© Marie Davis, RN, IBCLC
THE FIRST FOUR WEEKS: MOTHER
What can I expect in the first few days?
Some babies are avid nursers right from the start. Others may
take a little while to recover from labor and should pick up in
about 24 hours. The first feedings are a "get acquainted" time
for both mother and baby.
Typically, the newborn will take one or two tries to latch-on;
take four or five suckles, swallow and then pause and begin suckling
again. This is normal. Encourage the mother to keep the baby awake
by talking, rubbing and gently bouncing him at the breast when
the baby seems to pause for too long.
Is there anything in my breasts for my baby? My breasts feel empty.
Many of us think of the breast as a container that is either full
or empty. The breast does not work like a bottle. The majority
of breast milk is made during feeding. The breasts have very little
storage space. Breastfeeding confidently requires a mother to
trust that her breasts will do what they are meant to do, even
though she cannot see the milk go in. She can however, easily
see how many wet diapers and stools the baby is having every day.
Colostrum, the first milk is produced even before the birth. It
is thick, yellow and is like sucking maple syrup through a straw,
so feedings will seem a little long at first (up to 60 minutes).
Colostrum is a super booster of antibodies and contains everything
that baby needs. The baby will usually take 1 1/2 to 2 ounces
of Colostrum at each feeding.
Are sore nipples normal?
Mild tenderness sometimes occurs in the early days of nursing.
The mother may feel some discomfort in the first minute of a feeding
as baby stretches the nipple into his mouth. This nipple stretching
pain should stop in a few days. When the baby is nursing correctly,
the mother should feel a gentle tug, not a pinching sensation.
If the latch is incorrect, break the latch and try latching on
again until the latch is not painful. Limiting the time at breast,
will not prevent sore nipples. Long frequent feedings do prevent
engorgement that can lead to sore nipples.
If the mother develops blisters, scabs, marks, bleeding or pain
between feedings, she should contact a lactation consultant for
assistance.
When will my milk "come in?"
Mature milk begins within 3-5 days after the baby is born. Because
mature milk is thinner, feedings should not take any longer than
40 minutes. If the baby is taking longer than 45 minutes to complete
most feedings after her milk is in, there may be a problem. If
the baby is having a good amount of wet diapers and several stools
per 24 hour day and is gaining weight, then the baby may be a
gourmet type eater (the slow and easy feeder, who is enjoying
the experience). If there are symptoms of low breast milk intake,
the mother should contact a lactation consultant for assistance.
How will I know if I'm engorged?
The mother's breasts will start to feel heavier and firmer as
her milk comes in. This is due to increased circulation in the
breast. Mild engorgement is a sign that the mature milk is in.
Moderate to severe engorgement where the breasts become tender,
firm or lumpy, is not normal. Painful engorgement occurs from
tissue swelling, trapped milk or a combination of both. The breasts
may not be "full of milk" as many believe. The tissue around the
milk producing glands may be swollen and painful. Sore nipples
usually follow engorgement because the areola becomes too firm
for the baby to latch-on properly.
Why can't I feel my let-down?
In the early days of breastfeeding, many mothers do not feel the
let-down. It may take a week or two before she can recognize the
milk ejection reflex. Occasionally, some mothers never feel the
let-down but are aware of it because milk drips from the opposite
breast during a feeding, she feels warm or thirsty and/or the
baby has bursts of rapid swallowing.
How much rest will I need?
Immediately following the birth of the baby it is important for
the mother to get enough rest, whatever the feeding method. Many
new mothers neglect their need for rest. The mother's sleep is
interrupted by night feedings, so she should be encouraged to
nap, or at the very least, rest with her feet up when the baby
naps. For a week or two, mother should not use the baby's slumber
time as a time for getting household chores done. In the early
weeks after giving birth the mother's body needs to heal from
labor. If she has had a cesarean, two full weeks of good rest
will be needed. The mother should be encouraged to resist the
temptation to be "super mom." By becoming run down, depression
can set in and her body will not have enough stores for self healing,
much less the production of breast milk.
What is most important in my diet?
The mother should drink enough liquids to quench her thirst. For
good health, a minimum of eight, 8 ounce glasses of fluid per
day are recommended for everyone. A good habit for the mother
to develop is to have a glass of something to drink every time
she nurses her baby.
Many women worry needlessly about their diets while breastfeeding.
Often women feel deprived because someone told them that they
cannot eat certain foods while nursing. Some common myths are
that eating chocolate, makes chocolate breast milk; cabbage, beans
and other gas producing food will make the baby have gas. Onions,
garlic and other aromatic spices will flavor the milk, but babies
rarely object to the difference in taste.
On occasion, some foods may affect the baby. The mother should
make note of what the particular food was, eliminate it for about
a month and then reintroduce a little of the food. Usually, the
reaction was merely a sensitivity and not a true allergy. The
mother should avoid overdoing on any one type of food or beverage.
Everything in moderation is excellent advice.
The mother will need to eat a well balanced diet consisting of
all four food groups. She will need three meals and at least two
small snacks. As long as she is nursing, the mother should continue
to take her prenatal vitamins to replenish her own body stores.
If a mother does not drink milk, or use dairy products, a non
lactose (does not contain calcium lactate) calcium supplement
should be added to her diet.
The recommended caloric intake for the breastfeeding mother is
2200-2500 cal. per day or about 200-500 calories more than her
pre pregnancy diet. (The average U.S. adult female diet consists
of about 3000 calories per day.) The majority of the weight she
gained in pregnancy will have been lost by six eight weeks postpartum.
Most mothers do not gain weight while breastfeeding unless she
is severely underweight. Breastfeeding mothers will often retain
an extra five or ten pounds until several weeks after weaning.
This additional body weight protects the mother's ability to produce
milk in case of illness or a severe reduction in caloric intake.
Weight loss diets are not recommended while breastfeeding. The
mother who is gaining weight while breastfeeding should closely
examine her diet for "empty calories." I have found that fruit
juices are a major source of excess caloric intake for the breastfeeding
mother. Because she is thirsty, the intake of juice can be quite
surprising, sometimes as much as a gallon a day. Another source
of calories is whole cow milk. Many women falsely believe that
they need to drink large amounts of cow's milk to make breast
milk. Cow's milk is an excellent calcium source, but the calcium
is also present in low fat and skim milk.
If a mother is more than 50 pounds overweight after six weeks,
a reduction in calories to not less than 2200 calories per day
is recommended for weight loss while breastfeeding. Weight reduction
diets should be started no sooner than six weeks post partum.
Weight Watchers International; has an excellent diet program for
the breastfeeding mother. Besides watching calories, an increase
in activity is suggested, beginning with a nice walk outdoors
with the baby at least once a day. The mother should gradually
work up to an exercise program.
Liquid diets, powders and other very low calorie diets are not
recommended. These diets are basically starvation diets. In the
breastfeeding mother, body fat will be retained and lean muscle
tissue used for the production of breast milk. When the mother
returns to her previous diet, the body will then store more fat
as a defense mechanism against future episodes of starvation.
This may be how some individuals "diet" their way to obesity.
How will various drugs affect me?
Just as when she was pregnant, anything the mother ingests can
be passed on to the baby through her breast milk. Of primary concern
are social drugs (caffeine, alcohol, nicotine) and over-the-counter
remedies. The mother should inform her physician or dentist that
she is nursing a baby if a prescription medication is needed to
treat an illness. (See: Medications and Breastfeeding, for guidelines)
How can I best care for my breasts?
The breasts should be washed daily with water only during the
mother's shower. The breast does not need to be washed before
or after every feeding. This strips the natural protection from
the nipples, and may cause nipple soreness. The mother should
not use breast creams. Rather than creams, she should apply a
few drops of breast milk to the nipple and areola after each feeding.
The breasts should then be air dried for a few minutes and clean
breast pads placed in her bra. Remind her that she should wash
her hands well before each feeding, after changing diapers, and
after using the bathroom.
Leaking of milk from the breast is common in the early weeks of
breastfeeding. The mother should use breast pads to absorb any
leakage of milk (leaking will usually stop in a few weeks). Nursing
pads should be pure paper. The mother should not use pads with
plastic liners in them (if she is not sure, she should take the
pads apart). Washable pads can also have a moisture proof barrier
in them and can become rough after repeated washing. The mother
can make the best reusable pads herself or she can use folded
100 % cotton men's handkerchiefs. [Instructions for making pads:
Draw a four inch circle in the center of a cotton pre folded super
absorbent diaper, stitch along the line with a machine zigzag/over
lock stitch or use a tight hand stitch and cut out. Make enough
to be able to change them frequently. This will require cutting
about three or four diapers but the cost savings over disposable
pads is tremendous.]
Inconvenient let-downs can occur any time. If the mother is in
a place where she needs to stop a let-down, she should place the
heel of her hands against her nipples and press in, toward the
chest wall. The pressure will stop the flow. It is important to
tell her not to do this too often as repeatedly stopping the flow
can lead to painful plugged ducts and mastitis. She should also
be told not to stop the leaking that often occurs at the opposite
breast when the baby nurses. The milk should be allowed to flow
freely. Debate currently exists about the use of "Drip milk" for
later feedings. It is believed that the milk dripping from the
breast is primarily foremilk. If drip milk alone is used in a
subsequent bottle feeding, there is the possibility that the baby
may only receive lower calorie foremilk.
What special clothing will I need?
No special clothing is needed to breastfeed. The following is
just a suggestion:
The new mother should wear a good fitting nursing or supportive
bra as much as possible, especially in the early weeks when the
breasts are quite heavy. It is not necessary to tell the mother
that she must wear a bra at night. Many mothers feel more comfortable
if they wear a bra at night, but this may be uncomfortable for
other mothers.
How can I nurse without exposing my breasts?
Once she is comfortable nursing the baby and that "all thumbs"
feeling goes away, nursing around others will be easy. Nursing
fashions with hidden openings are available at maternity shops
or made from patterns available at fabric stores. Wearing loose
fitting tops that pull up, rather than unbutton, are better for
breastfeeding in public. The baby will hide the mother's bare
midriff. A blanket or large scarf thrown over her shoulder works
well. If a mother is at home and is concerned about visitors,
she can just excuse herself and go into another room if needed.
People are becoming more accustomed to seeing women breastfeed
but will occasionally make comments. Tell the mother to handle
comments as diplomatically as possible, but never to make excuses
to anyone for breastfeeding her baby. She is nursing because she
feels that breastfeeding is the best for her baby.
Are there women who do not make enough milk?
My experience has been that the majority of women produce an abundant
milk supply, enough for twins and triplets. Difficulties arise
with milk supply when too many bottles are given or the mother
doesn't keep up her supply by pumping when the baby cannot nurse.
Occasionally women who have had a mechanical change in the breast
like breast surgery, or an injury to the breast, may not produce
enough milk. If the mother thinks her supply is low, she should
contact a lactation consultant for assistance.
Questions After The First 4 Weeks
Storage Of EMM (Expressed Mother's Milk)
Last reviewed