Breast Feeding Basics

First Feedings

You can help establish your milk supply and avoid some early breast-feeding problems by nursing your baby as soon after birth as possible and by allowing your baby to suckle frequently. When mothers breast-feed within an hour after birth and feed their babies frequently, their milk comes in sooner (within twenty-four to forty-eight hours after birth) and engorgement is less of a problem than when they wait to begin breast-feeding.

The first feeding is special. You and your baby get to know each other better and begin the beautiful, synchronous interaction that characterizes breast-feeding. If you have never breast-fed before, the technique of feeding may seem awkward and cumbersome at first. But you can be reassured that the skill of breast-feeding improves with experience. Here are some suggestions:

• Breast-feed your baby as soon as possible after birth. Babies are often more alert and interested in feeding in the first hour after birth than during the next twenty-four hours.
• Use the help of experienced staff or request privacy if you feel confident about initiating feeding without help.
• Get into a comfortable position. If you nurse right after delivery, sit comfortably supported or lie on your side. If you have had a cesarean, try sitting in bed with the baby across your lap on a pillow or positioned beside you in a “clutch” or “football hold” for the greatest comfort.
• Nurse your newborn in an atmosphere of calm and tranquility, if possible; this will help you relax and allow you and your baby to concentrate on feeding. You might need to ask visitors other than your partner to leave for the first feeding.

What to Do

• Make yourself comfortable with your baby’s body tipped toward you. Cradle your baby’s head comfortably in the crook of your arm. Let his back rest on your forearm and cup his buttocks in the palm of your hand (this is called the cradle hold).
• Grasp your breast with your free hand behind (not touching) your areola with thumb on the top and four fingers below. Compress the breast with your thumb and forefinger, centering your nipple with the baby’s mouth.
• Stroke or tickle your baby’s lips with your nipple to stimulate his rooting reflex and to get him to open his mouth. Once his mouth opens wide (as wide as a yawn), pull or roll him rapidly toward you and hold him close, so that he is pressed tummy to tummy against your body. Be patient, because it sometimes takes a long time before your baby opens his mouth wide enough. Just keep stroking his lips. Bring your baby to your breast rather than bringing your breast to your baby.
• Make sure to get as much of your areola as possible in your baby’s mouth to ensure a good latch. (His nose will be touching your breast.) Unless your breasts are quite large, he can still breathe. He will not allow himself to smother. If you feel you need to help him to breathe more easily, lift your whole breast a little and bring his buttocks in closer to rearrange his position and give him more breathing space.
• Let your baby suckle at the first breast for as long as he wishes (at least ten to fifteen minutes), and then offer the second breast. This advice is much more appropriate than the instructions that you might get to limit feedings at each breast to five minutes or fewer in hopes of preventing sore nipples. Five minutes is hardly enough time to get started. During the first feedings after birth, the let-down reflex may not take place for three minutes or more after you begin the feeding. Once breast-feeding is established, the let-down occurs within seconds after the baby begins to suckle. Research has shown that limiting the amount of time your infant spends at the breast merely delays rather than prevents the onset of sore nipples. The most critical factor in nipple soreness is the baby’s latch. When the baby’s mouth is properly positioned on the nipple, soreness is rarely a serious problem.
• When your baby is finished nursing at one breast, he will stop sucking and release the breast. If you need to take the baby off the breast, do so by placing a finger in the corner of his mouth until you break the suction. Then move him away from your breast.
• Burp the baby, but do not be concerned if the baby does not burp until your milk comes in.
• Allow your baby to nurse from the other breast.

Initial Nursing Difficulties

Some babies seem to know how to feed right from the beginning, while others seem uninterested, sleepy, or have difficulty latching on to the nipple. If you have difficulty getting started, the following suggestions may help:

• If your baby is sleepy, make sure he is not swaddled too snugly. Talk to him, stroke his arms and legs, and wiggle his toes. Make him a little uncomfortable. Do not pry your baby’s mouth open. Be patient and in time he will be ready.
• Arouse your baby’s sense of taste and smell by expressing a few drops of colostrum and rubbing your nipple on his lips.
• Hold your baby close enough to you so that he can get as much of the areola in his mouth as possible and can compress the milk sinuses with his lips and gums.
• Ask for help from a breast-feeding counselor, experienced nurse, your childbirth educator, your baby’s doctor, or your physician.

Newborn babies don’t need much food in the first three or four days of life. Breast-fed babies get colostrum. Bottle-fed babies may be given sugar-water first; when they are offered milk, the water part of that milk is what they need most. They probably will not take much, anyway. As we shall see, feeding is something babies have to learn.

Because they take little food, babies usually lose weight for four or five days before they start to gain. It is quite usual to lose 8oz (225g) over five days and then gain it back over the next five. A baby’s weight at ten days is therefore expected to be roughly the same as it was at birth.

When a newborn baby is thirsty or hungry he feels uncomfortable so he cries. But at this early stage he does not cry to be fed. He does not know that his discomfort comes from hunger; that sucking will bring him food or that food will make him feel better. He has to discover that sucking = food = comfort.

Some babies are so ready to suck that this vital learning takes place quickly and easily. They may have been practicing sucking their fingers in the womb (we know that some babies do) and once they are born they suck anything that comes their way. Of course, when such a baby is offered the breast or a bottle he sucks that too. Sucking gives him milk. Milk makes him feel good. The feeding lesson is learned.

Other babies are not at all like this. They cry piteously with hunger-pain but when their mothers try to put a nipple in their mouths they yell around it. Even a taste of colostrum or milk does not stop the crying. The connection between that taste and comfort has not been made yet. With a baby like this early attempts at feeding can be a struggle.

However, whether yours is a “sucky baby” or not, you can be quite sure that he has been born with a set of sucking reflexes. If you use these reflexes, instead of trying to force a nipple into his yelling mouth, he will suck. Once he has sucked a few times and discovered the food-comfort, all will be well.

Evoking the Sucking Reflex

A baby who is hungry turns his head toward a gentle touch or stroke on the cheek. So if you are holding him in the crook of your left arm, ready to feed him from your left breast or from a bottle held in your right hand, stroke his right cheek, or let your breast do so, and he will turn his head in toward you.

As he turns his head his lips will purse. Both these maneuvers are reactions to your touch on his cheek, but once he has made them he is ready for a further cue: the touch of nipple, finger or anything suckable on his pursed lips. As soon as he feels it he will latch on and begin to suck. It sounds very simple and it is. But it is easy to give contradictory cues, by touching both cheeks, for example; to give them in the wrong order, by touching his lips first; or to spoil the timing, by not being ready with a nipple for that pursed mouth. Above all, it is easy to be too active. You cannot force him to suck. Give him the cues and trust him.

The Right Circumstances for First Feedings

If a baby’s sucking reflexes are respected and used in his very first feeding experiences he will quickly learn the lesson sucking = milk = comfort. But it helps him to learn and it helps him to get enthusiastic about the whole feeding business if the feedings are kept comfortable and peaceful. It is not always easy to arrange life for your baby exactly as you would like it, but here are some of the things you should try to avoid:

Don’t try to feed a baby who is really upset and screaming

He will not suck well. He is overwhelmed by his feelings. He cannot respond to your invitations to suck himself better. In a hospital this can be a problem. The staff may want your breast-fed baby to wait for his feeding because they want you to get an amount of rest – especially at night. The bottle-fed babies on the floor may be fed on a schedule, with nurses making up all their feedings at certain hours. If you are breast-feeding make it clear to the night staff that you do want to be woken up whenever your baby is hungry. If you are bottle-feeding insist on an extra bottle if he seems really hungry at the “wrong” times. If, despite all your efforts, he has been kept waiting and is upset, then he needs comforting by close wrapping, rocking or walking before you attempt to persuade him to suck.

Don’t let noise and movement distract your baby from sucking

If you are at home, try feeding him quite alone at least for a few days. If you are in the hospital, bend down over him so that your face is directly above his. If you can get him to focus on you, other things will be less distracting. Wherever you are, keep up a gentle stream of talk. Your voice will block out the other sounds.

Don’t try to force a sleepy baby to stay awake

In the very first days many babies are too sleepy to suck for long. It does not matter if he goes to sleep after a few sucks. He will wake again when he needs a few more. But it does matter if he is bounced and jolted and has his feet flicked in misguided attempts to make him take the “proper” amount. Feeding should be gentle bliss.

You want the baby to discover that sucking brings milk and that milk feels good, so it is important that the sucking should be properly rewarded. In breast-feeding a somewhat pendulous breast (especially one that is not yet full of milk but only has some colostrum in it) can block the baby’s nose when he tries to suck so that instead of reward he gets a panic because he cannot breathe. The answer is to adjust his position or use the fingers of your free hand to depress the breast a little just above the areola so that his nose is kept clear.

In bottle-feeding the baby may be offered a nipple with too small a hole. Instead of an easy reward for his sucking he has to work for every sip and in these early days he may easily give up. If you up-end the bottle, milk should drip out of the nipple at a rate of several drops per second . If it is slower than that, ask for a larger holed nipple if you are in the hospital, or enlarge the hole with a red-hot needle if you are at home.

Burping Your Baby

Babies sometimes swallow air along with milk while breast-feeding or bottle-feeding. You should burp your baby during and after feeding to help him get rid of the air. Try these burping methods to find the one that is most effective for your baby. With each method, use a burp cloth to protect your clothes. If there is no burp after several minutes, just lay him on his stomach or side or continue feeding.

• Over-the-shoulder

Place your baby high on your chest with his head peeking over your shoulder. Support him well across his back and buttocks. Gently rub or pat his back until you hear a burp.

• Over-the-lap

Place your baby on his tummy across your lap. Gently rub or pat his back until you hear a burp.

• Sitting and rocking

Sit your baby sideways on your lap. Place your thumb and first finger under his chin with your palm supporting his back. Gently rock him back and forth. You might lightly rub or pat his back until you hear a burp

Frequency of Feeding

Breast-feeding on demand means feeding the baby when he is hungry rather than on a schedule. It probably means feeding every one to three hours. Breast-feeding eight to eighteen times in twent-four hours is the best way to establish an adequate milk supply. Begin each successive feeding with the breast your baby last nursed from, since babies usually nurse most vigorously at the first breast. This will make sure that both breasts get an equal amount of stimulation. You might use a safety pin in your bra strap to remind you which side to begin with, or palpate your breasts and begin feeding on the side that feels more full. Feed from the first breast for as long as the baby is interested (ten to twenty minutes on average) and then offer the second.

If your baby remains with you in your hospital room, you will know when he needs to be fed. But if he spends some or most of his time in the nursery, you will want to ask the nursing staff to bring your baby to you when he is hungry, day or night. Also keep in mind that full-term, healthy babies do not need supplementary bottles of formula, sugar water, or water if they are breast-fed frequently and on demand from both breasts. Their requirements for nourishment and fluids will be met as long as breast-feeding is not limited. Policies restricting feeding time are often based on requirements for formula-fed babies and cannot be applied to breast-fed babies.

Supplementary bottles of formula and water have several disadvantages. Formula and sugar water contain calories that diminish your baby’s hunger and interfere with his desire to nurse. Furthermore, sucking on a bottle nipple is entirely different from suckling on your breast, and it can result in “nipple confusion,” the inability to nurse well at both breast and bottle and the development of faulty sucking patterns, conditions that are difficult to treat. If nipple confusion does occur, it may help to avoid the use of bottle nipples and pacifiers until nursing is well established.

How to Know When Your Milk Comes In

You will know your milk has come in when your baby begins to gulp and swallow rapidly while nursing. You may see some milk in the corners of his mouth; your breast may be heavy, hard, and tender; you may feel the tingling sensation of your milk letting down; and milk may drip from your other breast while your baby is nursing.

First Weeks

In the early weeks after birth, your baby will nurse every one to three hours. Over time, your baby will consume more at each feeding, and reduce the total number of feedings each day.

Babies do not always nurse on a regular schedule. Sometimes they nurse four or five times in five or six hours and then sleep for a stretch of several hours. If your baby sleeps five to six hours at a stretch at night, be sure to feed him frequently during the day so he will get all the nourishment he needs. If your baby sleeps a great deal during the day and awakens frequently at night to feed, you may try awakening and feeding him every two to four hours during the day in order to change the night-feeding pattern. This is worth trying, but not always successful.

Generally, avoid pacifiers in the early weeks. Besides causing nipple confusion, they may satisfy your baby’s sucking needs while interfering with nursing and adequate nutrition. Some babies are happy to suck pacifiers and not eat. These babies will not gain weight well. Other babies seem to nurse constantly without ever giving their mothers a rest. Offering a pacifier to a baby who is nursing well will have less impact on breast-feeding than offering one to a baby who feeds less vigorously and frequently.

Growth Spurts

At about three weeks, six weeks, three months, and six months, your baby may suddenly change his feeding pattern and return to more frequent nursing. He may be fretful, irritable, and more sensitive to stimuli during this time, and he may seem to need to nurse constantly. He is probably experiencing a growth and developmental spurt, and nursing frequently is his way of stimulating you to make more milk to meet his needs and to comfort himself. Do not be troubled by his increased demands. Usually, within about a week, your baby’s needs will level off once again.

Enhancing Milk Flow

Breast massage before a feeding or breast pressure during a feeding enhances the flow of milk from your milk-producing glands. If done before feeding or pumping, breast massage speeds your let-down reflex. An impatient, fussy baby will latch to the breast more easily if he does not have to wait long for the milk to flow abundantly. Pumping is often more productive if you “prime” your breast first with breast massage.

Before a Feeding

There are several techniques for massaging your breasts before feeding:

• Cup your hands around your breasts and stroke gently but firmly from the chest wall toward the areola. This is best accomplished if you are not wearing a bra.
• Massage sections of your breast with circular motions using your fingertips. Massage from the chest wall toward the areola.
• Gently jiggle or shake your breasts.
• Stroke your breast lightly with a comb or your fingertips from the chest wall toward the areola.
• In addition, try visualizing the milk flowing while massaging your breasts. This may help the let-down.

During a Feeding

Breast pressure during feeding enhances milk flow, helps to empty clogged ducts and makes more high calorie hindmilk available to the baby. This technique is especially useful for sleepy babies, babies with a less vigorous suck, and babies who are gaining weight slowly.

Once the baby has latched well, pay attention to his pauses in suckling. When he pauses, gently press your fingertips against the milk-producing glands located in the upper outer quadrant of your breast, near your underarm. You will notice a burst of suckling as milk is pressed toward the milk sinuses and into your baby’s mouth. If the baby pauses again, rotate the position of your fingertips and press another quadrant of your breast. Be careful not to press too close to your areola as this can interfere with your baby’s latch.

Involving the Family

Although you are the one who produces milk and feeds your baby, your partner’s and family’s support and encouragement are often the key factors in keeping you going in the face of difficulty. Your family can help you eat and drink well, allow you to rest by caring for the baby, and shield you from unnecessary stress. If they can relieve you of some or all of your day-to-day chores, you will be free to devote yourself to caring for yourself and establishing breast-feeding.