BY BREANNA DUNCAN, BSN, RN, IBCLC, RLC – THE MAMA MANTRA
1. How long will it take my milk to come in?
Trick question, you have milk even before baby comes! Colostrum is an early, concentrated milk that is chock-full of nutrients and antibodies. It’s quite literally liquid gold! It is the perfect first food for your baby and will meet all of their nutritional needs for the first couple of days until your milk begins to change. Milk “coming in” usually refers to the time when mom feels increased breast fullness and leaking, among other signs. Colostrum volume increases around 30-40hrs after placenta delivery, moving into transitional milk and then mature milk over the next days and weeks as it increases in volume. For most moms, transitional milk begins to arrive around days 2-3. In some scenarios milk may take longer than 3 days to come in. Breastfeed early and often, do lots of skin to skin and hand expression and you will make lots of milk and make it sooner. As long as your baby is peeing, pooping and weight loss is not too high, you are doing great!
2. How often should I nurse my newborn?
Early and often! You need not worry about clocks or timers. It’s ok to use logs to keep yourself reminded and have a general idea of how long baby is eating, but don’t let it take control or stress you. The first 24hrs, don’t be surprised if your little one is sleepy and will not latch. It’s ok! Enjoy skin to skin, continue to offer and hand express your milk and finger feed drops. Trust me, they will wake up after 24hrs and knock your socks off with how much they want to cluster feed!
You will want to offer the breast at least every 2-3 hours, but it is best to nurse on demand. Any time baby gives you feeding cues you should offer the breast. You cannot overfeed a breastfed baby and there is always milk available in the breast. Watch your baby, not the clock. Don’t “time” feedings and offer both sides (let baby fully finish the first side before going to the second side-dinner and dessert style). Make sure to wake baby for feedings early on, allowing for a 4-5 hour gap during a 24hr period if your baby is organically wanting to rest longer. Typically, 8-12 feedings every 24hrs is expected the first month or longer. Every baby is different and patterns will vary more after the first months.
Your baby will nurse for reasons beyond nutrition (for comfort, illness, to decompress, to sleep, for thirst, etc). The boob fixes everything! Your baby will cluster feed throughout the breastfeeding journey. This means that your baby will want to nurse very frequently from time to time. There is always a good reason for this pattern (growth spurts, hi!) and it helps to increase your milk supply, so power on mama!
3. How do I know when to feed my newborn?
Did you know that the mother’s right brain decreases functionality for some time once baby is born so that the left brain can light up and work more? Mom brain is real, but for good reason! It’s AMAZING because your brain does this in order to better understand your baby’s nonverbal communication (which the left brain interprets beautifully).
Babies give feeding cues when they are hungry. Early cues are wiggling before waking, opening the mouth and rooting (turning head to seek breast). Mid-hunger cues are when baby is getting a tad more active. These cues may consist of stretching, increasing movement and bringing their fist to their mouth. Late cues are their loudest form of communication when early or mid-cues are missed. During this stage, a baby may cry, become agitated and turn red. It is best that if your baby is in the late hunger stage to calm them first and then feed.
4. How do I know if I’m producing enough milk?
Easy! Is your baby peeing, pooping and are weights good? Is your sweet little one meeting milestones and they are generally happy and content? Then you’re doing great! Make sure you are seeing a breastfeeding-friendly pediatrician who is using the WHO growth chart for breastfed babies. Trust your body, trust your baby. Also remember that averages are just that, averages. We all come in different shapes and sizes, so will our babies. Your milk is always evolving and changing to meet your baby’s needs over time which is pretty magical. Managing breastfeeding well in the first month is a huge indicator for how your supply will look down the road. It’s important to seek assistance earlier rather than later to help ensure a good start if you are having trouble. Remember, the pump is not a good indicator of supply, but pumping may be a part of the plan if baby is having latching difficulty (or for other reasons).
5. My baby won’t latch. What’s the trick?
There can be many reasons why a baby won’t latch. Having a baby that won’t latch on is one of the most daunting things that new mother may have to deal with. This a very common problem, and there are lots of things you can do to help them get the hang of it. If it is right after delivery and baby won’t latch, that’s ok! It’s biologically normal. Most babies start to wake up and show more active interest on days 2 and 3. Once home is when most people encounter issues. Baby may be unable to latch, pulling off, fussy at the breast, not staying latched once on or sleepy once latched. Breastfeeding is an art form and it’s a learning curve for all involved. Baby is learning how to use their suckling reflex properly and you are learning positioning and latch techniques. Most of the time, these things come together with a little trial and error. You will both get the hang of it and find your groove. Having hands-on assistance can be helpful, watching videos of deep-latch technique and finding the best method that works for you and baby is key.
For babies that have trouble latching on, the biological nurturing (laid back) position is wonderful and helps to illicit all of baby’s natural suckling reflexes. It’s also super comfy for mama! Skin to skin will help, feeding baby when you see early cues, offering breast often, calming baby if necessary before attempting to latch (they can’t learn new skills if crying and upset), hand expressing to start milk flow for baby and everting the nipple/softening the areola some before latching can be helpful. Keep track of baby’s pees, poops and overall demeanor. Weight checks are done in the hospital and once you see your pediatrician again. They can be done more often if need be for a baby who is having more trouble latching. Avoid artificial nipples, bottles and pacifiers.
If baby isn’t latching well, pumping and supplementing with expressed breastmilk may be necessary to protect supply (pumping every 2-3 hours for 20min). Expressed breastmilk can be given via alternative feeding methods like syringe feeding, cup feeding, feeding with a small tube at the breast, feeding with a tube on the finger or paced bottle feeding until latching gets easier. The early weeks should be focused on resting, navigating new motherhood, learning about your baby and nursing. Above all, try not to get discouraged and seek help if needed.
6. One of my breasts produces much more than the other. How do I even it out?
The good news is, you aren’t alone! It is very common for one breast to produce more than the other, or one side to be smaller. Asymmetry is normal in humans and chances are, they were slightly asymmetrical even before pregnancy. However, sometimes the variation in sides can be more noticeable. This can be frustrating for some women and they may want to try and balance things out. If the asymmetry doesn’t bother you or baby, it’s not a problem. Asymmetry can be caused by normal anatomical differences, baby’s preference for one side, mother’s preference for one side or breast surgery/injury.
To try and even things out, you can attempt to increase volume on the smaller side by increasing stimulation. Try not to neglect the other side though! You can try starting baby out on the smaller side if they are willing, as they begin feedings suckling more vigorously. Pump the smaller side after nursing to increase stimulation when you’re able. It takes about 3 days or so for the breasts to turn around on the order you’ve placed, so give it some time. Do some breast massage, compressions and hand express to increase stimulation to the breast. Continue nursing both sides, not neglecting the fuller side. You can hand express for comfort on the fuller side if it ever feels overfull. You can also try different nursing positions, offer the breast when baby is sleepier (they are more likely to instinctively nurse without thinking about it), use breast compressions to speed flow on the less full side or start out nursing on the fuller side and swiftly switch baby over to the smaller side after the first letdown.
Baby can get all the milk they need from one side if allowed to nurse on demand. If one side only is given, the other breast may have lower production or stop producing which can create some degree of asymmetry. This will resolve once weaning occurs. Sometimes a strategic use of breast pads or a good bra can help to even things out. Remember that most of the time it’s much more noticeable to you than it is to anyone else.
7. How often should I nurse once my baby starts solids?
Continue to offer breast before solids, as breastmilk should be the main source of nutrition for the first year of life and is the best nourishment. Continuing to offer breast first will help maintain your supply and prevent early weaning. If solids are given first, babies will take in less milk. Solids in the first year are for play and exploration and are meant to complement breastmilk, not replace it or take precedence over it. Continue to nurse them as much as they want on demand. They will still get about the same amount of breastmilk for the first year and solids are added in small amounts on top of that (unless you are weaning within the first year). Don’t worry if your baby isn’t showing interest in solids right at 6 months and that is perfectly normal. Sometimes they aren’t interested for 8-9 months or longer. If baby refuses solids, try again in a week or two. Too many solids too early tends to lead to early weaning, whether or not mom intended to do so. Breastmilk has all the nutrients your baby needs to develop a support optimal growth and development in the first year.
8. I’m going back to work. How often should I pump, and when should I start so I can build a supply?
In the first few weeks, enjoy nursing and focus on your recovery. Pumping too often in the early weeks on top of a baby that is nursing well will put you into oversupply. It can be very problematic and create issues with plugged ducts, mastitis, etc. Pumping and storing can be implemented after breastfeeding is well established (typically after 3-4 weeks or so). Adding in 1-2 pumping sessions a day around the same time each day on top of nursing is a great way to store milk without over doing it. When you begin pumping, don’t expect a ton. You may not get anything out at first. You have to “place the order” for the supply to increase and that can take a few days to turn around. Creating a huge bank of milk isn’t necessary if you are going to be staying at home or know that you can pump while at work. Your body has been producing the exact recipe for what your baby needs. By adding in 1-2 pumping sessions, you are increasing your supply by just a little so that you can store some. The breasts are most full in the morning after nights of higher prolactin levels. Nurse first and then pump after to get the most residual. Start a storage plan 2 weeks or so prior to returning to work. In some scenarios, beginning 3-4 weeks prior to returning to work may be helpful.
Ensuring that your pump flange is a good fit, membranes are working properly and by using hands-on pumping (HOP), you can get the most out of pumping. Pumping at work will help to keep supply up. If this becomes a challenge, there are ways to still keep supply up (reverse cycle nursing, getting creative with pumping times, etc). Nursing frequently when you are with baby will still be important.
Once bottles are introduced, if they are, breastfed babies take roughly the same amount from a bottle the entire time that they breastfeed because milk is changing nutrients to meet needs. So, giving an increased volume of milk as baby grows is not necessary. Be sure to teach caregivers to use paced bottle feeding once you begin introducing bottles so that baby will not overeat from the bottle. Use slow flow nipples and bottles that are more like the breast. The mechanics of breastfeeding are entirely different from the bottle, so it’s best to wait to offer bottles until after breastfeeding is well established so the baby doesn’t get nipple or flow confusion and refuse breast. Of course, if supplementation is necessary, there are ways to go about feeding to help protect breastfeeding.
9. I want to continue nursing past a year, do I still need to introduce other milk?
Nope! As long as you are breastfeeding at least 3-4 times, there is no need to add any other milk because your toddler is getting the best possible milk they could have. Many breastfeeding mamas are told that they absolutely, without question, must introduce cow’s milk the moment their child turns one. Cow’s milk is essential for cows, not humans. The nutrients of mother’s milk are much more bioavailable and more easily digested than the nutrients of cow’s milk. Breastmilk also has many more nutrients that cow’s milk does not have. The fat content is higher in human milk which is optimal for brain growth! Your breastmilk still has benefits for as long as you choose to breastfeed (immunologically, nutritionally, developmentally and emotionally). Don’t let anyone tell you otherwise!
10. My baby won’t drink other milk. How can I keep nursing but help them to be interested in other milk?
If it’s within the first year, no other liquids other than breastmilk or formula are recommended, so you can stick to that. After the first year, if you are continuing to nurse, that’s great! Your milk is still the best milk. Cow’s milk is just one of many complementary options for getting good calories, fat, proteins, calcium and other nutrients into your child’s belly. There are many foods that can also deliver the goods. If your little one is not interested, there is no amount of coaxing them that you can do to make them want it…and that’s ok! Try not to force it. You can always take a break from introducing it and try again in a week or so. Toddlers are finicky and constantly changing their mind about what they like or don’t like and they may surprise you one day and be all about it!
Tips for getting other milk to your toddler:
1.You can gradually add milk to your own expressed breastmilk in a sippy cup and slowly introduce it to your child.
2.Toy around with different temperatures to see what your toddler prefers.
3. Some parents mix their toddler’s favorite fruit into the milk (throw it in a blender together…think fresh strawberry milk) and see if that does it for them.
Rest assured that there are MANY children out there who don’t drink other milk of any kind (in other countries it isn’t as common a practice) and they are perfectly healthy and get all the nutrients they need from other sources. I, and many others, believe that we put way too much weight on cow’s milk being a miracle food for children. If your child just prefers not to drink it, they can get dairy from other sources (whole fat yogurt, cheese, or foods that have milk as part of the ingredients). Your toddler can get many nutrients from other foods they eat that are high in healthy fats, vitamin D, calcium, protein, etc. There are wonderful nutritionists and resources out there to help you navigate those waters. If you are interested in trying another kind of milk or your little one is intolerant/allergic to cow’s milk, speak with your healthcare professional and just be sure that it has good nutritional content (which can vary widely brand to brand).
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