Early Feeding Expectations for a Typical Newborn
So, you just completed probably the most challenging 9 months (wait, 8 months - that’s a story for another day) AND arduous 48 hour labor (oh wait, that’s just me also - another story for another day) - but anyways, you came out of a crazy birth story and someone hands you your baby. They are the most beautiful baby you have ever seen. And now you think… Oh, right. I have to feed you.
Now, if you are me, you happen to be a speech language pathologist who has worked in the NICU before, and specializes in Infant feeding. Actually, before your pregnancy, you even got certified as a lactation counselor. So you think, I know what to do, I will just latch the baby and we will figure it out. I will follow their cues and he will be feeding on demand in no time. Even if we have some challenges, at least I will know how to find support.
Fast forward through a difficult 3 months later, and you finally latch your baby for the first time without a nipple shield. It still kind of hurts, but you say to yourself, we are doing it. We are actually doing it. A premature induction due to COVID complications, 3 weeks of tube feeding, 3 months of pumping and bottle feeding, a lip and tongue tie release, 4 craniosacral sessions, a lot of tears and post partum anxiety - none of that stopped us from this moment. We are breastfeeding.
So how do you get here? You are thinking - However long it takes and whatever challenges we face, I know I want to breastfeed. This is everything I wish I knew, as succinctly as possible below. To get you through the first 3 months. Here we go…
The first latch:
Sometime within the first 1-3 hours after birth, you need to begin latching your baby. Be patient with yourself. You are learning and so are they. They are new here. And you literally just become a parent. First thing’s first, look for early feeding cues such as alertness, mouthing, hands to mouth.
In the first 48 hours your body needs a STRONG message that your baby was born. This happens from the placenta being delivered triggering a strong hormone drop and from VERY frequent latching. You may have heard that the milk in the early day is “just” colostrum and is smaller amounts of milk. This is true, but the first 48 hours through Day 5 are truly what set up your milk supply for the rest of your breastfeeding experience.
This is how your body knows how much milk to make if you have twins for example - you would be latching twice as much, so that tells your body to put in the order for a double supply. If you latch half as much as expected for spearation/medical reason/latching reasons, then this tells your body to make half od a milk supply. Yes, maybe you can get it back later through different pumping methods, but really what lays that groundwork is those first few days after birth and how many times baby is able to latch.
This is why it is so important to just keep latching WHENEVER they are alert in the early days. And if they are not active or able to sustain the latch, then you need tto seek immediate IBCLC support. If that support is not available to you, or if you are still not able to get the baby to latch for a multitude of reasons - NICU stay, health issues for you or the baby, tongue tie and pain with latching, the baby is just “too sleepy” etc - then you need to be pumping 8-10 times within 24 hours. This works out to every 2-3 hours.
Yes you heard me right - you need some sort of milk removal (by the baby or the pump) every 3 hours. It is not an east task, but this is how you send the message to your body to make the milk. Even if nothing is coming out in the early days, keep hooking up those babies to the double electric breast pump - this means spectra or medela usually. The wearble pumps will not have a strong enough motor that you need in these early days.
Even with this frequent milk removal, you till should get as much skin to skin contact with your baby as possible - there are so many benefits for the baby and you but especially for your supply. If you are in the hospital, it is best for your establishment of breastfeeding to “room in” or keep the baby next to you 24/7, and if the baby is in the NICU for any reason, it is even more important to seek out and advocate for that skin to skin time.
As far as latching in the hospital - if no pumping is necessary and everything is going normally - proper positioning can help so much. Start with “cross cradle” or reclined nursing positions - these are the most natural for mom and baby. That said, positioning your body to feed this tiny newborn mouth is still a skill that will take some time to learn. Be patient with yourself.
Belly to belly - you and your baby’s bellies are touching
Nose to nipple (notice, I did not say mouth to nipple) - the latch should be asymmetrical and you should see a lot of your upper areola
First bring baby’s chin to your breast and help them bring their lip up and over the nipple
their nose should have a little space away from your breast so they can breath easily and are kind of looking up at you
if the latch is painful - seek help from an IBCLC; people might initially suspect oral ties like a tongue tie - but be wary of quick diagnoses and quick fixes. Get help and proper assessment from a training SLP or IBCLC first before doing anything surgical.
The first two weeks:
In the first 2 weeks, babies have very small stomachs, but it is growing each day. It is normal for babies to lose some weight after birth, but the expectation is that they regain the weight back to their birthweight by 2 weeks. This is why you typically have a 5 day and 2 week Pediatrician check up to ensure the baby is not jaundiced and the weight is on a steady incline.
Expect to be breastfeeding or pumping every 2-3 hours to establish milk supply
The first 2 weeks really matter for long term milk supply so many women like to just give it their all for those 2 weeks to get the max output they can get, and then you can always decide to downregulate your supply later
If baby is bottle feeding you stop when they are full - usually they start by taking 30 ml and gradually work their way up to 60 ml and then 90 ml (3oz)
Before 2 weeks you should look for how full they are after breastfeeding then may only have the stamina to feed enough to last them 1-2 hours in these early weeks
Once baby is 2 weeks old and back to birth weight, generally think of baby needing an oz per hour, so if they take 4 oz in a bottle, you could let them sleep 4 hours - always follow their cues
Talk to IBCLC if you are concerned with baby eating too much or too little or seeming to not be full after breastfeeding
If baby is too sleepy in the first 2 weeks, you want to wake them every 3 hours to eat
Proper bottle feeding technique to not sabotage your baby learning to breastfeed:
Side lying positioning (facial profile parallel to the floor)
Slow flow nipples or level 1 (maybe) but probably slow flow rate (this is how fast the milk drips out)
Long elongated bottles such as Dr. browns or Evenflo balance for oral motor skill development and easy transfer between breastfeeding and bottle feeding
Use the paced bottle feeding technique with slower flow nipples.
General recommendations I usually give my clients in the first weeks if breastfeeding is not fully established yet and you are doing some combo of pumping and direct breastfeeding:
1. Continue to offer breast and try to get sustained latch whenever baby shows hunger cues or cries - usually every 2-3 hours (even could be 1-4 hours, big range), evening out to around 8-12 times within 24 hours.
Until she is back to birth weight at 2 weeks, we typically wake her up if she hasn't cued/woken up for longer than 4 hours.
Getting a deeper latch: Mom and baby should be skin to skin - shirtless and unswaddled - baby should be tummy to tummy with mom.
Latching: Chin hits breast first and then she latches up and over on to nipple with top lip flanged all the way out
Use hands on pumping to keep milk flowing
2. Pumping - Any time a bottle is given, you need to send a message to your breasts to make that milk.
Breast gymnastics massage technique, reverse pressure softening, and hand expression for 5 mins.
Then Hand pump both sides 15 minutes or double electric (Spectra) breast pump 15 minutes both breasts.
Goal is stimulating breasts for at least 15 mins (either with baby or pump) 8-10 times within 24 hours.
Try to pick one 4-5 hour stretch to sleep, and someone else can give bottle during this, and you can pump right before and right after.
Might need to order size 19mm or 21mm spectra flanges so that the Spectra pump is less painful
Use the nipple butter before and after pumping as needed
Use the boon trove milk collector as needed
Fresh breast milk can stay out for 3-4 hours before refrigerating (so can be used for next feed)
3. When giving baby bottles as a full feed, keep feeding her based on cues, usually around 45-60 ml per feeding every 2-3 hours
eventually it will end up being closer to 3 oz (90 ml) per feeding probably by week 2-3
Can reevaluate based on weight gain (goal back to birth weight by 14 days)
Overall, just know learning to breastfeed takes time for both you and the baby. Be patient with yourself and your baby and give yourself time to figure things out. Recommendations change frequently based on your baby’s age and sometimes it feel like you are getting different advice from everyone. Seek out a lactation consultant you trust so they can help check in with you along the way.
