In this first post of this two-part series, we identify the four basic needs of all breastfeeding babies during the first six weeks.
This is a hard time of the year to have a new baby. After years of supporting mothers at all stages of breastfeeding, I've learned to be a bit more proactive with providing support in December -- or she may feel it's just too much of a hassle.
Breastfeeding isn't so much an issue during the holiday season with older babies as it is with newborns, or babies who need a little more time developing their latch, or babies whose mothers need a little more time building their milk supply. If there are any challenges going on with breastfeeding already, December just magnifies them!
In this first post of this 2-part series, let's identify 4 basic needs of all breastfeeding babies during the first 6 weeks:
1) A Good Milk Supply
You need to be making enough breast milk to satisfy baby. A satisfied baby will come off the breast on his own and not fussing and not giving you hunger cues. She may fall asleep at the breast, but doesn't then wake up almost right away looking for the breast.
Newborn babies do need to feed frequently, but if baby is breastfeeding nearly constantly -- like you literally have only a few minutes between the end of one feed and the beginning of another, and this lasts all day long -- it's time to contact your local lactation professional for a breastfeeding assessment.
It's nearly impossible to say how often your baby will need to breastfeed. At the hospital, you may hear that baby needs to feed every 2 or 3 hours. This guideline is more so a mom doesn't go over 3 hours without feeding, if she's missing baby's hunger cues or if baby is sleepy from having jaundice, for example.
We want to see babies breastfeeding on demand, or on cue, meaning whenever baby is showing pre-cry hunger cues: sucking on fingers or fists, just having the hands in fists, wiggling, pursing lips, sticking the tongue out of the mouth, turning toward the breast, even moving the eyes under the eyelids in that last phase of light sleep.
Crying is baby's last resort, and waiting til baby cries is ill-advised as baby will be much harder to latch and settle, being so frustrated, and often falls asleep early in the feeding because crying takes so much energy. If your baby is easily frustrated, watch for baby's earliest hunger cues and latch at that point.
So back to how often a newborn will breastfeed: It could be every 2 hours, or every 3 hours, or every 1 hour, or every 1-1/2 hours, or sometimes every 2 hours and sometimes every 1 hour during a few hours every evening. There is no set standard among babies, because all babies -- just as all moms -- are unique individuals, but trust that all babies instinctively know when they are hungry and then breastfeed them at that point.
(A caveat here is if your baby has a reason for needing close medical monitoring, such as being jaundiced or premature or another reason identified by his health care provider or your lactation consultant, these babies may need to be awoken before they show hunger cues to stimulate their feeding instincts.)
After all that, how does this relate to having a good milk supply? The newborn weeks are when you will be establishing milk supply, and the best way of doing that is by breastfeeding frequently. How much milk a mom makes depends on how much and how frequently milk is being removed, so to make more milk, she needs to find a way to breastfeed (or pump) more often. Think of the breasts like a milk factory -- you got to keep the product, the milk, moving or the factory slows down and stops.
Experienced low supply before? Barring any hormonal medical conditions or uncommon breast tissue complications, your potential for making a full milk supply resets with every pregnancy. So, if you want an abundant milk supply over the course of your breastfeeding relationship, concentrate on removing breastmilk frequently in the early weeks.
2) A Good Latch
Frequent breastmilk removal is key to building a good milk supply, but so is a good latch. Latch is how baby's mouth fits on the nipple. A good latch makes for a good milk transfer. A poor latch makes for a poor milk transfer. A baby with a good latch will be more likely to be satisfied and to be able to build up or maintain a mother's milk supply. A baby with a poor latch is less likely to do so.
It's generally easy to figure out if baby has a good or poor latch. A poor latch can be painful. While some initial tenderness is common in the first few days after birth, this tenderness goes away in the first seconds after a good latch, and then goes away for good after a few days to a week. Sometimes, a poor latch just causes an ongoing discomfort beyond a week; sometimes, a poor latch causes bleeding and cracked nipples. Either way, pain while latching is a sign to find your local lactation professional.
The good news is, poor latch is often relatively easy to fix. It really is something that mothers need to consult with their local lactation professional about, because the lactation professional can assess baby's mouth and mom's nipples as well as provide in-person or, if you like, hands-on tips as to better latching technique and positioning.
The best way to prepare for a good latch, in my opinion, is to take a breastfeeding class before baby is born. At my local hospital, the lactation consultants offer a class to all women in their third trimester. My first baby was an early preemie, so I didn't get to take the class and then ended up not having the first clue of how to latch her and decided to exclusively pump. With my second baby, I was able to take the class and, wow, did it make a difference! It was all about latching, and then when I delivered, breastfeeding wasn't such a mystery to me -- in fact, I simply picked up my baby and latched her right then and there. We did have some problems with poor latch in the first couple of weeks but was able to correct it quickly because of what I learned in the class.
That's not to say it always goes easy. I had much worse latch issues with my third baby and seemed to be constantly in the lactation consultant's office, but because I recognized the importance of a good latch and of seeking help to attain it, I was finally able to overcome the sore nipples that might have otherwise convinced me to quit. That baby, by the way, self-weaned at 3-1/2 years old -- of all the accomplishments in my life, full-term breastfeeding may be the highest on my list. So, ladies, breastfeeding is worth whatever hassles you may be encountering.
3) Ready Access to the Breast
We covered a lot of how often baby needs to breastfeed in the section about Good Milk Supply, but it's so important that it should be reiterated a few times. To save on space, though, let's focus on the need for baby to be able to exclusively breastfeed.
While some moms can build their supply by pumping, be forewarned that no pump, not even the highest-quality pumps, are as good at removing milk and building a milk supply as a baby with a good latch. The hands-on pumping technique can help moms who are truly pump-dependent, because of course, if baby is not latching well or not latching at all or if you are needing to supplement, it's incredibly important that you are pumping with a high-quality breast pump at least every time baby takes a bottle but likely even more frequently as determined by your local lactation professional.
What I really want to touch on here is cluster-feeding and growth spurts. Cluster-feeding is a period of usually a few hours, which can happen every day during the early newborn weeks, when baby want to breastfeeding basically constantly. You'll get done with one nursing, only to have baby cue you that she wants to latch again. This is very normal and is a way that baby builds up your milk supply. It tended to happen with my babies in the evening when my -- and many mothers' -- milk supply was naturally lower. It may also happen overnight or any other time of the day.
Growth spurts are like cluster-feedings, except they happen a bit more predictably. All babies go through growth spurts at about 7 to 10 days old, 3 weeks old, 6 weeks old, 3 months old, 6 months old, and 9 months old. From experience, those 3- and 6-week growth spurts really sneak up on moms! All of the sudden, baby starts nursing again like a newborn, wanting to latch very frequently and often being fussy. Even experienced breastfeeding moms may be tricked into thinking their milk supply is going out.
But your milk supply is fine. What's happening is completely normal. Cluster-feedings during and outside growth spurts signal to your breasts to make more milk -- remember that how much milk you make depends on how much is removed -- so by baby breastfeeding more frequently, this tells your body to make more milk, which is then able to sustain baby as she grows. It's a great system.
You may also notice more frequent nursing when baby is sick or overstimulated or otherwise not feeling centered. Breastfeeding isn't just nutrition, but also comfort. The act of sucking is comforting, and so is being physically close to mom. Try not to worry about the idea of being used as a pacifier -- pacifiers were created to be a substitute for you: the mom. Babies need that closeness to you, that ability to suck, and to get breast milk at the same time, for healthy development. A pacifier can't give all that baby needs! A pacifier is actually a substitute for a mother.
The best way through cluster-feedings and growth spurts is to just let baby breastfeed as much as he wants. This will get your milk supply to where it needs to be for baby, and will ensure your baby is getting enough milk for his growth.
How do you know if baby is getting enough milk? A satisfied baby at the end of a feeding is a good indicator, but the gold standard -- besides weight gain, which is best measured and monitored by a health care provider -- is watching baby's diapers. After the 4th day until about 6 weeks, you want to see at least 3 to 4 mustard-yellow, loose, seedy stools each day that are at least the size of a quarter as well as at least 5 to 6 sopping wet diapers.
Some babies, such as those who were born premature or early term or small for gestational age, need to play catch-up with their weight and it may seem like they are constantly cluster-feeding, every day and night. This is normal, but it would be good for you to contact your local lactation professional just for reassurance and perhaps some ideas for when it gets tiresome.
4) Skin-to-Skin Contact
I alluded to this in the above section, about how baby actually requires physical closeness to mom for healthy development. Breastfeeding provides skin-to-skin contact between baby and mom. The more, the better!
All nurturing touch between humans produces a hormone in the bodies of those involved in the touch -- called oxytocin, or aptly, "the love hormone." Oxytocin causes us to feel relaxed, among its many benefits. It also greatly helps moms and babies with bonding.
Skin-to-skin is done by undressing baby to the diaper and placing on mom's bare chest. A version of this happens with Kangaroo Care for premature or ill babies, as it helps baby better regulate body temperature, heart rate, breathing patterns, and other body functions that improve development. Not only does skin-to-skin contact help with bonding between healthy, term newborns and their moms, but oxytocin also boosts milk-making hormones and encourages baby to latch.
Skin-to-skin contact is promoted quite a lot in hospitals, but it's important to continue providing it at home, too -- especially with a baby who is having trouble with latch, or who is too sleepy to wake for feedings, or whose mother is needing to increase her supply.
Nurturing touch beyond skin-to-skin contact and breastfeeding -- such as through babywearing, cosleeping, being held in-arms, and shared bathing -- is still incredibly important to healthy infant development, even with a baby who has a good latch, whose mother has a good milk supply, and whose newborn period doesn't seem to have any challenges to breastfeeding. Babies just need to be held, and its best done by the breastfeeding mother who is in sync with baby's needs -- rather than a relative.
In the next post, we'll look at 5 main barriers during the holiday season, how they sabotage these 4 basic needs of all breastfed newborns, and ideas of how to skirt around them.