Getting Started

Breast and Nipple Preparation

• There is no preparation necessary for your nipples. It is no longer recommended that you rub your nipples with a towel or pinch or pull them. It is not recommended that you express any colostrum during pregnancy as it may cause premature labor.
• Don't use any soap on your nipples or areola, the darker part of your breast. Wash with clear warm water. Good handwashing is always important and will decrease germs significantly.
• Check to be sure your nipples are graspable. Breast cups or shells may be used prenatally in the eight and ninth month of pregnancy to help evert flattened or inverted nipples. An Evert-it Nipple Enhancer may also be beneficial, but should be used only after 38 weeks of pregnancy as it may cause labor contractions. Use upon recommendation by your physician.

Beginning Breastfeeding

• Attempt to nurse baby at least eight times in 24 hours. Many babies nurse more often. Allow baby to nurse as long as desired.
• Sleep Phase: Many babies are sleepy in the first 24 hours or so after birth. Term, healthy newborns are born with adequate fluid stores, so supplementation with water or formula is not recommended unless there is a medical problem. If your baby nursed well after delivery then you can rest assured that when your baby becomes more alert, he or she will continue to nurse well.
• It is a good idea to awaken your sleepy baby and attempt to nurse every one to three hours. Some babies will easily awaken with gentle stimulation such as unwrapping and a diaper change. If your baby does not awaken after 10-15 minutes of trying, stop and try again in an hour or two.
• If baby does awaken to nurse you may need to continue with some "gentle" stimulation to keep him or her eating, such as lifting the upper arm, stroking legs, feet, head and so on.
• After long periods of sleep, some babies will go through a "marathon nursing phase" where they want to nurse "all the time" and can't be put down. This is a good sign as the baby is allowed to stimulate the mother's body to establish an adequate milk supply. Allowing your baby to eat as often as he or she wants is best. If your baby does finally fall asleep during this frequent feeding phase, you can usually get a break from nursing if your baby is held and cuddled. If you put baby down, he or she may soon awaken and want to nurse again. Remember: The more you nurse, the sooner your milk will come in.
• Do all pacifying at the breast. Avoid pacifiers or bottle nipples until baby is nursing reliably and gaining weight.
• At home, keep a record (Daily Record for Breastfeeding Mothers) of your baby's feedings and wet diapers and bowel movements. Your baby should be having at least one wet diaper per day of life (i.e. three days = three wet diapers) and daily bowel movements. By day six, your baby should have six or more wet and two or more dirty diapers in 24 hours. Bowel movements are the best indication that your baby is getting enough to eat.
• Take advantage of classes and videos provided by the hospital where you deliver.

Adapted from Evergreen Hospital Medical Center Breastfeeding Center

Early Feeding and Colostrum

• The sooner after delivery of your baby that you begin breastfeeding, the quicker a fuller milk supply will come in. Babies and mothers adapt to the postpartum period better if they breastfeed soon after delivery.
• The best time to put your baby to breast is as soon as possible after delivery when babies are usually awake and alert. Ask your nurse for assistance if needed.
• The first milk your baby gets is called colostrum, which is only available in small amounts initially: approximately 1 ounce total in the first 24 hours or 1 teaspoon per feeding the first 24 hours. This is enough food for your baby unless there is a medical need determined by your baby's doctor. Colostrum will, with proper stimulation, increase to meet your baby's needs.
• Colostrum is high in protein and has antibodies and antibacterial properties to help protect your baby from infection. Colostrum is usually all your baby will need to provide his fluid and nutritional needs.
• As your milk increases, your breasts become fuller, heavier and perhaps slightly tender. You may have a low-grade temperature. (If above 100.5, call your doctor.)
• It is normal to have increased fluids in the breast as fullness occurs. This is called lactogenesis (milk coming in). It may be necessary to breastfeed every 1 1/2 to 2 hours, to pump, or hand express for comfort. This fullness usually lasts 24 to 48 hours, but may last as long as a week. It is important to make sure your breasts have no hard or lumpy areas. If you feel hard or lumpy areas, gentle massaging toward the nipple as you feed, hand express or pump should be helpful. 

Feeding Pattern and Routine

• Prepare yourself and your baby by checking for soiled diaper, getting comfortable, having something to drink and so on.
• Massage your breasts to allow colostrum to come out of your nipple for your baby to smell and taste; this will encourage the baby to suck.
• Position your baby at breast level, with baby's nose and chin touching your breast. Use pillows to help hold the infant in position. Holding your breast down with your thumb may cause clogged milk ducts and/or displace your nipple in the baby's mouth. This may cause your nipples to become painful.
• Stimulate the baby's rooting reflex by touching the baby's upper lip with your nipple and waiting for your baby to open his mouth widely, insert your nipple and at least one-half inch of the areola. Do not allow your baby to begin feeding unless his or her mouth is open wide, as when crying or yawning.
• If it is necessary to remove your baby from your nipple, insert your finger in the corner of the baby's mouth and between baby's gums to release suction and then gently remove your nipple.
• Offer both breasts at every feeding. However, your baby may be satisfied after the first breast the first day or two. Example: First feeding offer right breast, then the left breast. For the next feeding, offer the left breast first then offer the right breast.
• Alternate the breast that baby nurses first to help prevent nipple breakdown and soreness from vigorous sucking.
• It may be helpful to use different nursing positions to prevent nipple soreness and breakdown. The "football position" is generally the preferred position because it enables you to have more control of the baby's head and allows eye contact between mother and baby.

Frequency and Duration

• Feeding on cues from your baby is best. Watch for feeding cues: mouth moving while still asleep, bringing hands toward face and beginning to wiggle, sucking on hands, and/or rapid eye movement. (These same cues may mean the baby is beginning to stool and he or she will usually not feed effectively at this time.)
• Newborns may want to breastfeed every hour to three hours in the first two to seven days.
• Babies usually suck in bursts. Allow approximately 10 seconds between sucking bursts. The baby is learning to regulate the flow of milk.
• Listen for swallowing, which sounds like faint puffs of air. Ask your nurse to help you listen for swallowing.
• Breastfeeding your baby for about 10 minutes (sucking time) per breast is usually enough time, however, normal feeding time per breast is five to 30 minutes. If a baby feeds only five minutes, that is considered a feed. Allow your baby to release himself or herself from your breast unless you are getting uncomfortable and need to change positions.
• Limit lengthy feedings if your nipples are sore, but feed more often. The longer the baby waits to feed, the harder they usually suck, which can cause more discomfort. Remove your infant from your breast by inserting your finger in the corner of the baby's mouth and between the baby's gums to break the suction. A wet, warm washcloth to your breast after your baby is removed feels good, then let the nipple air dry and apply PureLan or Lansinoh ointment for comfort.
• Night feeds are important to maintain milk production and help assure that your baby will get adequate nutrition and fluids. Many mothers choose to sleep with their baby.

Digestion

• Remember that babies can digest almost 100 percent of the breast milk they take in and can do so in 1 1/2 hours.
• Always attempt to burp your baby after feeding at each breast. The baby may not burp, however, because the breast molds around the baby's mouth and does not allow your baby to suck in air. Babies quite often burp themselves. Unless a baby seems uncomfortable, don't worry if he or she does not burp.
• Wet burps are normal. (Breast milk forms soft, easily digested curds in the baby's stomach).

Crying

• If your baby is fussy, soothe him before attempting to breastfeed. Breastfeeding should be a pleasant experience for you and your baby.
• Check for causes other than hunger: hot, cold, wet or anxious from being separated from mother. Babies sometimes act hungry when they are having a bowel movement or passing gas. Babies may have sore areas from delivery. Babies may also be over stimulated from procedures or too much handling from people.