The First 48 Hours: Breastfeeding
The first few days of breasfeeding are tough, but with a little detetective work, even the most mysterious issues can be solved
Doing detective work isn’t exactly the first thing you associate with breastfeeding, but when breastfeeding gets off to a rocky start, some gumshoe action may be in order. Here to point out the clues that a nursing mom can watch out for in the first 48 hours and the culprits behind many early breastfeeding problems, is Dr. Lana Gagin, a pediatrician at Helen DeVos Children’s Hospital in Grand Rapids, Michigan.
Clue: Breastfeeding hurts… a lot.
Culprit: If your baby seems hungry and is interested in taking the breast, but the actual act of nursing hurts way more than you thought it would, it’s probably a case of improper latch or a positioning problem, explains Dr. Gagin.
The remedy can be quite simple if there are lactation consultants on staff at the hospital. “Ask the lactation consultant to observe you breastfeeding your baby,” advises Gagin. The lactation consultant can then offer specific feedback on improved positioning or latch-on technique, and answer any questions you may have.
Clue: Your milk’s not in yet
Culprit: It typically takes two to three days after birth for a mom’s milk to “come in”—a process known as lactogenesis. Until then, nursing babies are getting colostrum, a kind of “pre-milk” that is low in fat and high in carbohydrates, protein and antibodies. A mom might worry whether her baby is getting enough to eat, or whether she’ll produce enough milk to keep her baby healthy.
This is why pumping or learning how to manually express breastmilk is often recommended during the first 48 hours. “Pumping or manual expression can speed up lactogenesis by stimulating the breasts,” says Gagin. “This can help milk come in a little earlier and more amply—both of which help moms feel better about their supply.”
Additionally, certain groups of women may have more trouble than others establishing an adequate milk supply. Says Gagin, “older moms, moms who delivered via C-section, and moms with BMIs over 30″ can benefit from early pumping as a way to boost their supplies.
“The lactation consultant can show you how to use a pump or learn how to manually express your milk. Just ask,” she recommends.
Clue: Your baby is losing weight
Culprit: A nursing mom can be alarmed, and then discouraged, to learn her baby has lost 5, 7 or even 10 percent of his birth weight in the first few days. It’s easy to blame inadequate nourishment from breastfeeding, but, as Gagin finds, this is not typically the case.
“Losing weight in the first 24 hours is normal in healthy newborns, especially babies delivered by cesarean who naturally retain more fluids in their bodies at birth,” she notes. “In the first day after birth, babies are busy peeing out these extra fluids left over from life in the womb, and that’s what [often] accounts for the weight loss—not getting too little from the breast.”
A recent study suggested that a baby who loses more than 5 percent of her birth weight in the first 24 hours could benefit from formula supplementation. However, Gagin cautions to look at the whole picture—not just a percent—before deciding that any weight loss is excessive. “Is your baby eating? Is your baby making wet diapers? Is your baby otherwise healthy and thriving? Then chances are everything’s OK… don’t just go by a number.”
If you are concerned about your baby’s weight, don’t hesitate to talk to your doctor about it. Newborns should be gaining, rather than losing, weight by day five. Babies typically regain their birth weight between 10 days and two weeks.
Clue: Your baby has jaundice.
Culprit: When excess bilirubin builds up in the blood after birth, Baby’s skin can take on a yellowish appearance. How best to deal with jaundice? Feed your baby early and often: colostrum actually acts as a laxative, and frequent stools lower bilirubin levels.
When jaundice continues past the first week after birth in breastfeeding babies, it is sometimes called “breast milk jaundice” and may be a sign that a mom’s milk supply needs a little help. “As long as the baby is not very jaundiced, we can help a mom work through this without formula by helping her to pump as a way to boost her supply and give her baby more milk,” says Gagin, who also recommends seeking help from a lactation consultant on latch and positioning if jaundice is an issue. Jaundice usually goes away on its own by six weeks.
Clue: Your baby’s diapers are dry.
Culprit: What goes in must come out, and your baby’s wet and poopy diapers are actually a telltale sign that he’s getting enough nourishment from breastfeeding. What to be on the lookout for? “In the first 24 hours, we want to see at least one of each. This helps us know that the baby’s bowels and urinary tract are functioning,” Gagin says. And after that? “In the first two or three days, we’re looking for two to three wet diapers, and by day five, the standard is five wet diapers.”
Before you press the panic button because today you only changed her diaper four times, Gagin recommends taking a step back. “All of these things are really just general guidelines; every breastfed baby is different.”
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