You ab. Making Breastfeeding a Success. TexasHealth.org

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1 You ab Making Breastfeeding a Success Breastfeed your baby in the hour after delivery. Most babies are more alert soon after delivery. Research demonstrates the importance of breastfeeding and skin-to-skin contact between mother and baby within the first hours after birth. Inform your family and visitors before you deliver that the priority is for baby and mom to have quiet time together after delivery. This may mean that their visit may have to wait until you get to postpartum. Put your baby skin-to-skin before and/or after feedings. Place baby on your chest and cover both of you with a blanket. This will soothe baby and help stabilize his/her body temperature, pulse and breathing. This is also a wonderful way for Dad to bond with the baby. Feed on demand. Get to know your baby by learning his/her hunger cues such as lip smacking, mouth opening and bringing his/her hand to mouth. Feed the baby early when he/she shows these signs of hunger. Crying is a late hunger cue; the goal is to feed before crying begins. It is typical for babies to cluster feed, often feeding every 1-3 hours or 8-12 times during a 24 hour period. Feeding often will help bring your milk in. If your baby is sleepy, wake him/her every 3 hours. Make this time special. Realize that breastfeeding and bonding with your newborn may sometimes require you to limit visitors. Your family and friends will understand that this is an important and intimate time for your growing family. Let your baby room-in. At Texas Health Resources we want to minimize separation of mom and baby which is why we promote rooming in. By having your baby with you both day and night you are able to learn his/her feeding cues. You will learn to care for your baby and become confident and competent. Our nurses will check on you regularly to provide support and assistance. Night time feedings: Research shows that babies feed more frequently at night in the first few weeks and that mothers who have their baby fed in the nursery often have a delayed milk supply. In order for you to respond to your baby s needs at night, breastfeeding mothers are discouraged from taking sleeping pills. You may want to ask a family member to stay with you overnight to assist you. This will be especially important if you had a cesarean birth. Limit visitors during the day to allow you to take a much needed daytime nap. Avoid and nipples: They may interfere with optimal breastfeeding and the baby s suckling. If a baby is showing feeding cues, put him/her to the breast, this stimulation is important in the establishment of your milk supply. Do not supplement with formula unless recommended by your pediatrician. Your colostrum is all that your baby needs in the first few days of life. Your baby s stomach is very small and colostrum comes in small concentrated doses to provide just the right balance of carbohydrates, proteins and antibodies in an easy to digest form. A full term baby s stomach is only the size of a marble on day one; it will grow larger every day! You will want to count your baby s wet and dirty diapers to be sure he is getting enough. Your baby will have some weight loss (yes, LOSS it is expected your baby will lose some weight after delivery before they start gaining). Your baby should be back to his birth weight by 2 weeks. Be patient and let us help. At Texas Health Resources we are committed to supporting your family s decision to breastfeed. We have a comprehensive lactation program which includes prenatal breastfeeding classes, extensive breastfeeding training required for all nurses working in women s services, inpatient lactation consultations, and outpatient services. Our outpatient services include outpatient lactation consultations, pump rentals, free telephone support and retail products. See the Resource page for phone numbers and a location near you. TexasHealth.org Doctors on the medical staff practice independently and are not employees or agents of the hospital except for resident doctors in the hospital s graduate medical education program.

2 First 24 Hours At delivery your baby is alert and awake taking in all their surroundings and responding to your voice. Day Two & Three of Breastfeeding hours of age Babies during this period begin to be more awake and alert and breastfeed better. Placing your baby skin-to-skin on your chest after birth will maintain their temperature and facilitate bonding for the both of you. Breastfeeding in that first hour is very important to you and your baby. Many babies are sleepy in the first 24 hours after birth and are in recovery mode from the delivery. Healthy term newborns are born with sufficient fluid stores therefore they do not need water or formula unless there is a medical problem. It is a good idea to awaken your sleepy baby and position them at the breast every 1 to 3 hours. Unwrap the baby and remove the hat and hand covers and place the baby skin-to-skin on your chest or next to your breast to help wake the baby. Once the baby is positioned, a blanket over the baby will prevent chill while the mother s body keeps the baby s temperature stable. You may need to continue with some gentle stimulation to keep your baby eating, such as stroking their legs, feet and back. Some babies will wake easily when you unwrap them or change their diaper. If your baby does not awaken and nurse after minutes place the baby skin-to-skin on your chest. Unrestricted feeding in the first 24 hours is important as the baby is learning how to breastfeed and is establishing your milk supply. A newborn s sleep cycle is about 45 minutes to an hour, so try again then or anytime the baby shows feeding cues. Offer the breast anytime the baby starts exhibiting feeding cues. Attempt to nurse your baby at least eight times in 24 hours. Many babies will breastfeed times in a 24 hour period. Allow baby to breastfeed as long as they desire, feedings will average 5-30 minutes. Allow your baby to release himself from the breast unless you become uncomfortable and need to change position. After long periods of sleep some babies will go through a marathon nursing phase where they want to nurse all the time and can t be put down. This is a good sign as the baby is allowed to stimulate the mother s body to establish an adequate milk supply. It is NOT because you do not have enough milk. Allowing your baby to eat as often as he wants is best. If your baby does finally fall asleep during this frequent feeding phase, you can usually get a break from nursing if your baby is held or cuddled. If you put him down, he may soon awaken and want to nurse again not because he is hungry but because this is comforting and as close to home as he can get. Your little one has realized that he is no longer in the warm comfortable environment of your womb where they listened to your heartbeat, tummy rumblings and breathing. The most comforting place for your baby is at your breast. FEEDING CUES Moving, squirming or stretching Yawning or moving mouth while appearing to be sleeping Opening his/her mouth or turning head side to side Bringing hands to the face and/or sucking on fist or fingers TexasHealth.org Doctors on the medical staff practice independently and are not employees or agents of the hospital except for resident doctors in the hospital s graduate medical education program.

3 48-72 hours of age This is the time that your milk will begin transitioning from colostrum to mature milk. The breast will become heavier and fuller over the next few days as the volume increases. Milk volume is related to frequency and duration of feeds as well as effectiveness of the baby at the breast. You should be hearing more swallows from the baby at this time. Charting your baby s feedings and wet and dirty diapers will help you determine your baby is getting enough. Do all pacifying at the breast. Continue to avoid pacifiers or bottle nipples until your baby is nursing reliably and gaining weight. Baby s Second Night You ve made it through your first 24 hours as a new mom. Maybe you have other children, but you are a new mom all over again...and now its your baby s second night. All of a sudden, your little one discovers that he s no longer back in the warmth and comfort albeit a bit crowded womb where he has spent the last 8-9 months and it is SCARY out here! He isn t hearing your familiar heartbeat, the swooshing of the placental arteries, the soothing sound of your lungs or the comforting gurgling of your intestines. Instead, he s in a crib, swaddled in a diaper, a T-shirt, a hat and a blanket. All sorts of people have been handling him, and he s not yet become accustomed to the new noises, lights, sounds and smells. He has found one thing though, and that s his voice...and you find that each time you take him off the breast where he comfortably drifted off to sleep, and put him in the bassinet he protests, loudly! In fact, each time you put him back on the breast he nurses for a little bit and then goes to sleep. As you take him off and put him back to bed he cries again...and starts rooting around, looking for you. This goes on seemingly for hours. A lot of moms are convinced it is because their milk isn t in yet, and the baby is starving. However, it isn t that, but the baby s sudden awakening to the fact that the most comforting and comfortable place for him to be is at the breast. It s the closest to home he can get. It seems that this is pretty universal among babies lactation consultants all over the world have noticed the same thing. So, what do you do? When he drifts off to sleep at the breast after a good feed, break the suction and slide your nipple gently out of his mouth. Don t move him except to pillow his head more comfortably on your breast. Don t try and burp him just snuggle with him until he falls into a deep sleep where he won t be disturbed by being moved. Babies go into a light sleep state (REM) first, and then cycle in and out of REM and deep sleep about every half hour or so. If he starts to root and act as though he wants to go back to breast, that s fine...this is his way of settling and comforting. Another helpful hint...his hands were his best friends in utero...he could suck his thumb or his fingers anytime he was the slightest bit disturbed or uncomfortable. And all of a sudden, he s had them taken away from him and someone has put mittens on him! He has no way of soothing himself with those mittens on. Babies need to touch to feel and even his touch on your breast will increase your oxytocin levels which will help boost your milk supply! So take the mittens off and loosen his blanket so he can get to his hands. He might scratch himself, but it will heal very rapidly after all, he had fingernails when he was inside you, and no one put mittens on him then! By the way this might happen every once in a while at home too. Don t let it throw you sometimes babies just need some extra snuggling at the breast. 2001/Jan Barger, RN, MA, IBCLC May be reproduced for noncommercial purposes Doctors on the medical staff practice independently and are not employees or agents of the hospital except for resident doctors in the hospital s graduate medical education program.

4 Breastfeeding Log Day One Goal: 8 to 12 nursings Wet diaper: W Black tarry soiled diaper: S Day Two Goal: 8 to 12 nursings Wet diaper: W W Brown tarry soiled diaper: S S Day Three Goal: 8 to 12 nursings Wet diaper: W W W Green soiled diaper: S S S Day Four Goal: 8 to 12 nursings Wet diaper: W W W W Yellow soiled diaper: S S S S Day Five Goal: 8 to 12 nursings Wet diaper: W W W W W Yellow soiled diaper: S S S S Day Six Goal: 8 to 12 nursings Wet diaper: W W W W W W Yellow soiled diaper: S S S S Day Seven Goal: 8 to 12 nursings Day Eight Goal: 8 to 12 nursings Day Nine Goal: 8 to 12 nursings Day Ten Goal: 8 to 12 nursings If on a certain day your baby has less wet diapers and/or less dirty diapers than listed If on a certain day your baby has less wet diapers and/or less dirty diapers than listed on your breastfeeding log, contact your doctor or lactation consultant. This log is designed for use with a well, full-term newborn. Ask your doctor what you need to know about breastfeeding your premature or special-needs newborn.

5 Timeline for returning to work The Last Three Months of Pregnancy First Three to Four Weeks at Home Baby is Three to Four Weeks Old Three to Four Weeks Before Returning to Work Do something special for yourself during these few hours you deserve a treat! Five to Seven Days Before Returning to Work Countdown The Day Before Returning to Work Day One as an Employed Mother Evenings and Weekends

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