By Simone Casey, IBCLC
Yes, breastfeeding is natural, but it’s a skill that’s learnt. Back in the day when we lived with our extended families, we picked it up from our mothers, cousins, sisters, aunties and girlfriends. Now, we are usually at home with our new babies fumbling through breastfeeding alongside a partner, or even a parent for a few weeks if yours has the luxury of time off. That’s where professionals, like midwives, lactation consultants and maternal child health nurses can step in. Most mums really want to master breastfeeding, but some find it quite challenging. Babies are wriggly. They have reflexes to find the breast, but not all mums know how to best position their babies to take advantage of these reflexes and many find their babies desperately thrashing their heads from side to side and trying to suck their fists instead of a nipple. Also, from the moment your baby is born, breastfeeding changes rapidly. The first three days, the first week and the end of the second week mark huge physical changes to the milk composition and baby’s feeding behaviours. Here, I’ll explain what to watch out for.
When bub is born, whether you’ve had a vaginal birth or caesarean, one of the best ways to help breastfeeding along is to place your baby on your chest skin-to-skin. This naturally sets the oxytocin hormone to work in relaxing mum and bub and helping bub to use his instincts to find the breast. Babies will often start searching for the nipple and yourself or your midwife can help him along a little. A baby-led attachment style requires some patience, but it’s amazing when they use their little hands to crawl to the boob, snuffle around the nipple and pop on all by themselves! Not all babies will do this, but many do. There are heaps of videos on baby-led attachment online, so search them up and watch in awe as the clever little things locate the nipple and latch. My fave: https://raisingchildren.net.au/newborns/videos/baby-led-attachment
Ideally your baby will have had her first feed within the first hour of birth, but regardless, you’ll get lots of time to practise afterwards. Many babies are pretty sleepy for the first day (being born is hard work!) so take the opportunity to get as much sleep as much as you can between feeds as they will become more frequent as the days continue. Midwives will usually encourage you to demand feed, which means to breastfeed whenever bub wakes up. When on the breast, they will be drinking very low volumes of colostrum, a sticky, yellow milk which is very rich in antibodies. If your baby is early or jaundiced, sometimes they may encourage you to wake baby if she isn’t waking often enough. You can stick with baby-led attachment if you wish, or many mums like to try more mother-led positions, like the cradle or cross cradle hold — ask your midwifes for help with getting a deep latch each time to avoid getting sore nipples. By the second day, you may notice bub feeding more often, anywhere from 2-4 hourly. The third day is usually when babies start cluster feeding, and demanding the breast more and more. This is a VERY tiring day (and night), so keep telling yourself that your baby is bringing your milk in, and being demanding is a good thing. Each time your baby is on the breast, watch out for swallowing. This is characterised by a little change in breath and the more frequent the swallows, the closer you are to the colostrum transitioning into breastmilk, which is thinner in consistency and higher in volume.
A note about cluster feeding: This is when bub feeds quite a lot without sleeping much in between. The advantage is that bub gets more of the fattier hindmilk (which comes when the breast is emptier) and will end up sleeping longer, but this could take several hours! In the early weeks, cluster feeding is expected 1-2 times in 24 hours. If it’s happening more than this, have a chat to your midwife or lactation consultant.
This is an exciting time as your milk will ‘come in’ anywhere from about 72 hours onwards. You’ll notice more frequent swallowing (a 1:1 or 1:2 suck/swallow ratio) and bub’s poo will change from black to brown to yellow. Nappies will be heavier and although all breastfed babies lose weight at first, once the milk appears, they will start to gain. You’ll also notice bub settling easier after a feed, although don’t forget to allow lots of ‘upright’ time on your chest or shoulder after the feed to allow bub to digest the higher volume of milk. After all, if you downed a king-size milkshake, you wouldn’t want to lie down on the bed straight away, would you?
If your baby was born in hospital, you’ll probably by home by now and the adventure begins. Midwives aren’t there anymore to answer your buzzer or questions, and some parents feel quite overwhelmed to be in charge of this tiny little being and making sure he is happy and fed. In hospital, many babies are super sleepy and breastmilk volumes are quite low so they usually just feed and snooze. Once home, volumes increase and babies have a lot more milk to digest. Expect breastfeeds to take about an hour (babies are pretty inefficient at this age), and for them to continue to be 2-4 hours apart. After the feed, you may find it a bit more difficult to settle your baby, as they can get wind and gas and need a bit of time (usually around 20-30 minutes) to be cuddled and rocked to sleep. Swaddling and a firm rhythmical pat on the bum often works wonders here!
Your milk will continue to increase in volume for the first two weeks and the colour changes from the transitional yellow milk to more mature, whiter milk. The average newborn feeds 8-12 times in 24 hours — that’s a lot! To know he’s getting enough, we need to see 4-5 heavily wet nappies in 24 hours (whatever goes in has to come out), and at least a few poos a day (although most babies do a little bit of poo in most nappies for the first 6 weeks, I call them wet farts!). Average weight gain is about 500g a month (150-ish grams per week). Around the 2-week mark is when we expect baby will be back to her birthweight, but some babies take a bit longer than this, depending on how much they lost in the first place. As long as she is putting on at least average weekly gains by now, all is on track.
Phew, so that’s the first two weeks. Suddenly time will speed up and the next few months will pass in a blink and breastfeeding will become MUCH easier. You may even turn into one of those mums you’ve seen in cafes, cuppa in one hand, a babe on boob tucked into the crook of their other arm, and everyone laughing and feeling relaxed. But this stage takes time to get to. Put it this way, no-one expects the new girl at work to get everything right in the first week. After a few weeks, she’ll still make a few mistakes, and even after a month in the job, there will be things she doesn’t know. Becoming a mum and breastfeeding your baby is pretty much the same. Give yourself a break, don’t expect perfection and allow yourself time to learn. Patience and persistence are key in breastfeeding success. Find the people around you (whether they are friends, family or health professionals) who will help and encourage you to achieve your breastfeeding goals and keep asking for help until you get to where you’d like to be. When you make it, it’ll be so worth it.
Simone is an International Board Certified Lactation Consultant (IBCLC) and member of the Lactation Consultants of Australia and New Zealand (LCANZ). She works in a private hospital breastfeeding clinic in the inner-city, and has her own private practice, visiting mums in their homes in the northern suburbs of Melbourne.
She is passionate about helping mothers to breastfeed and can help with issues concerning supply, positioning and attachment, babies not adequately gaining weight, sucking difficulties, transitioning premature babies from tube to breast, breastfeeding multiples, and lots more.
She’s breastfed three children of her own, volunteers as a breastfeeding counsellor and community educator with the Australian Breastfeeding Association (ABA), and regularly blogs about breastfeeding on the ABA’s website. She can be contacted via her website simonecasey.com, on pop’d or Facebook page https://www.facebook.com/SimoneCaseyLactationConsultant/