Starting Breastfeeding in the Hospital

In the hospital, the first nursing may take place in the delivery room, birthing room, or recovery area. Breast feed as soon as possible after delivery. By breastfeeding early, you will lessen your chances of postpartum hemorrhage and will be giving your baby his first “early milk”: colostrum. This “liquid gold”, which is yellow or clear in color, is produced in a small quantity, close to your newborn’s stomach capacity. Colostrum contains protective antibodies and seals the inside of the baby’s intestines, thus preventing invasion of bacteria. Colostrum also acts as a laxative to help your baby pass his first stools and may lessen the incidence of jaundice. Supplemental feedings with water or formula in your healthy newborn are unnecessary and may cause your baby to lose interest in breastfeeding. By nursing early and often, you will be providing your baby with the perfect food in the right quantity.

Colostrum will gradually change into more mature milk between the 2nd and 5th day. The amount of milk produced is related to the demand of the baby. Your baby may be sleepy the first couple of days after birth and will need to be awakened for feedings. During your hospital stay, expect to nurse your baby every 2-3 hours during the day and at least once or twice during the night. Your baby should not go longer than 4-5 hours without feeding. Remember that breast milk is easily digested and breast fed babies need to eat frequently. Begin nursing slowly on either side, and build up to longer periods based on baby’s hunger.

Once you have mature milk, it takes approximately 15 minutes for the rich, fat, hind milk to “let down” and ensure that your baby receives the calories he needs to grow on. Many lactation consultants recommend that the mother continue to feed on either breast, for as long as the infant desires. Some mothers prefer to limit this to 15 – 20 minutes per breast, as long as the infant appears satisfied and content.

When you begin breastfeeding in the hospital, a certified nurse midwife will stay with you the first time to help you get started. Some babies are very vigorous nursers, while others are sippers and sleepers. It may take from several days to several weeks before both of you have mastered the techniques. Remember, both you and the baby are learning a new skill. be patient! We would like for your breastfeeding experience to be a positive one. Below are suggested guidelines to facilitate this.

Comfortable Positions

~ Cradle or cuddle position, sitting upright and cradling baby, with his tummy facing your breasts. Pillows are placed under baby and your arm for support.
~ Side-lying with a pillow to your back for support. Baby again is facing you. This position is helpful with an uncomfortable episiotomy, hemorrhoid, or a cesarean section.
~ Clutch or football hold: Sit the baby up at your side at waist level, so he is facing you. Support his back and head with your arm and hand, while holding his head at the level of your breast. (This is a terrific position if you are large breasted, have had a cesarean delivery, or are nursing a small baby.)

Offering the Breast

~ Using a “C” hold (thumb on top of breast and fingers underneath), compress the breast so that the nipple can be placed well back in the baby’s mouth.
~ Using the baby’s rooting reflex, tickle his lips with your nipple until he opens his mouth wide.
~ Center your nipple in his open mouth and quickly pull him toward the breast.

Proper Nipple Placement

~ The baby and you should be tummy-to-tummy in the cradling and side-lying positions or “chest-to-chest, knees-to-breast”.
~ The baby’s ear, shoulder, and hip should be in a straight line.
~ The baby’s tongue is cupping the areola and is over the lower gum.
~ The baby’s mouth is well behind the nipple in order to draw milk from the ducts.
~ The baby’s cheeks should be rounded; his jaw is gliding back and forth. You should feel a gentle tugging after the first few sucks. If nursing continues to be painful, your baby will need to be taken off the breast and repositioned. It is normal for your baby to have a suck-suck-pause pattern. Nursing is hard work and babies need rest breaks.

Timing

~ Encourage your baby to nurse 10-15 minutes on each side and gradually increase to 15-20 minutes by the end of the week.
~ Breast fed babies need to nurse 8-10 times a day or every 2-3 hours. This is timed from the beginning of one feeding to the beginning of the next.
~ Begin each feeding on the breast nursed last.

Ensuring Your Baby Is Getting Enough Milk

~ You will know your baby is getting enough to eat when your breasts soften during the feeding, when your baby is gulping and swallowing during let down, and by his relaxed body posture at the end of the feeding.
~ Your baby should have 6-8 wet diapers and at least 1-2 stools a day by the time he is five days old. (Some babies may stool with each nursing.)

Supplementation

~ If you baby is nursing well, there is no need to supplement with water or formula. Babies have to learn a different suck pattern with bottle feeding and may become confused when trying to breast feed. This may also decrease your milk supply, if the baby is taking a bottle rather than nursing from you.
~ Supplements may be introduced after your milk supply is well established, after 4-6 weeks of age.
~ Someone other than mother should introduce the first bottles to the infant.
~ The infant might take the bottle more easily if breast milk is used initially, rather than formula.

Creams & Ointments

~ The montgomery glands around the areola excrete an antibacterial substance to lubricate, cleanse, and protect the nipple during nursing. Lanolin is not usually needed.
~ If nipple and areola are very dry, a small amount of lanolin or pure olive oil may be used after nursing. If you are sensitive to wool, don’t use lanolin.

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