BREASTFEEDING FAQs
How often should I breastfeed my baby while in the hospital?
Mothers are encouraged to breastfeed their baby at least every 2 to 3 hours or 8 to 12 times in 24 hours, but nurse sooner if your baby is giving any hunger cues. Infants typically nurse well right after birth for the first one to two feedings, then enter into a "sleepy phase" around 4 to 6 hours of life. It is normal for newobrns to sleep a lot in the first few weeks of life. Skin-to-skin is encouraged, which makes feeding cues much easier to recognize.
What are hunger/feeding cues?
Observing for feeding cues is key. Feeding cues include eyes wide open and looking around, rooting for the breast, and sucking on the fingers or fist. Crying is a late sign of hunger. It is best to catch baby during the earlier signs for a better feeding experience. Keeping infant skin-to-skin is a great way to recognize feeding cues in the early days. If your baby still seems unsettled after most feeds and you feel you have had a good nursing session, then contact your lactation consultant for an evaluation.
How long do I need to nurse my baby at each feeding?
Breastfeeding sessions may vary in duration. More important than duration is watching baby's behavior at the breast. Try to keep baby "active" at the breast. If falling asleep, stimulate to wake up or take off of the breast. Infants do their most active nursing during the first 10 minutes on each best. Typical feedings last 15-30 minutes, but often shorten as the baby becomes more efficient. Infants like to suckle at the breast and stay close to mom. Mothers should be able to hear and see their baby actively sucking and swallowing at the breast.
How do I know my baby is getting enough milk since I cannot see the amount?
Since you can't "see" just how much colostrum or mature milk your baby is taking in, many women worry that their baby is not getting enough. There are 4 signs to look for indicating your baby is getting enough from nursing:
- Your baby has an adequate number of wet and dirty diapers each day
- You will hear audible swallows while your baby is nursing
- Your breasts feel fuller at the beginning of the feed and softer as the breast empties
- Your baby is gaining close to 1 ounce per day after day 5 for the first 2 to 3 months of life
Once your baby has nursed effectively, he may sleep for 2 to 3 hours. Hunger cues suggesting otherwise would include continued rooting at the breast, sucking at his fingers/fist, and not settling well after feedings.
How many wets & dirties should I expect daily, & what should they look like?
In the first few days of life, infants take in small amounts of colostrum which is rich in nutrients and filling for your baby. In the first 4 days of life, parents should expect 1 wet and 1 dirty diaper per day of life (for example, baby should have 3 wets and 3 dirties on day 3 of life). By day 5, most infants will have a minimum of 6 wets and 3 to 4 dirties per 24 hours. Infant's stool will start out as black and tarry (this is called "meconium"). With adequate amounts of milk, stools will transition to green and then to a yellowish-mustard color. Infant's stool can be seedy and watery. When counting dirty diapers, each stool should be at least the size of a quarter. If you see blood or mucous int he stool, notify your child's pediatrician. This could signify illness, injury, or allergy.
Should I wake my baby to breastfeed if he is sleeping?
Infants should feed at least every 2 to 3 hours in the first few weeks of life, or 8 to 12 times in 24 hours. "Rooming in" with your infant is encouraged in the hospital after delivery so parents do not miss these hunger cues. Once at home, we encourage a safe sleeping area next to mother's bed such as a bassinet or crib. Most infants will start to make noises or "stir" close to feeding time.
How often should I burp my baby?
Breastfed infants get small amounts of colostrum the first few days of life and may not need to burp. The breast is a closed loop system and infants do not consume as much air during breastfeeding as they do during bottle feeding. However, burping before switching breasts may encourage your baby to wake for feeding on the second breast.
When does my milk come in?
Colostrum is the "first milk" produced by a mother's breasts. It is often produced during the third trimester of pregnancy, and some pregnant mothers may experience spontaneous leakage from their breasts before baby is born. There is evidence showing that hand expression of colostrum from 37 weeks gestation until delivery may help a mother's body prepare for spontaneous labor and may help mother's mature milk come in sooner after baby is born. Colostrum is very rich in nutrients. Mother's "mature milk" typically comes in on day 4 to 5 postpartum for first-time mothers and day 2 to 3 for second-time mothers. It is important for mothers to remove colostrum frequently to encourage mature milk to come in. In the event your infant is unable to nurse, mothers are encouraged to remove milk by pumping or hand expressing as often as their baby would eat (every 2 to 3 hours).
Is breastfeeding supposed to hurt?
No. Breastfeeding can make nipples "tender" for the first few seconds of nursing, but should improve. The first week or two, nipples may be somewhat tender, but there should be no pain. Severe pain and discomfort are most likely caused from a shallow latch or incorrect positioning. Your infant's oral anatomy, including a high palate or "tongue tie," may also contribute to pain with breastfeeding. In genreal, breastfeeding should never be painful. See your lactation consultant if you are experiencing pain.
How long is breastmilk good for at room temperature, in the refrigerator, freezer, or thawed?
- Room temperature: 4 to 6 hours (if not used within 4 hours, then refrigerate)
- Refrigerated milk: 3 to 6 days
- Refrigerator freezer: 6 months
- Deep freezer: 12 months
When do I need to start pumping?
When a full milk supply is established, most mothers experience breast engorgement or fullness. FUll term infants are encouraged to breastfeed at least every 2 to 3 hours to bring mature milk in. If engorgement is a problem, pumping or hand expressing from the breast may be used to relieve discomfort.
Pumping can be indicated for many reasons, such as:
- Engorgement unrelieved by a nursing baby
- NICU baby unable to breastfeed
- Preterm infants or small for geststaional age infants who are not yet effectively removing milk when nursing
- Maternal preference
Many insurance companies will now cover electric breast pumps. Check with your insurance company about which breast pumps are covered. In West Alabama, breast pumps and their supplies may be purchased in-store at Target, Walmart, or Northport Pharmacy. You can also go online to https://www.aeroflowbreastpumps.com and enter your insurance information to determine which pumps are covered. You may need to obtain a breast pump prescription from your obstetrician or your pediatrician. It is helpful to purchase a breast pump well in advance of your due date, as your lactation consultant may be able to teach you how to use your pump correctly before your baby is born.
How will I know when my milk is fully in?
When milk supply is established, most moms will experience breast engorgement or fullness. You will also hear an increase in swallowing during feeding sessions and softening of the breasts after feeds are finished. Your baby should appear satisfied after feeds.
What are some things I can do to help keep my baby awake during feeds?
Infants are often very sleepy after the first few feeds after birth, and this can continue for 1 to 2 weeks, especially if your baby is jaundiced (jaundice is the yellowing of the skin exprienced by many babies after 1-2 days of life and peaking on day 4 to 5 of life). Infants in this stage may need to be awakened for feeds.
Here are some tips for to keep your baby awake for feeds:
- Undress your infant down to a dry diaper with each feed
- Place her skin-to-skin between feeds
- Gently massage baby's hands and feet
- Gently compress breasts while infant is nursing to aid in milk transfer
The American Academy of Pediatrics (AAP) and World Health Organization (WHO) recommend at least 6 months of exclusive breastfeeding followed by introduction of solids and then continued breastfeeding for 2 years and beyond. You can enjoy breastfeeding your little one for as long as is mutually desired. There are many benefits to keeping your child on breastmilk for as long as possible.
Some online resources include:
www.firstdroplets.com (videos on latching and early feeding days)
https://med.stanford.edu/newborns (search "hand expression" for a video demonstration)
Information provided from Mommy & Me Lactation Services
