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Breastfeeding: The First 2 Weeks
People say prevention is the best medicine, and breastfeeding concerns are no different. With that in mind, my goal here is twofold. First, make sure your milk comes in. Second, make sure you continue to have enough for your baby.
In my experience, the first two weeks is the most common time where breastfeeding doesn’t work out. With your first child, we don’t expect the later “mature” milk to come in until days 3-5 of the baby’s life. But if you trust the process, your mature milk will come in, and your baby will be working on her second and third chins in no time!
In the first 2 weeks of life, the name of the game is regular stimulation of Mom’s breasts. That’s how we tell your milk glands to develop, so they make the transition from early “colostrum” to the mature, high-volume, milk we always imagine. These guidelines are my attempt at helping make sure that happens.
1) Feed your baby at least every 3 hours, around the clock.
Set a 3-hour alarm on your phone, and start it at the beginning of every feed. If your baby is still asleep when the alarm goes off, do your best to wake him for the next feed. More often than not, he will wake before the alarm chimes (sometimes after 15-20 minutes!). If that happens, you should restart your 3 hour alarm, and start the process again.
2) Feed baby on both breasts every time.
Sometimes I will hear people recommend you alternate breasts with every feed. Right breast this feed, left breast next feed. Eventually, your baby will need both breasts with every feed, and so, we should stimulate your body accordingly from the start.
3) How long should I feed per breast? At least 10 minutes, no more than 20 minutes.
At least 10 minutes of feeding ensures the breast has received adequate stimulation to increase production. You must, however, cut baby off after 20 minutes on either breast. In 20 minutes on your breast, the baby has certainly emptied that breast. After that time, the baby will slip to the end of your nipple, creating a shallow “bad” latch, and two important things will happen. First, that shallow latch will lead to nipple symptoms (pain, blisters, cracking, bleeding), which we clearly want to avoid for you. Second, your baby will lose extra weight trying to get food from an empty breast. Feeding is an energy-intensive process, and we want to make sure your baby is getting the right “bang for their buck.”
4) What if baby only feeds on one breast, and I can’t wake her for the other breast?
When babies are first born, their tiny tummies may be satisfied with the milk from one breast. This is the first situation where the breast pump comes into play. If baby feeds less than 10 minutes on either breast during any feed, please use the breast pump to make up for the difference. Somebody (baby) or something (pump), must stimulate each breast for at least 10 minutes with every feed.
Example: Baby feeds for 13 minutes on the first breast, but only 2 minutes on the second breast. Pump the second breast for at least 8 minutes to make up for what baby didn’t do.
5) What if baby feeds on both breasts for 20 minutes, and he is still crying?
If your baby is still crying (hungry) after 20 minutes from both breasts, you can’t put him back on an empty breast (see #3). When this happens, the right thing to do is to offer small amounts of formula, as a very short term bridge, until your high-volume, mature milk has arrived. In this case, have another caregiver (enter Dad!) give formula. How much formula? Feed him until he stays asleep when you put him down in the bassinet. If he wakes up and cries, he needs more formula. Which formula? Never mind the clever marketing, all baby formulas are the same medically. What is Mom doing during this time? She should pump both breasts, despite the fact they are empty. This tells the body your baby needed more milk than was available and we need to increase production. How long should Mom pump? As long as it takes the other caregiver to get baby to sleep in the bassinet.
6) What if baby is crying and won’t latch well on either breast?
Spend no more than 5 minutes trying to get baby to latch on either breast. After that time, pass her off to another caregiver to feed with formula, while Mom pumps her breasts for 10 minutes.
7) What if I can’t wake baby up after 3 hours, no matter what I do?
First, be sure she is sleeping outside your arms, in the bassinet. If this doesn’t wake her up, try unswaddling, blowing on her face, or dripping cold water on her chest. If this doesn’t work after 5 minutes, pump your breasts for 10 minutes for stimulation. When your baby wakes up later, restart your 3 hour alarm, and restart the process. *Please remember, this is a good thing! It means your baby is full, and doesn’t want to wake up to eat.
8) How do I know if my baby is hungry? How do I know she is full?
In the first 2 weeks of life, use this simple test: put her down in the bassinet. Does she stay asleep? She is full. Does she cry? She needs more food. Nevermind the dirty diaper, the spitting up, the swaddle quality, or the room temperature. Your baby’s hunger cues are literally this simple.
9) When I use the pump, I don’t seem to make any milk.
Please don’t worry, this is very normal at the beginning. I encourage parents to ignore how much milk is or isn’t coming from the pump. Trust the process, and your milk will come in by the 5th day of life.
10) This schedule is intense. How long is this necessary?
Babies lose up to 10% of their birth weight in the first week of life. Mom’s milk comes in around day 3-5 of life, and we expect baby to have regained their birth weight by the end of the second week. Once the doctor tells you your baby is at or above birth weight, breastfeeding is established, and the new rule in the house is “never wake a sleeping baby.” This rule makes a lot more sense to everyone, and I’m always excited to tell them. Until that time, however, following this schedule is very important.
11) What if I have nipple symptoms (pain/blisters/cracking/bleeding)?
By definition, this means your baby’s latch is not as good as it should be. Assuming baby is not feeding for more than 20 minutes at either breast (see #3), you should reach out to a lactation specialist so they can help troubleshoot your latch. In the meantime, your ObGyn or pediatrician can prescribe medicine called All Purpose Nipple Ointment (APNO) to make you more comfortable.
12) How do I increase my breast milk production?
Over the years, I think I’ve heard just about every idea for increasing breast milk production that Google has to offer. Some of these are evidence-based, while others, unfortunately, are not. More important than water, oatmeal, fenugreek (whatever that is!), or even your best friend’s lactation cookies, the quickest way to increase your breast milk supply is to pump your breasts for 5 minutes when they are empty. This is the strongest signal you can send to your brain to increase the milk production in your breasts. How do I know my breasts are empty? The flow of milk has either ceased completely, or slowed to a trickle.
The first 2 weeks of life are critical in establishing a breast milk supply for you, but if you follow this guide, you’ll be well on your way to breastfeeding success. Thanks for reading!
-- Dr. Tim
