The First Week of Breastfeeding: What to Expect
Breastfeeding is normal, natural, and instinctual, but it’s also a learned process for both moms and babies. It’s to be expected that new moms will have questions, and need information as breastfeeding unfolds after birth. Along with some loving care and guidance, and a good dose of trust in the process and your body, it’s vital to have good information about what to expect in the first few days of breastfeeding, especially since so much changes that first week—from birth to colostrum to “milk in”! So here’s a breakdown of the first week—what’s normal, and what to do if something goes wrong.
The First Few Hours After Birth
Unless you or your baby have a medical condition that requires immediate attention, it’s important to spend a good few hours with your baby skin-to-skin directly after birth. Even babies born via c-section can be placed in a mother’s arms after birth. Most babies (especially ones born to mothers who didn’t have pain medication) will crawl up to the breast and latch on themselves. Numerous studies have shown the importance of these first few hours (here’s one). Babies are most alert and primed to nurse in these post-birth hours. After the first few hours, babies often fall into a deep sleep and are less able to nurse well. There is also evidence that nursing in the first few hours leads to long nursing duration in the long-term. Babies are learning as soon as they are born, so give them the chance to learn to nurse. If you aren’t able to, or if something goes wrong, don’t worry—with help, almost all babies can learn to latch later.
For the first few days after birth, expect your baby to nurse very frequently. There is absolutely no schedule yet. If you are in a hospital, have your baby room-in with you. Keep your baby skin-to-skin with you for most of the day. This way, anytime your baby looks for the breast, it will be right there! Rooting, head bobbing, fist sucking, mouth fluttering—these are all signs your baby is ready to nurse. You can’t nurse too often. Ask that the hospital give your baby no artificial nipples—no bottles or pacifiers. You are all the food and comfort your baby needs.
During the first three days, you are producing a kind of milk called colostrum. It’s small in amount, but rich in vitamins, proteins, antibodies, and anti-viral agents. It’s your baby’s first inoculation. It also acts as a laxative, and helps your baby clear out his first poop (meconium).
It is normal for breastfed babies to lose a bit of weight in the first three days of life. 5-7% is in the normal range. Part of this is the passage of the first poop, and other fluids from birth. You don’t need to supplement your baby. In fact, your baby’s stomach is about the size of a marble right now, so feeding a few ounces in a bottle will most likely make your baby spit up. The colostrum your body produces is small in amount for a reason—it’s just the right amount for your baby’s stomach to hold.
What if your baby is not latching? While rare, it does happen that some babies have trouble latching in the first few days. If this is the case, get some help from a lactation consultant, or trusted helper right away. In the meantime, keep your baby skin-to-skin, hand express your colostrum (pumps don’t work as well in these first few days before your milk “comes in”) and feed your baby the colostrum with a small spoon or a medicine dropper.
Sometime between the third and fifth day after birth, your milk will become more abundant. It can often happen suddenly, but is sometimes more gradual. Some women just feel fuller, and might notice their baby swallowing more milk (not everyone can hear a baby swallow, and that doesn’t mean the baby isn’t getting milk!). Other women become quite engorged when their milk comes in, which can be a challenge in itself. The key is to make sure your baby is deeply latched on, and to nurse frequently to empty your breasts and prevent them from overfilling. If your breasts are so full that your nipples become flattened, your baby may have trouble latching on. Hand expressing a little milk to soften the nipple, or trying a technique called Reverse Pressure Softening can make the nipple more pliable and make latching easier. Get some help with these techniques if necessary. If you are so engorged that your milk isn’t flowing, gentle massage can help. Cold packs or chilled cabbage between feedings can also be helpful.
Soon after your milk comes in, your baby’s poops will transition to a greenish/brownish color, and will take on a mustard yellow color soon after. Wet diapers will become more abundant as well.
Once you’ve gotten over the hump of the first few days, you might be starting to find a groove with breastfeeding. Your baby will still be nursing very frequently, about 10 times in 24 hours. Some will have a slightly longer stretch (though not always at night!), but most will need to nurse every two hours or so. Once your milk is in, and you know that your baby is gaining weight, you can let some longer stretches happen, but remember to always nurse when your baby shows cues. Even a baby making light sucking motions is a cue to nurse! Some babies will seem to have an erratic eating schedule, wanting to nurse every hour for a few hours, and then being passed out for a few hours after that (i.e., cluster feeding). All of it is normal.
Babies generally have 3-5 poopy diapers per 24 hours. The poops should be at least the size of a quarter, yellow in color and sometimes seedy in texture. Variations in color are normal too. Some babies will poop after every feeding, and some will consolidate the poops more. Pee diapers vary, but 5-6 wet diapers per day is normal.
But diapers only tell half the story of how much milk a baby is getting. The most reliable test of how much your baby is getting is a weight check (no clothes or diaper, and on the same scale each time if possible). It can take up to two weeks for a baby to get back to his birthweight, but by the end of the first week, a baby should be gaining rather than continuing to lose weight. If your baby isn’t gaining weight, get help right away! If you need to supplement, pump your milk and feed it to your baby. Here is a post I wrote about supplementing the breastfed baby, and the importance of doing so early on if your baby is losing too much weight.
Nursing should be pain-free by the end of the first week. Some initial mild tenderness when your baby first latches on is within the spectrum of normal, but pain that is severe, lasts more than a few seconds, lasts between feeds, or that is accompanied by broken or cracked skin is not normal. If this is the case, get help sooner than later because these problems only tend to get worse with time. Often all that you need is a quick adjustment to your latch, or positioning. Some moms and babies need a little more help. Find a lactation consultant or other trusted helper. This type of thing usually requires in-person help.
Beyond The First Week
You just had a baby and your body needs to heal after birth. Your baby will want to nurse a lot and be near you. Now is the time to clear your schedule and let yourself be lazy and snuggly with your baby! Lots of new moms have trouble with this because they are used to getting things done and feeling independent. But this time is brief and you will thank yourself later that you took the time to rest and establish breastfeeding. But don’t do it alone. Get help! Your partner, your family, your neighbors—accept all offers of help. Let others keep house and feed you so you can rest and nurse.
Do you love breastfeeding? Hate it? Feel overwhelmed? All of these feelings are normal, and it’s normal to feel all of them all at once (here is a good article to help you distinguish these normal feelings from postpartum depression or anxiety). You need to find your tribe. Once you have recovered from birth and breastfeeding is established, join a local breastfeeding support group. Meeting other breastfeeding moms will help you feel normal. Plus, more concerns come up after that first week, and it’s great to have the wisdom and support of other mothers.
A version of this post first appeared in Natural Child Magazine