Breastfeeding - The Initiation

I have been asked by several friends and patients to write a blog about breastfeeding. Turns out, I can go on  FOREVER about this subject, so I am going to break it up into topics, starting with the initiation of breastfeeding. My experience comes not only from working with mothers and newborns in the NICU, nursery, hospital and clinic, but also from having spent two years of my life breastfeeding/pumping. During pregnancy, you will develop your own opinion about breastfeeding, every person has a different goal in mind, from formula feeding only, to extended exclusive breastfeeding. Research has shown that most mothers in America set a goal of breastfeeding for at least 3 months, though less than 30% reach that goal. If you decide that breastfeeding is best for you and your infant, I would like to provide my support by answering questions and sharing information to help you be successful in reaching your goal.


Once you have made the decision to breastfeed, you will hear differing advice from EVERYONE - your relatives, friends, co-workers, doctors and lactation consultants. You will hear about how natural, beautiful, and rewarding breastfeeding is, but few people will admit how difficult, painful, and anxiety provoking it can be. During my course of breastfeeding, I have felt all of these emotions and more. In the end, listen to all the advice offered and use only what works for you. Not every breastfed infant is fed the same way, some breastfeed exclusively, some take pumped milk from a bottle, and others take a combination of breastmilk and formula. Infants benefit from any amount of breastmilk, however, it is best if they get at least half of their milk as breastmilk. In the end, the most import part of breastfeeding is the health of your infant, so if there are medical complications, like prematurity, poor weight gain, or jaundice, your infant my need to supplement with formula or pumped milk for a short period of time. 


The best time to start breastfeeding is within the first hour after delivery. After an uncomplicated vaginal delivery, most infants are awake and alert for about an hour and will latch and start to suck right away. Not all infants are able to go to the breast immediately and it is OK to wait until you and your infant are ready. Some have problems with blood sugar after birth and need a small amount of formula or sugar water to keep them safe - this is common practice in most hospitals. These infants will not have the energy to breastfeed if they do not get their blood sugar into the normal range. If your infant requires supplementation in the hospital, I recommend pumping every time this occurs, even if you don't produce any milk - this will let your body know that your infant needs more milk and will help your supply.

During the first days of breastfeeding, most mothers produce a small amount (5-10 ml) of colostrum with each feed. You will feel tugging and pulling, but should not feel severe pain. If you do, then your infant's latch may need to be adjusted. Take advantage of the nurses, doctors and lactation consultants in the hospital - they will have lots of advice and can provide hands-on help. You will also feel uterine cramping with each feed, this the due to hormonal contraction of the uterus - it hurts, but is good for your body. The more often your baby breastfeeds, the more milk you will produce, the more contacted your uterus will become, and the more experienced you and your infant will be prior to going home.

You will not "know" how much milk your infant is getting, but if they are waking to feed every 1-3 hours, having wet diapers and clearing their meconium, they are getting enough. All infants loose weight after delivery, but should start gaining it back after 5-7 days. Your infant should see the pediatrician for a jaundice and weight check within 3 days after discharge from the hospital.

Breastfeeding for the first time will be uncomforable and sometimes stressful for the fist couple of weeks, but it gets easier. If if continues to hurt or your infant is not getting enough milk to gain weight, then find support. Most hospitals, doctors offices, and specialty baby stores have lactation consultants available. You can also talk with an experienced breastfeeding mother, who may have some great tips for you. Just remember, for every person who tells you that breastfeeding was the easiest, most natural part of motherhood...there are 10 others who will give you a different story.

Next up...the first days home and pumping (aka The Milk Machine).

Heather Joyce, MD