Lactation Services

Congratulations on the decision to breastfeed your baby! Breastfeeding is one of the most natural acts, yet it may seem like a lot of work initially. However, it is extremely rewarding for both mom and baby. The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life; breastfeeding with complimentary solids until 12 months of life; and continued breastfeeding past one year until mutually desired between mother and baby. The benefits of breastfeeding include:
• Protection from infection for baby
• Decreased risk of allergies
• Decreased risk for ear infections
• Less expensive than formula and more convenient
• Quicker weight loss for mom
• Reduced risk of postpartum bleeding
• Reduction of breast cancer risk
• Reduction in the risk of maternal ovarian cancer
• Reduced risk for maternal cardiovascular disease

Don’t be discouraged if breastfeeding doesn’t come easy – we are here to help! It takes practice for both mother and infant, and each pair has their own unique breastfeeding journey.

• Days 1-2 after delivery: The first milk you will produce is called colostrum. You may have noticed some leaking from your breasts during pregnancy. It is thick, pale orange to yellow in color and rich in antibodies to protect your baby from infection. Your body will produce very small amounts of colostrum, but it is all your baby needs in those early days.
• Days 2-5 after delivery: Your milk will start to transition. This is commonly referred to as your “milk coming in,” and during this time your breasts may feel very full and possibly become engorged (see Engorgement below). This milk is considered transitional milk and it has everything to support the nutritional and developmental needs of your growing baby at this stage. This milk is usually produced until about 10-14 days after delivery.
• Days 10-14 and beyond: Your mature milk is being produced now. It is more watery than transitional milk. You will produce mature milk for as long as you breastfeed your baby.

Most newborns eat around 10-12 times a day (about every 2-3 hours). The more demand there is, the more milk you will produce. It is especially important in the first few weeks of life for baby to feed at least this much in order to establish a good milk supply.

Engorgement is when your breasts are full of breastmilk and usually occurs 2-5 days post-birth when you switch from producing colostrum to mature milk. Your breasts may feel tender, heavier and full and breastfeeding may become difficult.

With normal fullness, your nipple and areola remain soft and latch shouldn't be affected. Frequent nursing (on demand or at least every 2-3 hours) helps regulate supply and reduce engorgement.

As your milk comes in, your breasts may enlarge and become hard, firm and even painful. To minimize engorgement:

Engorgement can look different for each mom. Some mothers have uncomfortable fullness with flushed and warm breasts. Some mothers have severe engorgement with red, hot very uncomfortably full breasts and a low- grade fever. The breasts may appear red, tight, shiny and taut. The increased fullness will sometimes cause your nipple to flatten, making it difficult for baby to latch.

Don't worry - this won't last forever! However, it is important to treat engorgement right away so that it doesn't lead to mastitis or damaged nipples due to poor latch.

Think of severe engorgement as stuck milk. Getting the milk to flow from the breasts and relieve the congestion is the goal.

• Nurse often. Aim for at least 8-10 feedings per 24 hours, or every 2-3 hours.
• Apply a warm compress to breasts 5-10 minutes before feeding to help milk flow or if painfully full, immerse breasts in a bowl filled with warm water for 5-10 minutes while gently massaging down towards the nipple
• Gently massage breasts and any lumpy areas with your fingertips while feeding baby. Massage in a downward motion towards your nipple. Light vibration (back of an electric toothbrush, etc) can help with stubborn clogs.
• If baby is having difficulty latching, remove milk first using a Haakaa pump or hand expression into a clean container (save in a bottle for later]
• Apply a cold compress after or between feedings for comfort. A frozen bag of vegetables wrapped in a cloth or cold cabbage leaves work well. Apply for 15-20 minutes
• If after feeding, your breasts remain tight and full, you can hand express or pump to relieve pressure. To avoid overproduction, express or pump only until you feel relief or your breast tissue feels soft. The more milk you remove, the more milk you will make
• If you are relying on pumping or hand expression to continually manage engorgement, or your baby continues to have difficulty latching, consider making an appointment with a lactation consultant

There is no magic number for knowing if you have enough. In the first few weeks, feeding on demand is the best technique for building an adequate supply. If you think you are feeding enough and baby is not gaining weight or still appears hungry after feeds, then we recommend you seek advice from a lactation consultant.

Baby is feeding 8-12 times per 24 hours.
◦ Feed on demand - do not wait until baby is crying to feed.
◦ In the first few weeks, look for these hunger signs: hand-to-mouth movements (rooting on fists), tongue movements in sleep, rooting in their sleep, “pecking” when holding against you or your partner’s chest
• You can hear/see baby actively swallowing during every feed. Typical pattern when baby is at the breast is to suck-suck-swallow-rest-repeat. When babies are younger rest will be a little longer in between sucks and swallows.
• Baby is back to birth weight by week 2.
• Baby is gaining about 3/4 to 1 ounce per day in the first 3 months.
• Baby has 6 or more wet diapers a day by day 6
• Bowel movements have transitioned from dark brown meconium to yellowish and seedy by day 6. Typically, babies will have 3+ bowel movements a day, but not all babies follow this pattern.
• Baby appears satisfied after feedings. Look at their arms - are they pulled in close to their chest and are they fussy (aka still hungry) or are their arms flopped out towards their side in satisfaction?

Weighing is always a good indicator of how much baby is getting. You can always drop in for a weight check in office. You can also make an appointment with a lactation consultant to see what your baby is transferring and gaining from each feeding.

Pumping also helps to ensure that your breasts are being drained regularly, as this tells your body to make more milk. Sometimes it is necessary to rent a hospital grade pump to help get your supply up in the first few months. If you think you have a low supply, we recommend making an appointment with a lactation consultant.

There is a wide variety of lactation supplements intended to help increase supply. Good hydration and enough calories in your diet are also important. 

Skin to skin helps not only with breastfeeding, but bonding in the first few days and weeks. Even older babies can benefit from skin to skin contact with their parent or parents. Studies have shown that skin-skin contact can help increase breast-feeding duration and help regulate a baby’s temperature, among other benefits.

The latch in the first few days may come with a strong sensation as you and baby figure out how your anatomy works together. If you experience pain that continues through feeds, let your caregiver know or schedule a visit with one of our lactation counselors. Any position is fine as long as you and your baby are comfortable and the latch doesn’t hurt. Here are a few tips:

• Turn your baby completely onto his side, "tummy to tummy", so his mouth is directly in front of the breast and he does not need to turn his head at all to get to the nipple.
• Position your baby with his nose to your nipple so he has to "reach up" slightly with his mouth to reach the nipple. His chin should touch the breast first, then he will open his mouth wide to take- in the nipple and latch-on.
• Look for a straight line from your baby’s ears, to shoulders, to hips.

Your baby’s mouth is open wide and both the top and bottom lips are rolled out, more of the lower part of the breast is drawn in

• Your baby’s mouth is open wide and both the top and bottom lips are rolled out, more of the lower part of the breast is drawn in
• His or her chin is resting against the breast during feeding and his or her nose is close to or touching the breast
• Your baby is sucking rhythmically and deeply, in short bursts separated by pauses
• You can hear your baby swallowing
• Your nipple is comfortable after the first few sucks, pain is less than a 3 on a scale of 1-10
• Your baby seems happy and satisfied for an average of one to three hours between feedings
• On days 1-2, expect black, tarry stools (called meconium), which will transition to yellow-green stools on days three to four. After day 4, your baby should be having around three to four yellow, loose, seedy stools per 24-hour period. Usually, by day 5-7 of life, baby is having 5-6 wet diapers light yellow to nearly colorless wet diapers per 24-hour time period
• Weight loss is no more than 7-10% of birth weight, with baby reaching birth weight by 2 weeks of age
• Your baby is gaining 0.5 to 1 ounce a day once you are producing milk

  
When initiating bottle feeding, to best be able to transition back to the breast, it is important to mimic breast feeding as best as possible. This is accomplished through Paced Bottle Feeding.  Please watch the below tutorial by Stacy Kucharczk, IBCLC, and contact a lactation consultant for further questions.
                                                  Paced Breast Feeding

Early-term babies are unlikely to be expert breast feeders until they are closer to term.

• Put baby to breast as often as possible but don't expect him to be able to get a full feed in the early days. Pump after feeds and feed back pumped milk if he is too tired or disorganized to directly breastfeed for a sustained amount of time.
• Rent a hospital grade pump to drive your supply up. Aim to pump 8 times a day until baby can sustain a latch for a full feed, then decrease pump sessions for every breastfeeding session.
• Skin to Skin is a great way to bond! In the early weeks it is important to keep the baby in her "natural habitat” - skin-to-skin with either parent. This is important because this is the place where the baby is the least stressed. As little holding of the baby by other people as possible will ensure that feeding cues are not missed.
• Paced Bottle Feeds: A bottle can be helpful for an early (less than 40 week), small (under 6lbs), sleepy or jaundice baby. Paced bottle feedings help baby take the bottle in the same way they would approach the breast. There are many examples of paced bottle feeding online for reference. A good example of paced bottle feeding can be seen above
• Hang in there - as baby starts to grow and get closer to her due date, she should start to wake up to directly breastfeed more often!

Pumping may be used to help relieve engorgement, to help increase your breast milk supply, or to provide breast milk for your baby when you can’t breastfeed. Options for expressing milk include: • Manual pumps: these pumps are hand-held and create suction by manual squeezing. These are inexpensive and helpful for an occasional bottle. A great alternative to a manual pump is hand expression.

Double pumps (electric): these pumps are powerful and quick, and they are recommended for most mothers who want to express and store their milk for later use and for working moms who will be returning to work and plan to pump for an extended period of time.
• Hospital-grade pumps: these pumps may be rented and are beneficial for moms with hospitalized infants or moms who need help establishing breast milk supply

Breast milk may be stored either in bags or in special bottles that can be used for both storage and freezing. It is best to store milk in feeding sized quantities, about 2- 3 ounces to start. You don’t want to thaw out more milk than your baby will take in 24 hours. After you have some experience with how much your baby takes from a bottle, you can freeze milk in that quantity.

Breastmilk can be thawed overnight in the refrigerator (it takes about 12 hours), by being placed in a container of warm water for a few minutes, or with a bottle warmer. • When heating milk, never make it warmer than body temperature. • The cream will rise to the top of the milk during storage. Gently swirl milk (do not shake) to mix before checking temperature and offering to baby.

• Never use a microwave to thaw or warm breastmilk.
• Thawed breastmilk must be discarded after 24 hours. Do not re-freeze it.

If you have any questions or concerns about your breastfeeding experience, please call our office to make an appointment with a member of our lactation team at 303-756-0101.