Lots of women find the few hours and days post labour to be a complete shock. Many have no idea that the changes that take place in that transition between baby in and baby out will affect them so profoundly: from being so sore that even thinking about going for a wee will make you cry, to being so exhausted that the thought of sitting up to breastfeed your baby is simply out of the question, to experiencing the hormonal fallout so acutely that even dropping your toothbrush down the loo accidentally will make you weep uncontrollably for ten minutes until someone comes to your rescue.
If you are pregnant, it is probably useful to find some women with children and ask them about their experiences, or maybe not. Perhaps it is better to not know until you get there! Anyway, seeing as this is a breastfeeding blog, I should stick to the topic and give you a few ideas of what to expect from, and how to deal with, breastfeeding your baby in those first few hours.
Lots of babies, if given the chance, and if not suffering from the effects of maternal pain relief from the labour or any other mitigating factor, will actually crawl up their mother's tummy and latch on themselves. In fact, babies who do this are more likely to breastfeed without problems and for longer. It is the way nature intended things to go and like most things in today's modern world, we try to rush it. So when you are exhausted, lie back and let your baby do the rest. Like this lady. Your baby is very likely to latch on within an hour, maybe 90 minutes. There is no hurry - allow your baby time to find your nipple, and take the time to inspect and get to know your baby.
Your midwife or obstetrician should know about this way of getting a baby to latch. If they don't, which is depressingly common, speak up. Start saying words like 'Unicef' and 'Birth Crawl' and 'Baby-friendly Initiative'. This should get them to support your choice of strategy. And it is your choice - you are not a patient when you have given birth - you are a mother with her baby, and providing there is no medical emergency of any sort, your health care providers should abide by whatever you say. In fact, it is probably a good idea to brief your partner too so that he can do a good job of insisting on what you want, particularly as you are likely to be entirely shattered. You can go into the hospital with definite intentions and information about what it might be like. These mums have been through it and have some great tips. I had an emergency caesarean and all I could say was 'skin to skin', 'we need to have skin to skin' over and over again. My husband did too. It worked thankfully and we had 90 minutes of skin to skin and my son did latch on by himself.
If your baby latches at this time, great. If not, don't panic, he or she might just need to sleep a while and is likely to wake up and want to feed later particularly if kept skin to skin next to mum's chest or tummy. When your baby does wake up, again, lie back and relax and let your baby do what nature intended. If your baby still does not latch on, it does not mean they never will. It might be that they are groggy from the medication, or they may be unable to latch properly due to a physical issue such as tongue tie. Some women have found expressing some of their colostrum onto your finger and giving it to their baby to suck a good way to get them interested in feeding. Reading this article by world breastfeeding expert, Jack Newman, before the birth will help you be confident that you know what to do should your baby decide that latching on is for losers. He has some great practical tips.
It is important to say at this stage that when your baby is first born, their tummy is about the size of a small marble and doesn't need much to fill it - around 5ml in fact. The small quantities of colostrum in your breasts are perfect for your baby and breastfeeding your baby while there isn't gallons of milk there is a great way for him to practice sucking, breathing and swallowing.
The only answer to this is 'it depends'. It depends on how efficient the baby is at getting the milk. It depends how fast your let down is. Some women literally spray milk, for others it is a slow and steady flow. It depends on whether your baby wants a drink, or a snack, or a four course meal. It depends on too many variables to have one definitive answer. Lots of women find that watching their baby rather than the clock helps them learn all about how a baby breastfeeds.
How much time did your baby spend feeding and did it change over time?
Knowing and trusting that your baby is getting enough is one of the hardest things about breastfeeding, especially in our modern culture where everything is measured and valued and evaluated and monitored, from business to breastfeeding.
There are some signs though that will help you decide to remain calm and enjoy your baby :)
The first and most obvious one is weight gain. If your baby is gaining weight steadily, even if he lost quite a bit at the beginning, all is probably ok. Your baby should be weighed ON THE SAME SCALES and WEARING THE SAME THING - PREFERABLY NOTHING. This is incredibly important - scales can vary! Research shows that scales can be different by 5-8 ounces. But weight gain is not the only indicator of a healthy baby. Indeed, some perfectly healthy babies drop down the percentile lines (although gaining steadily) over time and find their own place on their own line. They often stay there for the rest of their childhood and beyond.
The other signs include at least 4 or 5 heavy wet nappies in a 24 hour period. It is very difficult to measure this with today's nappies - if you are unsure, fill a clean nappy with at least 3 tablespoons of water. This will give you an idea. At least 3 pooey nappies at least the size of a 10p piece in a 24 hour period. Some babies have been known to do one massive one but if it less than 3 then it should definitely be a really big one! Another sign the baby is healthy is she has a nice pink healthy colour and when not asleep is alert and active (as opposed to pale and limp). And the one we often fail to realise - the mother will often KNOW if something is wrong with her baby.
All of these signs are important, and all of them add up to a healthy baby. It is no good looking at one alone, such as weight gain, as some slow gainers produce lots of wet and pooey nappies, are alert and a good healthy colour and are completely fine. Some babies are really slow at first but gain momentum in the following weeks. Sometimes mums are unnecessarily worried about their babies if they weigh them and they haven't put on the 'required' amount, but all the other signs of a healthy baby are present. Breastfed babies often plateau and spurt in the weight gain department. I know my little boy put on nothing for three weeks (I was beside myself) and then proceeded to put on a pound a week for the next two!
Remember. it is important to get real life support if you at all concerned. Go to a support group run by a knowledgeable breastfeeding support worker and discuss it. Often talking to other breastfeeding mums too will put your mind at rest.
This is an excellent podcast from Diana West IBCLC.
If your baby is falling asleep after a couple of sucks it might be worth helping him latch on again to get a deeper latch so that he gets milk more easily. It is also worth getting someone knowledgeable to check for tongue tie. Babies sometimes fall asleep all the time because they are not getting the milk they want. It can be really frustrating for a mum with a really sleepy baby as sometimes it seems like nothing will wake them up, particularly in the early days, and expressing and feeding via a cup or bottle is often needed to give the baby the energy needed to have another go at breastfeeding. Interestingly,
Jack Newman advocates the use of the supplemental nursing system (SNS) as it gives the baby an opportunity to breastfeed while still getting the milk he needs. He also has a useful article on his website.
Often, with enough practice, mums and babies can have a difficult couple of weeks but go on to breastfeed happily once the mum has learnt how to position the baby correctly, and the baby has learnt what to do with their tongue and jaw to get the milk. Babies need to learn to breastfeed too and although it can be really stressful, it is important for mums to summon as much patience as possible to give the baby a chance to get it right.
It is important to note that if a biological problem, such as tongue tie, is foiling your baby's attempt at getting milk, no amount of poking, blowing or stroking will help him. This website has more information about tongue ties.
What worked for your sleepy baby? Sitting them more upright? Cooling them down? Or did something help your baby to get more milk more effectively?
The chin is pretty important in latching your baby on. Getting the chin to the breast first will help the baby get a good mouthful of breast, with more of breast in her mouth on the chin side than on the top lip side. You can often see more areola (the pinky brown bit surrounding the actual nipple) by the baby's top lip than by her chin as the nipple by her chin should be in her mouth as this is how she can compress the milk sinuses and get lots of milk.
A baby can feed for a short time with a good latch and good drinking, and be happy for a few hours before she needs more. If your baby is spending hours at the breast, it might be worth working on the latch to help the baby get more milk in a shorter amount of time so you can both take a break!
This Jack Newman video is quite a good demonstration of what I am talking about.
My baby is tongue tied, and in the first month or so I had an awful cracked nipple which didn't seem to be healing. I remember vividly weeping through each feed and hoping it would be healed by the time I had to feed him again. Breastfeeding was turning out to be a nightmare. It didn't feel natural, it felt strange, and it hurt. Alot. How was I going to feed my baby for the next year with excrutiating pain at each feeding? I needed a solution, and quickly. Two and a half weeks after having a caesarian with my husband back at work, and having wept through one feed too many, I got on the bus with my baby in the pram and went and bought a pump. I barely made it home in time for the next feed, pumped out the milk and gave it to him in a bottle. The relief, I can't tell you, was unparalleled.
I knew however, that this was a short term thing. That I couldn't pump forever, and that I needed help. I didn't know much more. I was also a bit concerned about the affect all the pumping would have on my supply.
I had been told about the local breastfeeding drop in which was nearby, and reluctantly went along to see if anyone could help. They could. The health visitor was great - extremely well informed about breastfeeding, and she put my mind totally at ease. And within minutes, I'd met a couple of mums also struggling with early breastfeeding. I was not alone. By the end of the session, I had spent half an hour talking to another mum struggling with a tongue tied baby and had an action plan worked out for me by the health visitor who watched my baby feed and helped me with positioning and attachment, which I now know to be arguably the most important element of successful breastfeeding. I left with a totally different attitude and a feeling that perhaps this was doable after all.
Breastfeeding Support Groups are just that: supportive. They often have peer counsellors who have breastfed their own babies and done a twelve week course in the mechanics of breastfeeding, common problems and counselling other mums, and always have an experienced health care professional who has usually done the UNICEF three day course on breastfeeding management. Sometimes there is even a lactation consultant. It is an opportunity to talk to other mums who are breastfeeding, ask lots of questions, swap experiences, and of course sit down with a cup of tea and enjoy your baby.
Was there someone at your local support group that really helped you cope with a difficult problem?
This is arguably one of the most important aspects of establishing breastfeeding. If your baby is latched on well all (or at least most - it can be hard at first!) of the time, breastfeeding is unlikely to be painful for you and it will be satisfying for her as she will be able to get milk easily - and along with connection with mum, this is what every tiny baby wants: milk. A 'good latch' will also keep your supply going effectively.
It appears that the best way to latch your baby on initially is by using the birth crawl or 'biological nurturing' approach in the hour or two after birth. (See Basics - The First Days for a link to the birth crawl video). After that it is up to you whether you wish to continue with the biological nurturing style of latching on (See Useful Information for a link to a biological nurturing explanation) or you wish to pursue other ways of latching your baby on so you can breastfeed any time, anywhere, as comfortably as possible.
The cradle hold is the most commonly taught way of latching your baby on. Not always the most comfortable incidentally - it can tire your shoulders, until later when perhaps you are stronger - but useful if you wish to enjoy breastfeeding while out, or discreetly with other people around. For the cradle hold position, start off by getting as comfortable as possible yourself. Some people find having cushions behind your back and under your arms can support you and take the weight of your baby, particularly early on when you are recovering from the birth and later when you are just plain exhausted! Some people find it useful to have a cushion on your lap to support your baby's weight and a few books on the floor to put your feet on so your legs are also supporting the weight of the baby. Whatever position works so that you are not straining to hold a position in order to feed your baby - you might be there some time! It can be a good idea to hold the baby firmly and confidently at the base of the skull or back of the shoulders so that you are supporting the weight of her head. You can hold her like this so that she feels comforted and reassured by your touch.
At this point, touching your nipple to her top lip may make her open her mouth wide and lift her head up to come up and over the top of the nipple, so that there is more of the whole nipple in the bottom gum side of her mouth and her top jaw has just gone sort of up and over - you will probably be able to see more areola this side. Don't be afraid to hold her head and shoulders slightly away from your breast for a little bit while keeping the rest of her close to you with your elbow. This is all part of the process of her learning that getting a good mouthful of breast enables her to transfer milk effectively which in turn prevents you suffering any nipple trauma. It may be worth making her wait to enable this learning to take place. Anyway, once she has her mouth wide open, quickly bring her to the breast, chin first so that she can get her gums underneath the milk sinuses (just behind your nipple - these will squirt milk into her mouth if she compresses them effectively). Her top lip will then come up and over the nipple to compress the other side of the milk sinuses. You want to aim for an asymmetrical latch - her bottom lip and gum should cover more of the nipple than her top one - most of the areola on the side where her top lip is will probably be visible and her chin should be massaging the breast as she sucks. Once a baby is latched on effectively, they will often start with quite fast sucking with a few swallows, depending on how much milk has collected in the milk ducts (like the pipes in your breast that channel the milk down to the nipple and out), and then progress to larger gulps as the milk is let down from deeper inside the breast. He or she will probably 'finish' that side with lots of sucks and the odd swallow as the milk flow slows. A very young baby, and some older ones!, will fall asleep at this point, which is when it is a good time (although not imperative) to change sides and start the whole process again. Sometimes a baby wants the second side, sometimes they are quite satisfied with one side. It is a good idea to be led by your baby.Having said all of that, like most things where breastfeeding is concerned if your baby appears to be doing none of these things, or didn't like one of these methods or techniques for latching a baby on to the breast, but is thriving on your milk, that is really all that matters.
This is an excellent, excellent article by Jack Newman on the myths that undermine breastfeeding.
I can't tell you whether or not you have supply issues and whether these are unsolvable, but I can tell you that there is genuinely only a small number of women who would biologically not be able to breastfeed. I sometimes hear women talk about how their breasts feel empty, or they are trying to express and they will say that they didn't have enough milk to feed the baby so they supplemented with expressed milk or formula, or they want to get the baby to wait longer to let their breasts fill up, or their baby took a good feed one feed so they had less milk the next. None of these situations reflect how breastfeeding actually works. Now obviously, a baby needs feeding and if the situation is getting stressful then it may be useful, and necessary to simply feed the baby, but I wonder sometimes whether this problem is sometimes a let down problem, rather than a supply problem.
When a baby sucks vigorously at the beginning of the feed, he is working hard to elicit the milk let down reflex which enables milk to be released from the milk alveoli. So the baby sucks actively for a while and doesn't appear to be drinking much (and he needs to learn that this is the right thing to do if he wants more). Your brain gets the message - baby needs milk! and milk is released. Now the timings and strength of these things vary among women*, but I know that when I am stressed, the milk let down reflex doesn't work. And sometimes it can take a few minutes of active sucking as this is what triggers the hormonal response. Think about it - as a cavewoman protecting your young, if there was danger about, you wouldn't be sitting feeding your baby with the oxytocin flowing, you would be running.
Most times, I have been able to actively relax - breathe deeply, try and clear my mind. Once I had to actually stop and feed my son later because it just wasn't happening. Nothing. No milk. This is not because I had run out of milk though, it was because the milk had not been let down. I am often amazed that seemingly TOTALLY empty breasts (particularly months down the line) can suddenly start releasing copious amounts of milk that is being stored in those little cells. This is because milk production happens all the time. In fact, a well drained breast will produce milk quicker than a full one. So when your baby sucks actively on a seemingly empty breast, after a while milk will suddenly start flowing - this is the milk being released from those little cells - AND it will be of a higher fat than the milk from a full breast. (Incidentally, if milk supply is the problem, the very way to increase your milk supply is letting your baby have constant access to the breast!) Providing you are not sore and the baby is actively sucking and has a good technique, it is the best way to increase your supply and establish it. This will also mean that when your baby is 8 months old, eating more, breastfeeding less, and he gets ill and needs to breastfeed more often for comfort, fluid and countless antibodies and other helpful things, your supply will increase within hours to match his needs.
So if you are worried that you have run out of milk, don't be. As long as your baby is feeding well and chugging along nicely in the weight gain department, there will always be milk, and the best thing you can do is give your baby some extra feeds and don't limit the time at the breast. Oh, and find somewhere you can both relax.