Setting yourself up for breastfeeding success: the early days
To give yourself a good start to your breastfeeding journey, consider the following in pregnancy and the early days:
-Take a breastfeeding class or comprehensive childbirth class that includes breastfeeding. Ask your instructor if they can help you prepare for nursing and any specific challenges you may have
-Attend La Leche League meetings in pregnancy and after baby is born
-Have a low-intervention birth if possible. The fewer medical interventions, including fluids, medications, and surgical birth, the easier breastfeeding will be in the first hours and days.
-Remember that it takes time for your milk to come in--often 3-5 days. This is normal. Although low milk supply is possible, colostrum is a different biological mechanism. It is extremely rare to not make enough colostrum as baby can only tolerate very small amounts of food at a time
-Do skin-to-skin immediately after birth
-Nurse baby within the first hour. If baby does not latch in the first hour, seek experienced help and hand express or pump as soon as possible so as not to miss this key window
-If baby cannot be nursed in the first hour, pump in the first hour and nurse as soon as possible, ideally within the first 4 hours
-Nurse baby before baby is hungry. Watch hunger cues to catch baby before baby is worked up and upset
-Nurse frequently! Every time baby stirs, offer the breast to help settle them. Do not let baby go more than 2-3 hours from the beginning of the last feed (in the early days)
-Offer both breasts at every feeding
-Allow baby to nurse until they are done-- as in, until they unlatch or fall asleep. Still offer the other breast if they fall asleep as they will often wake for it
-Compare weight loss and gain to baby's 24 hour weight, not birth weight. Fluids used in birth can artificially raise the birth weight, making weight loss look greater than normal
-Remember that normal weight loss for a breastfed baby can be up to 10% in the first 3-4 days. More typical is 5-7% and higher than this should prompt discussion with a breastfeeding expert. By day 5, baby should be gaining weight
-If engorged, feed baby and then hand express or pump only until comfortable
-If concerned that baby isn't gaining enough weight or is losing too much weight, do not give formula yet. This can stretch baby's stomach and confuse baby's latch while just getting started. Instead: pump after every feed and give baby what was pumped via syringe (push the syringe when baby suckles and pause when baby pauses), spoon, or cup. Contact an IBCLC, La Leche League leader, or other experienced breastfeeding helper for guidance.
-Most issues can be remedied by a simple change in position, guided latching help, and a little bit of time. Sometimes a nipple shield or a little bit of pumping can help get you on the right foot
-Use a nipple shield only under the guidance of experienced help, weaning from the shield as soon as baby can get a good latch without it. To make sure you are getting proper stimulation, pump after feedings with a nipple shield
-Do the "pinch test" prior to birth to assess if you have flat or inverted nipples. Gently press fingers around your areola on each side, about an inch or so from the nipple. With gentle pressure, the nipple should evert, or stick out further. If it does, your baby should have no trouble latching, although you may need to pre-draw the nipple out in the early days if you are engorged. If the nipple remains the same or goes inward, it is flat or inverted. You may need to pump or use a nipple everter prior to latching, and you may need a nipple shield. This will help to draw the nipple out enough for baby to latch. The hormones of pregnancy are primed to help draw the nipple out. You can use nipple everting shells or cups in your bra in pregnancy to take advantage of these hormones to draw the nipples out further and prepare for birth
-Size your nipples prior to birth. Although this can change throughout pregnancy, birth, and even throughout your breastfeeding journey, if you know that your nipples are an atypical size (that won't fit well in a 24mm or 28mm standard flange), you can prepare to have some ready for birth or soon after in the event you need to pump in the early weeks for any reason
-Surround yourself with supportive people. Breastfeeding is hard! It's okay to feel this way. It takes time to get the hang of it. You can do it!
-Remember that even people who have been tandem feeding for years experience discomfort in the first days and weeks nursing a new baby. It's an adjustment for both people getting used to each other!
-Newborns often throw their hands in front of their faces when nursing--this is normal, too! Some women find having a helper at home can get them used to latching newborn with wiggly hands
-Try different positions. Laid back breastfeeding is great to try right after birth--lay back at a 45 degree angle or so and allow baby to "breast crawl" to the nipple. Often they will latch perfectly on their own! If yours doesn't, though, that is okay, too. Some babies latch better with the football hold, particularly with women with larger breasts or with C-section incisions. Cross-cradle is great for helping baby with the latch. Side lying can be comfortable for tired moms--just be sure you are on a same surface in case your eyes close
-Some newborns appreciate being "woken up" a bit while nursing, either while just wearing a diaper and skin to skin, with a gentle wet washcloth, or with some light. Sleepy newborns are normal!
-Keep track of wet and dirty diapers. Sufficient diapers indicate sufficient milk transfer
-Do not introduce a pacifier or bottle before 4-6 weeks. This can cause nipple confusion where baby prefers the easier suckling of a pacifier or bottle to the more rigorous and beneficial motions of nursing from the breast. A baby soothed by a pacifier instead of the breast in the early days can stall weight gain or even lose weight as this suckling is crucial for sufficient milk supply and weight gain
-Don't be afraid to ask for help! Trust in the process and seek guidance from an IBCLC or other knowledge provider if you aren't sure.
Sources: Kellymom.com, Bradley Method of Natural Childbirth teacher training, Personal correspondence with IBCLC Michele Chronister, IGT & LMS Support Group documents, Finding Sufficiency: Breastfeeding with Insufficient Glandular Tissue by Diana Casser-Uhl, Making More Milk by Diana West, The Womanly Art of Breastfeeding a La Leche League publication