If you are reading this before your baby has arrived, congratulations on taking a proactive step towards a successful breastfeeding journey. If you have already had your baby (congratulations!!), don't worry, you have come to the right place! Read ahead to learn about what to expect during these first six weeks of your breastfeeding journey.
The Very First Breastfeed
Regardless of how you have birthed your baby, your baby will want to have a breastfeed shortly after they have been born. For moms who have had a cesarean, I suggest opting for skin-to-skin as soon as possible, as this will help your baby's instincts towards the breast come alive. If you have birthed your baby vaginally and you and your baby are doing well, have your baby placed on your bare abdomen so that they can use their instincts to crawl towards your breasts; this is known as the "breast crawl". I would suggest having a look at what a breast crawl looks
like by searching on Google or checking out my little playlist on YouTube here - keep in mind these clips are edited, so patience is a key factor! Allowing your baby the space and time to find the breast and nipple on their own will strengthen their learning to breastfeed, and you will be in awe of just how much they know what to do even when they are just minutes and hours old! The first 1-3 hours of their life are very important in terms of laying down the pathways for a successful breastfeeding journey, as this is when your oxytocin levels are the highest. Have your baby skin-to-skin and avoid any unnecessary interruptions/interventions that can be delayed until after this time, like baby checks, injections, and other tasks staff may want to complete. Immediate skin-to-skin, the breast crawl, and uninterrupted golden hours are great things to write in your birth plan. Once your baby has had all they wish to drink from your breasts, which could go on for an hour or more, they may wish to have a long sleep. This is often called the "recovery sleep" as they, too will be tired from all that has occurred during the birthing process.
The First Week With Your Baby
During the first few days of your baby's life, their mission is to get your breast milk flowing! They will be enjoying the colostrum that is already available to them (produced in the breasts from as early as 16 weeks during pregnancy) and "demanding" your milk supply by feeding very frequently. These early feeds may seem like snacks and naps, and that is very normal. When your milk supply does increase, typically expected around 36-72 hours onwards, the volume of milk your baby will be drinking will increase, and they may appear more satisfied after feeding and sleep a little longer. It is normal for your baby to feed 8-12 times in these early days. Hang in there, stay hydrated, well-fed, rest as much as possible, and enjoy the mood-boosting benefits of unlimited skin-to-skin time. Because your baby will be feeding so frequently, it is normal that their sleep may seem erratic, short, and more abundant during the day compared to during the night. Babies don't know the difference between night and day, and this takes time for their bodies to learn. Also, your baby will be experiencing a huge growth in their gut bacteria, as they don't have any bacteria in their gut when they are first born. This can be an uncomfortable process where your baby will be gassy and want lots of cuddles and comfort sucking to get them through - just go with it.
If you and your baby are separated after birth or if your baby needs to be admitted to the Special Care Unit, it's important to prioritise skin-to-skin contact as much as possible during your visits. Additionally, you should hand express your milk every 2-3 hours to establish and maintain your milk supply while your baby is away from you. Seek support from a Lactation Consultant to develop a breastfeeding plan and learn how to use a breast pump effectively. Monitoring your baby's output is also important. On the first day, you can expect one wet and dirty diaper, two of each on the second day, three of each on the third day, and once your milk supply increases, around 6-8 wet and dirty diapers per day. The colour of the stools will change from dark green/black (meconium) to a mustard yellow colour as milk flow increases.
It's worth noting that jaundice, a condition characterised by elevated levels of bilirubin, occurs in 80% of newborn babies. Some babies may have high levels of jaundice, which can affect their behaviour, making them sleepy and uninterested in feeding. This type of jaundice requires medical attention from a Pediatrician. On the other hand, mild jaundice, with a slight yellow tint to the skin, usually clears on its own as long as your baby is regularly feeding.
A Note About Conflicting Advice
During your hospital stay, you'll encounter various healthcare professionals contributing to your care, and it's common to receive conflicting advice. It can be overwhelming to navigate through all the information and suggestions. Prioritise learning about breastfeeding before your baby's arrival and find a trusted expert, such as a Lactation Consultant, who can provide guidance and support. Remember that you don't have to follow every piece of advice you receive. Choose what feels right for you and your baby, and adapt as needed since your baby's needs will change day by day. It's normal to feel overwhelmed, both with the advice and the emotional journey of becoming a new parent. Give yourself time to adjust, be gentle with yourself, accept help, and ride the waves until you find your stride.
Some Early Challenges
Nipple pain is one of the most common challenges mothers face, often leading them to discontinue breastfeeding earlier than intended. Nipple pain is primarily caused by incorrect breastfeeding technique, with the nipple not being deep enough in the baby's mouth. When your baby latches deeply, you should feel an intense tug and vacuum of your nipple and breast in their mouth. If you're experiencing prolonged pinching or sharp pain during feeding, seek support to improve your latching technique and reduce discomfort.
Engorgement is another common challenge that occurs when the breasts start producing more milk for the first time. It typically happens around 3-5 days post-birth and resolves within 2-3 days. Engorgement can feel sudden and intense, but you can alleviate it by using ice packs, regularly feeding to relieve fullness, and taking pain relief as needed. If your breast is so firm that your baby struggles to latch deeply, you can hand express a bit to soften the area around the nipple. However, avoid pumping as it can further stimulate milk production and prolong the discomfort of engorgement.
Sometimes, the increase in breast milk volume may be delayed due to various factors such as pregnancy and birth complications, hormonal conditions, separation of mother and baby, or inadequate milk removal or stimulation. If you haven't noticed an increase in your milk supply by day five, it's advisable to seek extra support from a Lactation Consultant who can assess your situation and provide a plan to improve milk volume.
Your baby will be weighed soon after birth, and then also around 48 hours to assess if they have been getting enough milk. A 7% weight loss of their birth weight is average, and over 10% requires a plan from a lactation consultant and potentially the pediatrician. We like to see your baby gain weight at around 20 grams per day and back to their birth weight by around two weeks. Your local Maternal Child Health Nurse will monitor this once you are discharged from the hospital.
What's Normal For Newborns From 1-6 Weeks
It helps to know what is in the range of normal behaviour for a newborn, as it takes time to get to know your baby, and there can be a lot of doubts about whether your baby's behaviour is normal. They will want to feed very frequently, and this can feel relentless. They may also cluster feed (periods of back-to-back or constant feeding) as a way to increase your milk supply and seek comfort for digestion upset and feelings of tiredness. It is normal for your baby to prefer cuddling and contact napping throughout the day and night rather than sleeping in their cot. Their awake windows are quite short initially, with about an hour of feeding and digestion support taking up most of their awake time. Once your baby is around four weeks of age, they will be more alert and seeking a bit more play and stimulation from you as they wake up to the world. Your baby will continue with 6-8 wet and dirty diapers per day, with the frequency of bowel movements potentially slowing down for some (not all) around the six-week mark. In terms of weight gain, we are looking for around 20 grams per day or 150-250 grams per week. You will notice in your baby's health book that the growth chart climbs a lot in the first four months, and then weight increases at a slightly slower rate thereafter.
Other Common Challenges
Breast lumps can occur when milk is not being drained consistently. This can be due to a poor latch or an oversupply of breast milk, either naturally or from using a pump or silicone let-down catching device. The best way to ensure you don't get lumps and inflammation in the breast is to aim for a well-matched supply with what your baby needs.
If lumps are not treated, they can turn into mastitis, a painful inflammation in the breast, causing your milk supply to temporarily lower, and full-body symptoms similar to the flu. Mothers who have experienced mastitis say they feel dreadful. Mastitis requires assessment by a medical breastfeeding expert and potentially antibiotics. Avoid stimulating your supply further, use heat and massage when you have breast inflammation, and stick to ice, pain relief (anti-inflammatories), rest, and feeding and/or pumping just enough for your baby.
Under supply of milk can be either perceived or genuine. Sometimes a mother just needs reassurance that she is producing enough for her baby, and consistent weight gain and periods of contentedness are enough to show this. In other cases, low supply or inadequate supply can be a genuine challenge. Every mother’s capacity to produce and store breastmilk is different, and there are some cases when a mother may not be able to provide all that her baby needs - this is when the help of a good lactation consultant can be invaluable in creating a plan that is realistic and sustainable, meeting the goals of the parents and needs of the baby.
If nipple pain is prolonged, and you are sure your baby is getting a deep latch, it may be time to consider other reasons. Enlist the support of a lactation consultant who can give you guidance on other causes for nipple pain, such as conditions like thrush and vasospasm.
To Sum Up,
Getting through the first six weeks can be a challenge, which calls for support from close friends and family, trusted professionals, and some preparation for good nutrition and time for self-care. It can be a huge adjustment to living life on your newborn's terms, and many parents can feel lost in the process, especially in those early stages. Discuss with your partner all the ways they can support you with breastfeeding, such as nappy changes, bathing the baby, cleaning, pumping and feeding equipment, prepping meals and snacks, keeping you hydrated, and caring for your baby when you need to rest. If you can get the support of an expert lactation consultant, I would highly recommend it. They can give you a plan that is tailored to your unique needs and challenges and help to cut through all the noise that comes with the conflicting and unsolicited advice parents inevitably face. I wish you all the best for your breastfeeding journey, especially in these first few weeks, and don't forget to take stock of all that you have accomplished in keeping your tiny human loved, fed and alive!
Joelleen Winduss Paye is a holistic, Internationally Board Certified Lactation Consultant (IBCLC), endorsed midwife, naturopath, and educator, and is the founder of JWP. Joelleen has supported breastfeeding families for over 13 years and offers a uniquely holistic perspective. Joelleen supports clients face-to-face in Melbourne and consults virtually with clients from around the world. She teaches a live breastfeeding workshop every second month, supporting parents to learn about breastfeeding before their baby arrives. Joelleen also has a Breastfeeding eGuide, and her services are available here. Follow Joelleen @jwp.ibclc for holistic breastfeeding and baby content.