BREASTFEEDING IN THE FIRST 2-3 HOURS AFTER BIRTH
***For the purposes of this instruction, the baby will always be “he” and the mother will be “you” or “her”; additionally, “LC” is the abbreviation for “Lactation Consultant”
***Also, these first articles will address only WELL, TERM Newborns (i.e. those babies born without complication and after 37 weeks of gestation in a hospital setting) and a mother WITHOUT medical complications
****The information I need to tell you regarding the first 2-3 hours after your baby is born is Very extensive. Therefore, I will be breaking it down into much smaller chucks so you can digest it more easily. Please read all of the sections as they all go together to support your success in the first moments after your baby’s birth.
Make no mistake…the first 2-3 hours after birth ARE the most important to breastfeeding. Not only for your personal time with your new baby (before the REST of the family descends and you feel like you’ll never get him back!), but additionally (and honestly more importantly), it is important for your baby to latch on and nurse as well as possible as he will still have a good surge of your calories running around in him to give him the energy for a nutritive feeding effort.
Just Sucking VS Transferring Milk
You’ll hear me use this term a lot…”Nutritive.” There IS a difference between a baby Sucking at the breast…and having a Nutritive suck. All babies are born knowing how to suck. It’s an innate reflex that if you stick something in their mouth…they will suck on it (or at least try!) This is also where I get to dispel a myth – Breastfeeding should NOT hurt! I cannot count how many times I’ve found a mother tolerating an infant’s incorrect latch and feeding rhythm because their assumption that it’s “supposed to hurt” was ingrained within them from their family members or friends who did not have appropriate lactation assistance. When an infant has a correct latch and is using a nutritive suck, you should feel constant tugging….but it should NOT hurt.
There are many different feeding positions to attempt to breastfeed your infant. However, there are only a few that are truly useful right after birth. And don’t get me started about all those breastfeeding pillows and other accessories that are marketed. Don’t get me wrong…they have their place and usefulness, but not right now….not right after birth….so don’t get fixated on not having something. It doesn’t matter if you forgot to pack it or it was left in the car. Right now is about you and your baby getting started on long journey. Needless to say, all you really need right now is several pillows. In a hospital setting, there is no shortage of pillows. Happily, most Labor and Delivery departments have an abundance – so ask your nurse for more if you need them. Generally, I found that you need about 5….That’s right…5! You need about 2 for you to sit you up and support your back and neck, and about 3 to properly position your baby.
In my experience, the “Football Position” had the most success right after birth (and really for the first few days) for a plethora of reasons, but I’ll stick to 3:
- You can actually see your infant’s mouth/face,
- It’s actually the least awkward, and
- It’s the most comfortable for both of you.
There are other LCs and mothers that will disagree, but when done properly, it has the best results for a solid first feeding. So…
As soon as possible after birth, you should sit up as well as you can so your breast tissue falls forward. Place a couple of your pillows behind your back to give yourself adequate support. IF you’re leaning too far back, the breast tissue falls away from your baby and makes it difficult for him to adequately access breast tissue.
Breastfeeding Should NOT Hurt
Here I will dispel another myth….When an infant is breastfeeding well he has more than just your nipple in his mouth! It’s called BREASTfeeding….NOT NIPPLEfeeding. However, as soon as your baby is in the vicinity of your breast, he will start to nuzzle and root (also innate reflexes) as he begins to smell your colostrum (that ‘concentrated breastmilk’ that you’ve been making since you were 20 weeks pregnant). If you ALLOW him to “slurp” just your nipple into his mouth…..it’s gonna hurt! Please remember….he knows how to suck—you must teach him how NOT to hurt you and how to feed the most efficiently. If this happens – DO NOT just jerk your nipple out of his mouth! Use your finger and insert it into the corner of his mouth until he releases it. You can actually make more damage to your nipple just “popping” him off.
How do you keep him from doing this uncomfortable thing to your nipple? Control
Now I know by saying this I will incur the wrath of some LCs who prefer to allow an infant to “find the nipple” on their own in a more “natural” way…however, in most hospital settings, you probably won’t be given the time (it can take an hour or more sometimes) to allow this to happen, nor will you likely have the LC assistance available to guide you through it. Babies are delivered 24 hours a day, but most hospitals only have lactation staff assistance during the day, and most hospitals do not require their labor & delivery staff, nor their nursery staff, nor their postpartum staff to take breastfeeding courses or even become lactation counselors. Now in the United States, there is a Baby-Friendly movement where some hospitals (<3% of the hospitals in the US as of 2016) have taken steps to educated their staff how to support breastfeeding….but predominantly it is left to the LCs…if and whenever they get there.
So…..I stand by my previous statement….control of your infant is important.
This starts with support. Both yours and his. Start with yours while his daddy/your partner (or your
baby’s nurse) changes baby’s diaper. Again, sit up as straight as you comfortably can. Place a couple of pillows to maintain your position. Now let’s prepare to place your baby in the “Football Position.” First, place your pillows (probably 2) on your Right side (most people are right-handed and I’m going to make this assumption, but if you’re left-handed, just reverse the process) such that they run parallel to your legs; then put the top pillow horizontally across those pillows such that this top pillow supports your breast. This builds height for your newborn to be AT THE LEVEL of your breast – it’s going to seem that the pillows are now too high, but trust me you want them supporting your breast and the weight of your infant will squash them down a bit, so be patient.
Now place your infant on your pillow-side parallel with your legs so he’s seated under your armpit and face up. Now with his Right arm down use your thumb and middle finger at the base of his neck to turn his Whole Body toward your breast so he is now facing your breast – DO NOT just turn his head!! (When was the last time you ate with your head twisted to the side? No…you don’t eat that way and neither should he.) His ears, shoulders and hips should pretty much make a straight line – Facing your breast. Keeping your right hand at the base of his neck, pull him back so that he’s just out of reach of your nipple. With your left hand, grasp your breast so that your fingers are just outside your areola (that’s the darker skin surrounding your nipple) – or at least place your fingers so they are about 1-1/2inches outside of your nipple. Turn your hand under your breast so that your fingers (thumb on top and first finger on the bottom) are parallel with your baby’s lips. Now bring your baby slightly toward you with your right hand and use your left hand to stroke your nipple from his top lip to his bottom. BE PATIENT. Eventually he will tip his head back with a wide open mouth at which time you must QUICKLY do 2 things at the same time : pull him to you AND put as much of your breast in his mouth as you can (for most women this will include ALL of their nipple and areolar tissue.)
If you moved too slow, or he closed his mouth too quick…it’s ok….just pull him back, and try again. Be patient. Remember you are learning too. Have patience with yourself to learn a new skill. No one learns a new skill overnight. NO. ONE. You are learning to nourish your infant and to be a new mother all while being mentally and physically exhausted from a long day of labor/surgery recovery (if you had a C-section.) Patience is a virtue that not everyone is born with….but as a new mother, you’re going to learn some.
When you finally get him latched correctly…Wait. Wait for him to start sucking. Again, be patient. You may need to take your left forefinger to stroke up under his chin…do so gently. As he starts to suck you will feel a moment of “Oh! He’s got it!” and then consistent suckling. When he’s feeding Nutritively (there’s that word again), you’ll notice that his is sucking in a very significant pattern of long….slow….smooth…sucks (about 6‑7)…stop and breathe…long…slow…smooth…sucks (about 6‑7)…stop and breathe….etc. THIS is Nutritive feeding. You’ll also notice that if you close your eyes and think about it, you can feel a “tug” deep on the inside of your breast. Not just at the nipple….deeper. If I were to touch your breast while your baby was nursing, I would be able to feel this deep tug in your breast tissue – that’s how significant it is. Recognizing this feeling is important, but as everything is so overwhelming, you may not notice it right away……but I encourage you….close your eyes….think about it. Think about Where you feel tugging.
Once you recognize he’s in a Nutritive rhythm, RELAX! Take a deep breath in…and as you let it out, Relax your shoulders…..I bet you didn’t realize they were up around your ears…did you? Now…relax your left hand….if you were successful with your positioning in the first place, you should be able to completely remove your Left hand Without disrupting baby’s latch.
Now…as you are able (or get help to) support your infant’s head with a rolled-up blanket or fold that top pillow. Remember your infant does NOT have neck control! He’s like a rag doll….so you want to make sure that you feel like you completely remove your hands and your baby is going to stay Right where he is…Now, I’m not encouraging you to remove your Right arm…..but I want you to feel like you Could, if you wanted to.
Now relax your shoulders again.
If everything has gone to plan. Your infant is latched. He is feeding well. He is well supported. And you are SO comfortable that you feel like you could remove your hands if you wanted to.
The only thing to do now? Relax! The hard part is done!
How Long Will He Feed?
Most infants will feed for an average of 20-30 minutes altogether (roughly 10-15minutes per side.) He may require a little “reminding” along the way. So stay engaged with what he’s doing. Make sure he continues to suck nutritively with a steady rhythm. If he slows down, gently stimulate him up under his chin….or rub the back of his head….or something, just until he starts again. Then leave him alone. Don’t make the mistake of overstimulating him. He’s had a crazy day too!
If he has slipped down to the tip of your nipple and/or the latch/suck has begun to hurt, repeat the process to relatch and support your positioning.
After about 10 minutes, ask yourself this question “Who is working harder than who right now?”
If the answer is HIM….leave him alone! Encourage his good behavior! After another 5 minutes…ask yourself again….”Am I working harder than him? Or is he working harder than me?”
If the answer is YOU…carefully unlatch him as we discussed before. Place your finger into the corner of his mouth until he releases your nipple.
Nipple Care and Switch
Inspect your nipple. It should go his mouth round AND come out round. If it comes out flat, or slanted like a lipstick tube….he has done something very wrong to you! And whether you allowed it to happen because you thought to yourself “but it took so long to get him on! I’ll just deal with it for now.” Or you fell asleep while he was nursing (more on this later)…if your nipple is misshapen, it is now also damaged. Now would be a good time to use a Very small amount of whatever nipple cream you have procured to use for such occasions (Lanolin or a marshmallow root-based ointment are the most popular and definitely help with nipple damage discomfort. There are other nipple-care therapies, but we will discuss them later.)
Now it’s time to switch sides! ALWAYS OFFER BOTH BREASTS WITH EVERY FEEDING! Think of it like “dinner and dessert”….you always Offer dessert….but he can choose not to nurse on it.
Most babies, once you’ve taken them off the breast; taken them out of the little hole under your arm; and placed them up to burp them…they wake up enough to want the second breast. Yes….he may look like he’s sleeping….and you’ll think to yourself “I don’t want to wake him….he looks so cute!” but if you don’t at least give him the opportunity to nurse on the second breast, you may find yourself in the unhappy position of feeding every hour for only 5-10minutes. I don’t know about you….but after changing a diaper and going to the bathroom, I don’t think I’d feel very rested (I recognize that sleep is a commodity at this point….so go with me here….it’s definitely better to at least offer both breasts every feeding.)
As you switch sides, reposition your pillows and reverse the directions above to latch infant again. Most people have an easier time with their dominant side, and struggle a little more with their non-dominant side. Don’t worry about it…you’ll have plenty of time to practice!
Same rules apply to the second breast: once you get him on and nursing nutritively OR you’ve attempted to get him to feed and he is clearly saying “No, thank you”…after 10-15minutes, ask yourself “Who’s working harder here? Am I working harder than him? Or is he working harder than me? If the answer is YOU…STOP!
So…how long is a “good feeding”? The truth is a “good” feeding is about 20 minutes ALTOGETHER. So if he feeds for 15minutes on the first breast and 5minutes on the second….that’s a good feeding! If he feeds 10 minutes on each side…that’s a good feeding! If he feeds 20minutes all on one side…that’s a good feeding too- but make sure you still offer both breasts! However, don’t look at the clock and think “it’s been 10 minutes…maybe I should switch sides.”
This is important: If your baby is breastfeeding well…don’t interrupt his progress! Encourage the good behavior. If you take him off when he’s doing well…what did you teach him?? But again…ALWAYS offer both breasts with every feeding.
Now You’ve Earned Some Rest
Now you’ve earned some rest. Not too much though…you’ll need to try again in 2-3 hours from the time you STARTED. There is a common misconception here: That you count time from the end of one feeding to the beginning of the next. No! You count time from the beginning of the feeding to the beginning of the next feeding. This is because you are using your baby’s energy the entire time you are trying. This energy needs to be replaced in a timely manner to keep his little brain active. Right now you don’t have a lot of volume (you do have colostrum though)… so efficiency is important.
Colostrum (the stuff you’re making now before your mature supply comes in) is SUPER dense stuff. Your breasts don’t feel different yet because you’ve been making it and concentrating it since you were 20 weeks pregnant. Most mom’s only make a teaspoon to a Tablespoon per day! That doesn’t sound like much, but considering a baby’s stomach at birth is about the size of a marble….it doesn’t take much to make him feel full. Having said that, his stomach will begin to stretch out….whether you feed him or not! By the time he’s 3 days old, it’s the size of a ping pong ball; and by the time he’s 5 days old, it’s the size of an egg! So very soon you feel like the feedings are getting longer….and longer….and closer together: They ARE! Remember, his JOB is to tell your body how much milk he wants you to make. This is totally supply and demand – he demands and your body responds with a supply. [More on this later.]
Up Next: The Next 10-12 Hours