be difficult for mom. Either way, remember that if the breasts are not stimulated and emptied enough, milk supply will decrease.
Pumping not only stimulates milk production, it also enables someone other than mom to feed your baby if necessary. It is best to hold off on the bottle until breastfeeding is well established (usually about three to four weeks of life). At this time, most babies can take a couple of bottles a day and still continue to breastfeed well. In fact, once in a while after breastfeeding is well established, we encourage mothers to give a bottle occasionally so that their baby will not refuse a bottle in the future. If a bottle is never introduced, things may become difficult when mom needs to go back to work, go out with Dad, or go out of town unexpectedly.
Follow the same guidelines for healthy eating recommended to you during your pregnancy. As a nursing mother, you’ll need to eat a balanced diet that contains about 500 calories more per day than the diet you needed before pregnancy. In general, lactating women should get nutrients from a well-balanced, varied diet, rather than from vitamin and mineral supplements. Eat generous amounts of fruits and vegetables, whole grain breads and cereals, calcium-rich dairy products, and protein-rich foods (meats, fish, and legumes). Make sure you are getting enough calories.
Continue taking your daily prenatal vitamins. Remember, however, that vitamin and mineral supplements do not take the place of food. It is better to get your nutrients from a well-balanced diet than to rely on a vitamin and mineral supplement.
Be sure to drink lots of fluids – at least 8 glasses of water a day, one glass every time you nurse or pump. You need the fluids to replace what you lose through your breast milk. Don’t drink more than 2 cups of coffee, tea, cola, or other caffeine-containing beverages a day. Caffeine passes into your breast milk and can make your baby irritable or cause difficulty sleeping.
It is best to abstain from alcohol while you are breastfeeding, just as you did during your pregnancy. Alcohol is readily passed into human milk. Any heavy drinking or daily drinking of even small quantities of alcoholic beverages could hurt your baby. If you have a hospitalized premature or ill newborn, DO NOT drink ANY alcohol. An occasional beer or glass of wine is probably OK as long as you “pump and dump” your breast milk two to three hours after drinking. You should not have more than one or two drinks a week.
Do not smoke. Smoking can decrease your milk supply. Also, the breakdown products from nicotine can pass to your baby in your milk. If you cannot stop smoking altogether, try to cut down. If you must smoke, do it shortly after nursing your baby. Above all, do not smoke in the same room as your baby or even in the house and change your shirt before holding them. Breathing your exhaled smoke, even the particles on your clothes, can hurt your baby. It can cause cancer later in life and can make your baby more at risk for asthma, allergies, and even ear infections.
Foods in mothers’ diets very rarely have a disturbing effect on their babies. Foods such as tomatoes, onions, cabbage, chocolate, and spicy foods have a reputation of causing gas. Other foods such as milk, soy, eggs, nuts, wheat, and fish have a reputation of causing allergies. If your baby has loose stools, blood in their stools, colic, or excess gas for no reason that you can think of, you may review your diet from the previous 24 hours and even consider eliminating some of the foods listed above (milk and soy first) to see if it helps. Call us if you think your baby is reacting negatively to foods that you are eating.
Daily Food Guide for Breastfeeding Mothers
- Milk, yogurt, and cheese – at least 4 servings
- Meat, poultry, fish, dry beans, eggs, and nuts – at least 3 servings
- Vegetables – at least 3 to 5 servings
- Fruits – 2 to 4 servings (choose two foods high in vitamin C and folic acid, and one food high in vitamin A)
- Bread, cereal, rice, and pasta – about 6 to 11 servings
- Fats, oils, and sweets – go easy!
This is just a guide. You may need to eat more than this based on your size and activity level.
Beware of Medications
Medications taken by a mother can pass into her breast milk. This applies to both prescription and over-the-counter drugs. The most common medications that can cause problems with breastfeeding babies are sedatives taken for sleep, tranquilizing agents, mood-altering drugs, a few antibiotics, anti-tuberculosis medications, chemotherapeutic agents and seizure medications. Almost all over-the-counter medications are safe in their recommended doses. If you need to take a medication that is compatible with breastfeeding, always take the medication immediately after you complete a feeding. This gives your body several hours to metabolize the medication before the next feeding time. If you ever have questions about the safety of breastfeeding while you are on a certain medication, please call our office. The following resources offer similar information:
- TCH Lactation Program and Mother’s Own Milk Bank: (832) 824-6120
- Medications and a Mother’s Milk by Thomas W. Hale
- LactMed smart phone app