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Breastfeeding in the days following
birth is characterised by frequent feedings (often every 1-2 hours).
This is absolutely normal and desirable. Here's why:
Breastmilk is very rapidly digested.
From birth to about 5-6 days, the baby's stomach can only
contain 5-7 ml of milk at a time (the size of a marble). Perfectly
in tune with her baby's needs, the mother produces about
30-100 ml of colostrum per 24 hours. It is therefore perfectly
normal from a physiological standpoint that the baby takes in
relatively little quantities on a frequent basis.
Frequent, efficient stimulation of the breasts contributes to
the milk « coming in » within a normal time period,
and without pronounced discomfort.
When breastfeeding is optimal (baby feeds frequently and efficiently),
the milk « comes in » around day 3-5 after birth.
The mother's breasts will feel warm to the touch with perhaps
some engorgement, but this is tolerable and is relieved by the
baby feeding. This is called « physiologic engorgement »,
and it generally does not last more than 48 hours.
"How much does he/she weigh?"
Weight loss of up to 7 to 10% of the baby's birth weight
occurs during the first days after birth. This is normal, and
there is no reason to worry or supplement the baby. A skilled
professional should assess the situation as a whole as well as
breastfeeding, observe the baby and intervene only if weight loss
is important or continues for several days. Continue to breastfeed
frequently.
Beware! Some babies born by induction, cesarian or whose mother
received IV medication (no matter what type) during labour retain
fluids and therefore seem to lose a lot of weight rapidly after
birth. However, this is probably mostly water loss and there is
no need to worry if the baby is doing well.
Remember that each baby (like each adult) is unique and that weight
is only one of many parameters to assess his/her status.
Baby's behaviour:
normal or not?
In the first hours after birth, the baby is generally awake, alert
and eager to feed. During the 24 to 48 hours that follow, the
complete opposite can happen, and the baby may be very sleepy
and show little or no interest in feeding. Don't worry.
Room in with your baby 24 hours per day. Have lots of skin-to-skin
contact, and offer the breast frequently, taking advantage of
wakeful moments (even though they may be very short and fleeting).
The stores the baby has accumulated during gestation will ensure
that he will sail through this transition period without problem.
However, he may be subject to more pronounced jaundice or to hypoglycemia
(especially if there are other risk factors). Observe the baby
and intervene only if necessary. In most cases, everything gets
back to normal within 24-48 hours, when the baby starts being
more alert and the mother's milk production naturally increases.
Jaundice
Jaundice is the result of the normal process of elimination of
surplus bilirubin in the baby's circulation. This is why
it is called physiological jaundice, not to be confused with pathological
jaundice, which is a serious medical condition. Physiological
jaundice peaks between days 3 and 5. It manifests itself by a
yellow pigmentation of the baby's skin. Since bilirubin
is eliminated mainly in stool, the best « remedy »
to lower bilirubin levels is to increase the volume of breastmilk
ingested by the baby. Breastmilk is a natural laxative, and it
is especially effective in accomplishing this. When jaundice is
managed appropriately, it rarely reaches toxic levels. Water or
formula supplements are not indicated in this situation. Assess
breastfeeding, increase feeding frequency and monitor the baby's
output.
See also Dr. Jack Newman's
article Breastfeeding
and Jaundice
5 days to 6 months
From about day 5, and until the age of 6 months, the baby's
stomach can contain 50-60 ml of milk at a time (the size of a
golf ball), and the mother produces between 500-750 ml of milk
per 24 hours. As breastfeeding is established, feedings become
relatively longer and less frequent compared to during the first
days (every 1½-3 hours).
«
Growth spurts »
At certain times, the baby may seem to cluster feed 24 hours a
day. As the baby's needs increase, these «growth spurts»
are his/her natural way of increasing the mother's milk
supply. They can last 2 to 3 days, and in no way means that your
milk supply is inadequate. The solution is not to supplement the
baby, but rather to breastfeed more frequently. The more the baby
drinks, the more milk you make.
"Growth
spurts" also seem to coincide with periods of rapid neurological
development, which leads us to believe they are probably a manifestation
of many important changes in your baby and not only a question
of feeding or weight gain. This is a good sign! Your baby is meeting
his/her developmental milestones!
Expressing breastmilk
During the first days, if there is a need to express breastmilk,
the most simple and efficient way to do so is hand expression.
This is an easily acquired skill that is free and always accessible,
and there is less waste of precious colostrum than with the use
of a breast pump.
If you must use a breast pump at any time during
the breastfeeding period, be sure to chose one that is appropriate
for your needs. All breast pumps are not equal, and the type of
pump chosen will vary depending on the use you will make of it.
What
you need to know before buying a breast pump
Be
vigilant! Here are certain pitfalls (some avoidable, some not)
and the breastfeeding problems that can be associated with them:
It has been shown that pain medication and epidurals given during
labour can have an impact on breastfeeding initiation, and this
undesirable effect may last from a few hours to a few weeks
(delayed first breastfeed, sleepy baby, disorganised suction,
supplementation, breast refusal...)
If you
have a history of yeast infections and/or you have had antibiotic
therapy during the perinatal period, this is an additional risk
factor for yeast infections of the nipples and/or thrush in
the baby. There are several ways to prevent yeast infections.
Ask your Lactation Consultant.
Use
of artificial nipples (pacifiers/dummies, bottles) can interfere
with the establishment and/or maintenance of your milk supply,
as well as the baby's suckle and latch.
Unnecessary
supplementation (there are very few medical
reasons to supplement a baby with formula) can interfere with
the establishment and/or maintenance of your milk supply, disturb
the breastfeeding routine and affect the baby's appetite. Unnecessary
supplementation causes more problems than it fixes.
Incorrect
latch causing pain and inefficient drainage of the breasts (can
lead to nipple damage, cracks, engorgement, blocked ducts, mastitis,
yeast infections, low milk supply, slow weight gain...)
Infrequent
or scheduled feedings, or limiting the duration of feedings.
Follow your baby, not the clock.
Infant-mother
separation can affect bonding, and prevents the mother from
responding quickly to her baby's needs and learning to
recognise her baby's hunger cues. When mother and baby
are healthy, they should room in together 24 hours a day.
Here are some easily recognised
signs that your baby is doing well:
A breastfed baby feeds frequently: at least 8-12 times per 24
hours, with intervals ranging from 1½ to 3 hours between
the beginning of a feeding and the beginning of the next feeding.
During the early weeks, feedings (including burping, diaper
changes, etc.) may last up to 1 hour. Most babies cluster feed
at one point or another during the day (or night), often before
sleeping for a longer period.
Day 1: 1 stool, 1 urine minimum
Day 2: 2 stools, 2 urines minimum
Brick red traces in the diaper are not worrisome at this stage.
From day 4 onwards, the baby should no longer be passing meconium.
From this age until about 4 to 6 weeks, the baby passes at least
2-3 liquid, yellowish stools, or more, per 24 hours, and at
least 6 wet diapers (beware of disposable diapers that are very
absorbent and may seem dry even though they are not. Notice
the diaper's weight when it is dry compared to when it
is wet.) Urine should be clear and with no strong odour.
After 6 weeks, some babies decrease the frequency of their stools,
to the point that they may stool only once every 10 days. If
the baby is doing well, this is not a cause for concern.
The baby has a sustained, regular suction at the breast: there
is audible/visible swallowing (suction-pause-swallow)
The baby has regained his birth weight by 2 weeks, 3 weeks maximum.
If, however, initial weight loss was greater than expected,
or breastfeeding was slow to start, the baby may take longer
to regain birth weight. His growth corresponds to about 15 to
30 gr (½ to 1 ounce) per day, or 105 to 210 gr (3.5 to
7 ounces) per week until the age of about 4 months, calculating
from the baby's lowest weight (not birth weight). Weekly weight
checks are sufficient, as too-frequent weighing is very imprecise,
and rarely gives an accurate indication of the baby's well-being,
as well as being very stressful for everyone involved. Get help
from a skilled breastfeeding professional to follow the baby
closely and intervene only if necessary.
The baby is active, alert, has good skin tone/colour and seems
generally healthy.
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