When I was pregnant with my first child I read an awful lot of pregnancy information. I read a lot of articles about pregnancy, what to expect with the birth, how to prepare for a natural birth… lots of pregnancy stuff. I had babysat and nannied through high school, college, and beyond and I knew I had the whole “caring for a baby” thing down. I was not worried at all. I thought sure, I’d breastfeed, but truly assumed it was an instinctual thing that we would just do.
Left: Early in the morning just before we left for the hospital to have our first. Right: When we got home with our beautiful baby boy.
When I got to my room after my c-section with my first child and finally had a chance to nurse my baby I just looked at my husband and said “okay I guess I’ll feed him now.” I offered my breast, and my son chomped on like a little baby piranha. Okay…they say it hurts at first. Holy crap. I didn’t know it would hurt like THIS. I called a nurse in who stood at the foot of my bed and said “Well his latch looks fine.” She then stuck a gloved finger in his mouth and said “he can suck. It must be your pain tolerance.” By the next day I was bleeding as I fed him and had badly cracked nipples. Pain tolerance does not cause that. I knew I needed help and started searching for it. You know what made me most upset? I was searching for it! Why wasn’t this talked about during pregnancy? Why didn’t I know to line this up?! Why didn’t anyone TELL ME?! The hospital told me they did not have a lactation consultant. The nurses I had didn’t know how to show me to latch him on. I suddenly became very focused on fixing the issue. I was frustrated! I couldn’t possibly be the first person to have damage from breast-feeding so if this was instinctual and what I was “supposed” to do why wasn’t it working? Something was WRONG. I asked for an early discharge and went to the pediatrician. They identified a tongue tie, gave me a list of recommended lactation consultants, and I was lucky to have someone at my house the next day. I was very fortunate that I found good help quickly, but it’s not that way for many. Here is what I wish I knew before having my first baby and what you should expect in the first month of breastfeeding.
This blog is written assuming baby is full term, healthy, with no medical conditions and the goal is to nurse baby at the breast. If this is not your goal, keep your eye out for posts regarding supplementing by bottle, induced lactation, supplemental nursing at the breast, and more!
Third Trimester
You have noticed by now (or will soon start to notice) your breasts begin to change. Your nipples will get larger, darker, and you will see bumps on your areola. These bumps are your Montgomery glands and they emit a scent that help baby find your nipple. Some may even leak milk, and this is normal. Baby has limited sight at birth so the contrast of the areola and your skin along with the scent released from the Montgomery glands helps lead them where they need to be. As you near your due date you may notice you begin to leak. This is the early form of colostrum and whether or not you leak is no indication of whether or not you’ll produce milk. Now might be a good time to grab some reusable nursing pads and a nighttime nursing bra to help save your sheets!
At Birth
When your baby is born and the placenta detaches from the uterus your body will be signaled to produce colostrum. The hormone shift of the placental release tells your body a baby is here now and needs to eat. If all goes well with birth, your baby will be placed directly onto your chest. Leave them here. If you deliver in a hospital ask that they not take the baby from your chest for at least an hour, but preferably two. Cuddle that baby and soak them in. You’ll start to notice them open their eyes, lick your skin, bop their head around and nuzzle and nudge their way down to your breast. This is called the breast crawl and YouTube has some pretty amazing videos where you can watch this process take place. This process could take an hour, but it’s important that baby stay on your chest undisturbed. If you deliver in a hospital they should wait until after the first feeding and at least an hour to take weight and measurements. If baby has to be separated from you after birth for more than an hour ask for a double electric pump and pump as soon as you’re able.
Colostrum is very dense in nutrients for your baby so they only need about about a teaspoon (5ml) per feeding on this first day (average intake on the first day is 35-37ml total). It’s important that you nurse baby as often and for as long as they want. They are communicating with your body and telling your body how much milk to make. You may hear nurse every 2-3 hours for 10-15 minutes each side, and for some this may be enough, but for most newborns it is not. You may find your baby likes to sleep at the breast after a feeding, or just be on your skin and this is all normal and helping to establish your supply.
You can expect at least one wet diaper today. If you received an IV with fluids or pain medication during labor you will likely get more than this as the fluid that your baby received from you during labor works its way out. Your baby will be passing meconium so stools will be dark, almost black, and a thick, sticky consistency.
Be sure to nurse every two hours. Baby will probably be pretty sleepy so stripping them to a diaper, stroking their jawline or back, or changing their diaper will wake them up enough to nurse. I’d suggest learning how to latch your baby before they’re born. Either see an IBCLC for a prenatal consult, attend a group class, or even watch YouTube videos.
You may find your baby likes the laid back breastfeeding position. In this position, they’ll also kind of dig their knees into your stomach and wiggle around. This, coupled with the release of oxytocin while nursing, helps the uterus contract so practice this position with your baby. It is the most biologically natural position and can help encourage a deeper latch and more successful early feedings.
Pay attention to the early breastfeeding cues. Rooting is when baby turns toward you and nuzzles into your chest. Opening their mouth and turning toward you, bringing their fists to their mouth, and small noises are all early breastfeeding cues. Crying is a late cue and may be more difficult to latch baby when they hit this phase. Hand expressing a drop or two onto their lips can help calm and entice them on.
You should seek support if the latch is painful. This could be a simple adjustment to positioning or manually showing you how to get a deeper latch.
Important reminders:
Expect at least 1 wet diaper today (more if you received fluids during labor)
Nurse as often and for as long as baby wants
Lots of skin to skin!
Respond to early nursing cues
When to seek help:
If latch is painful or if you are experiencing any damage to your nipples
Baby will not latch
Laid Back Breastfeeding Position. Photo credit to La Leche League International.
Week One
During this first week your baby will be nursing frequently. They could finish a feeding in 10 minutes or 45 minutes. They could go two hours between feedings or want to nurse again 45 minutes later. There is no schedule, only instinct and needs. There are some ways to tell that your baby is getting enough when you’re questioning why they want to be at the breast so much. First, watch for swallows. If you see your baby swallowing at the breast then you know they are pulling milk. Second, watch their hands. Loose open hands, and limp, relaxed arms are a good sign your baby is full following a feeding. If their hands are closed in fists and they hold their arms tight when you try to lift them then they have fallen asleep from exhaustion, not from being full. Third, track the output. During the first week output should at least match age in days. So on day 1 at least 1 wet diaper, day two 2 wet diapers, day three 3 wet diapers, and so on. From day 6 onward your baby should wet at least 6 diapers per day and have regular stools. You will see their stool transition from black meconium to dark green and finally to a regular stool- seedy looking honey mustard colored poop. Do not be alarmed if you sometimes see a green stool. If your baby is switching sides frequently they may get more fore milk than hind milk which can cause a green frothy stool. There is nothing wrong with this, but you may want to leave them on side 1 longer before switching to side 2.
Your milk will come in sometime around day 2-4. If you had a c-section it could take a day or two longer. Nurse often for as long as baby wants so your milk comes in sooner than later. You will likely experience engorgement. Engorgement is the breast tissue swelling with the production of milk. It can be uncomfortable and the fullness could make it difficult for baby to latch. Prior to feeding you can apply a warm compress to your breasts for 5-10 minutes and massage or hand express to soften. Once baby is on they should be able to pull milk from the breast without causing you any pain. You should feel softer after a feeding. If the engorgement is still uncomfortable you can apply a cool compress for 10 minutes and massage your breasts so the lymphatic system can help drain some of the swelling.
The amount of milk your baby takes at each feeding has gradually increased this week and by day 7 your baby is taking about 45-60mls of milk per feeding (approximately 1.5-2oz) and feedings are spaced about every 2 hours from the start of the feeding. Again, it may be more often as baby will nurse for comfort as well as for food.
If you are not noticing a change in your breasts, or your baby is not peeing or pooping as they should, you need to seek help as soon as possible. Baby should not lose more than 10% of their birth weight and if they do call your lactation consultant. If your baby develops chapped lips, depressed soft spot, or any other signs of dehydration you need to call your pediatrician. They will advise how to proceed. Your next call should be to an IBCLC to help figure out the source of the issue. If you are bleeding excessively call your OBGYN. This could be a sign of retained placenta which could suppress milk from coming in. If you experience any pain while breastfeeding or have any damage to your nipples call your IBCLC. Breastfeeding should not hurt.
Important reminders:
Wet diapers should match day in age, 6+ wet diapers from day 6 on
Regular stools, transitioning in color from black to a seedy honey mustard by the end of the first week
Nurse at least every 2-3 hours, but baby will likely nurse more often than that and that is okay!
Loose open hands, limp arms, sleepy after a feeding=full. Fists, tense arms after a feeding=still hungry.
When to seek help:
Milk does not come in
Pain or damage while breastfeeding
More than 10% weight loss
Not wetting enough wet diapers or stool is not regular and/or not changing to a lighter color
Baby will not latch or refuses one side
Week Two
By now your milk should be in and baby should be gaining weight. Their stool should look like seedy honey mustard and they should be peeing at least 6 times per day. You should notice them swallowing and your baby should be satisfied at the end of a feeding. Feedings could last anywhere from 10-45 minutes depending on what they need at that time. You don’t want to let them go more than 2-3 hours between feedings.
Remember they are not just getting food from nursing. Being at the breast helps your baby regulate their body temperature, heart rate, breathing, and blood sugars. Still do skin to skin with your baby when they are fussy as hearing your heartbeat will help calm them. You may also start experiencing cluster feeding. You may have heard of a “Witching hour” babies go through and honestly it’s not just an hour. It’s a chunk of the day (commonly in the evening) when all your baby wants to do is nurse. If you’re not nursing them, they’re crying. This is a very common phase and it will pass, I promise. Just nurse your baby as much as they want, do skin to skin, grab some snacks and water, pick a binge worthy show and settle in!
Your baby should be hitting birth weight this week. You want to see 0.5-1oz gain per day (3.5-7oz per week) and this rate of weight gain will continue until about the four month mark.
If you are not getting the diaper count you need, if breastfeeding hurts, if baby is not gaining weight then this is the time to seek help from your IBCLC. If your baby is fussy or crying all day, spitting up excessively, arching their back in discomfort these are also reasons to call an IBCLC.
Important reminders:
Nurse every 2-3 hours maximum, more often if baby shows signs they want to.
Wetting 6+ diapers per day, regular stools
Cluster feeding is normal!
Weight gain should be 0.5-1oz per day
When to seek help:
Pain or damage while nursing
“Cluster feeding” is all day, everyday, or they arch their back and cry at the breast
Baby is not gaining weight
Baby is not showing signs of being full after a feeding
Week Three
If your baby was full term you will experience your first growth spurt this week. You might have a few days where baby is extra fussy and is either crying, nursing, or sleeping and that’s a sure fire way to tell that that growth spurt is here. If there is an increase in nursing and a decrease in output you should call your IBCLC. If your baby is not gaining weight as they should this is another reason to be in touch with the IBCLC. You will have had a weight check with the pediatrician at week 2, but if baby did not hit birth weight they may want to see you back in week three. If that is the case by now you should have a care plan together with an IBCLC.
Important reminders:
Baby should be gaining 0.5-1oz per day and should be back to birth weight by now.
6+ wet diapers per day, regular stools
Nurse on demand without letting more than 2-3 hours go between feedings
When to seek help:
Baby has not hit birth weight
Cluster feeding all day
Not producing enough wet and dirty diapers
Signs of reflux, pain while breast-feeding, damaged nipples
Week Four
Take a picture of your baby and compare it with a birth picture. Only four weeks have passed but your baby has grown 1-2 pounds, gained length, is more awake and alert, and should be filling out. That is all thanks to you! Great job! Whether feeding at the breast, by bottle, or supplementing your hard work is keeping your baby thriving. If your goal is feeding at the breast you are likely hitting a stride now. Keep going with the flow. Month two will bring another growth spurt (6 week) and more changes. If you do not feel like you are in a groove with breastfeeding you should be seeking help from an IBCLC. Do not talk yourself out of listening to your instinct. If you have a nagging feeling that something isn’t right ASK! You will never regret seeking the help. That intuition you have is a valuable tool. Use it!
Important reminders:
Baby should be above birthweight and grown in all areas- weight, length, and head circumference.
Nurse on demand! Watch for those early hunger cues (rooting, hand to mouth, light fussing)
When to seek help:
Pain or discomfort while nursing
Concerns regarding supply
Cluster feeding all day, rarely shows signs of being full after a feeding
Weight gain concerns
Anything that makes you feel in your gut that things are not as they should be
The Takeaway
There are some general guidelines to follow when exclusively nursing at the breast. You want to nurse 8-10 times per day. You want to see baby swallowing and your breasts should feel emptier after a feeding. Your baby should seem satisfied and sleepy, loose open hands, and have limp arms to signal that they are full. Your baby should wet at least 6 diapers per day from day 6 of life on, and have regular stools. Seedy, honey mustard color stools are normal, as are some shades of green, but should not be black after the first week of life. Your baby shouldn’t lose more than 10% of their birth weight and if they do you should be in contact with your lactation consultant. If there are any reasons you do not feel as though nursing is going as it should you should seek a consultation. You will never regret asking for help. Either you will be reassured everything is fine, or you will identify an issue before it gets worse. Your parents instinct is a valuable tool and you should always lean into that gut feeling.
This newborn stage is HARD. You just spent the past 40ish weeks pregnant, birthed a whole human, and now your body is working to be the sole nutrients and keep this small person alive. You’re still recovering from pregnancy and birth, you’re not sleeping, and leaking from… well everywhere. When a baby is born, a parent is born, and let’s be real… it’s an adjustment. Give yourself so much grace. Cry if you need to. Talk to your support system. If you don’t have one at home then you have found one here. We’re here for you to navigate these weeks and months where there are more questions than answers. Congratulations on your new little love. You’re doing a GREAT job.