Anne Smith, IBCLC
Avoid artificial nipples, supplemental feedings
Avoid artificial nipples and supplemental feeding during the early weeks of nursing. While some babies switch back and forth from breast to bottle easily from the first day, many babies will become nipple confused if you introduce artificial nipples before they have mastered the art of breastfeeding.
Colostrum, the yellow fluid that your breasts start producing during pregnancy, is the perfect first food for your baby and will meet all his nutritional needs for the first couple of days until your milk comes in. Interesting piece of trivia: in lower mammals, newborns die if they don't receive the immunities from their mother's colostrum. Ask someone who raises horses or puppies. The mother horse who refuses or is unable to nurse her newborn is dooming him, unless another newly lactating horse can be found ASAP. Thank goodness this isn't true for humans!
While colostrum isn't quite as important to human babies, it does provide immune factors that newborn infants can't receive anywhere else. It is easy to digest, and is full of antibodies and immune factors. Colostrum is often called "baby's first vaccine."
During the first couple of days after your baby is born, he will take in only teaspoons (not ounces) of this precious fluid. His immature kidneys are not meant to handle large volumes of fluid at this time, and the colostrum has a laxative effect that clears the meconium (the black tarry first stool) out of his system. Excreting the meconium will help him avoid becoming jaundiced.
Your baby is born with extra fluid in his tissues, and will excrete it during the early days. Most babies will lose some weight in the first couple of days after birth -- the average seven and a half pound baby will lose about 7 percent of his birth weight, or around 8 ounces. This is normal, and he will quickly regain his weight in a few days once your milk comes in. Babies don't need water, even when it is hot outside. Human milk contains plenty of water.
Giving formula supplements at this early stage can cause all kinds of problems, including a decrease in your milk supply. Formula takes longer to digest than breastmilk, so your baby stays full longer and is less likely to nurse as often as he needs to stimulate your supply. While many babies tolerate formula well, the younger your infant is when he is exposed to artificial milk, the greater the chance of allergies or digestive problems. The longer you wait to introduce formula -- if you introduce it at all -- the better.
If supplements are medically indicated, it is best to use alternate feeding methods rather than bottles. Alternate feeding methods include cups, syringes, tubes or finger feeding.
Make sure that your baby is latched on correctly and is nursing effectively. The article on Sore Nipplescontains detailed information on how to make sure your baby is positioned and latched on correctly. His mouth should be open wide, his lips flanged out, his tongue extended over his gum and under your nipple and he should have not just the nipple but some or all of the areola (the dark area around the nipple) in his mouth as well. He should be pulled in close with his chin and nose touching the breast. His whole body should be facing yours, tummy to tummy, so that he doesn't have to turn his head to nurse.
Learn signs of effective, nutritive nursing. Look for a long, drawing, rhythmic motion along his jaw-line and a wiggling at his temple. You should be able to hear him swallowing after your milk comes in. Some babies will stay on the breast for long periods of time, but will "flutter suck" ineffectively in their sleep, and won't get the milk they need or supply you with the stimulation to produce more.
For the first couple of days, your breasts will produce sticky yellow or gold colostrum. Once your milk comes in, you will produce transitional milk -- a mixture of colostrum and mature milk, which may be yellowish and creamy looking. During the next week or so, less and less colostrum is produced, and by the time your baby is two weeks old, mature milk has replaced the transitional milk and no more colostrum is produced.
Even if you only nurse your baby for a few days or a couple of weeks, you are still providing him with important immune factors. Of course, very few mothers who make it through the first two weeks of nursing will give up at that point. That's just when you are over the hump and things are starting to get easier. Most breastfeeding problems (sore nipples, engorgement, latch on problems, etc.) will be resolved after the first two weeks.
The adjustment period
Days three and four are usually the roughest, and the time when most mothers are likely to give up and switch to formula. There are many reasons for this: the physical stress your body has been through (you often just don't feed good -- even with a natural childbirth with no complications, you are still physically drained, and you may be dealing with additional stresses like constipation, hemorrhoids, episiotomy stitches, or recovering from a c-section), the hormonal upheavals, sleep deprivation and the overwhelming pressure of being the one person totally responsible for the nourishment of this new little person in your life.
It's normal for babies to become agitated and fussy on the third or fourth day, because they are feeling hunger pangs for the first time. Their little tummies rumble and growl, and they don't like this new feeling one bit. They have no way of knowing that if they go on the breast, they will get milk and feel good again. They will soon figure it out, but it is a learning process. Be patient and hang in there.
Do whatever you have to do to survive the first two weeks. If you have to use slings, swings, bottles, pacifiers, formula or pain medicine, use them and don't feel guilty about it. The most important thing is that you make sure your baby gets enough to eat while lowering your stress level, enjoying your baby, getting your strength back and continuing nursing. It really won't matter down the road, and sometimes using these things can make the difference between continuing to nurse or giving up in the early days.
Be prepared for growth spurts
These are periods of time when your baby wants to nurse constantly and never seems satisfied, and usually occur around seven to 10 days, three weeks, six weeks, three months and six months. If you have been feeding every one to two hours around the clock, and your baby doesn't go any longer stretches than that in 24 hours, consult a Lactation Consultant if this pattern continues longer than a few days.
The baby who nurses "constantly" for several hours, then sleeps for a 4 or 5 hour stretch, is probably still getting in his minimum of eight feedings in 24 hours, and is likely to be getting enough to eat. However, if he nurses "constantly" around the clock with no long stretches between feedings and never seems satisfied, he may not be getting enough milk for a variety of reasons, and a consultation to discover the cause is indicated.
Remember that nearly all breastfeeding problems can be solved if you are strongly committed to nursing your baby, and you receive advice and encourage from a knowledgeable breastfeeding professional. Don't ever be afraid to ask for help.