After much effort, we have finally started to really inform pregnant people about their labor and birth options. We have included the partner and educated families about the value of having a professional birth attendant like a doula. Pregnant people know which classes to take, what questions to ask, which comfort measures to use. Though we still face abysmal rates of unnecessary medical interventions, there is definitely more access to education and families are better prepared for labor and birth. But where we are still failing is in adequately preparing parents for the newborn phase and especially for normal infant feeding and normal newborn behaviors.
As a private practice IBCLC, I consistently hear from lactating parents during the initial breastfeeding assessment: “I was never told any of this. Why didn’t anyone tell us any of this information?” This even coming from families that took group breastfeeding classes.
The First 24 Hours After Birth
Babies, when born without medicalized interventions, are very alert in the first hour after the birth. This alert state is designed to help babies latch after the birth to initiate the process of signaling to the birth parent’s body that they need nutrients, calories and hydration. After this first hour babies can become very sleepy and can be difficult to rouse over a period of up to the next 24 hours after the birth. This is because, just like birth parents, babies go through a lot of work and energy expenditure during the labor and birth stages.
It is essential that babies be allowed uninterrupted access to the birth parent in the two hours after the birth. I believe that two hours, not one, is essential because of the fact that in the United States birth is highly medicalized and babies need more time to be able to recover from the birth experience and be able to initiate imprinting on the birth parent. During this time having baby skin to skin with the lactating parent, in a calm environment, will allow for hormonal imprinting for the dyad (baby and parent) that will help encourage the process of milk production. In these early moments after birth and especially through the first three days of life, babies need very frequent, small feedings.
Despite the widespread of misinformation, there is, in fact, milk PRESENT AT BIRTH!!! Colostrum IS milk! We need to stop using misleading phrases like “your milk has not come in yet” or “when your milk comes in.” Pregnant people start producing milk, in the form of colostrum, some time around 16 to 20 weeks gestation. This precious first milk is highly concentrated in its protein and other nutritional content, as well as, in its immunological properties. Because of this high concentration of the nutrient content, babies only require small amounts of our first milk. In the first 24 hours post birth, again despite popular misinformation, babies typically only require about 8-10 MLs (about a teaspoon) per feed, depending on the baby’s weight and individual metabolism.
Since baby’s stomach is so very small in size and because human milk is the most perfectly designed food for human digestion, the need for feeds will be quite FREQUENT! In addition, because of the fact that babies can be extra sleepy in the first 24 hours after the birth, you can expect that your baby will be more alert and a lot hungrier on day two. This is a time where baby’s cumulative hunger, from extra long naps and likely ineffective milk transfer on day one, will lead baby to be quite hungry on day two when baby will work hard to catch up.
Day Two After Birth
If baby experienced a highly medicalized birth, it may be that baby may still be recovering on day two and will really start to more actively catch up on feeds on day three. On day two, babies require about 10-12 MLs of milk, as opposed to the 2 ounces typically recommended by MANY healthcare providers in the hospital environment. Because the feeds continue to be small, you can expect the frequency of feedings to be between 8 to, some times, up to 14 feeds per 24 hour period. Babies feed to satiate hunger, to hydrate, and to soothe.
Normal Infant Weight Loss
It is normal for babies to lose about 5 to 7 percent of their birth weight in the first two to four days of life. Some babies will lose as much as 9 to 10 percent of their birth weight. This is NORMAL because the baby passes meconium and urine and is transferring very small amounts and in some case not transferring effectively yet! Let’s all remember that breast or chest feeding is a SKILL, after all. All skills require repetition in order to achieve competency! During this time of normal weight loss it is important that you keep a close eye on baby’s output (the number of urine and poop diapers baby produces per day). You also want weight loss to stop by day four after the birth.
What is important to note is that babies who have experienced a medicalized birth, where the birth parent has received intravenous fluids, can pass meconium and urinate in the first 24 hours as a result of this excess fluid. You want to pay closer attention to baby’s diaper output from day two and beyond. An easy way to remember how to monitor output the first five days of your baby’s life is to expect a number of urine and poop diapers (separately) that is equal to the baby’s age; for example one urine and one poop diaper on day one, two of each on day two, three of each on day three and so on until about day five; after which time each baby will vary depending on their individual caloric needs and intake and should average about 5 to 6 urine diapers and about 4-6 poop diapers per day. Remember these are averages so your baby may be okay with slightly less or more output. This is why it is a good idea to have an early assessment with a highly qualified and experienced International Board Certified Lactation Consultant (IBCLC), who will offer the highest level of clinical lactation expertise.
Day Three, When Things Can Get Really Hard
Day three after birth, whether you are already home with baby after a vaginal delivery or you’re still in the hospital after a cesarean birth, can be a time of a lot of stress. At this point, baby is REALLY HUNGRY and working hard to catch up on caloric intake. Babies can really cluster feed (feed with frequency of as much as every 45 to 60 minutes) for a period of several hours. Baby is not only trying to get more hydration and calories in but also signaling your body to complete the transition from small amounts of milk production in the form of colostrum to larger amounts of mature milk. When your baby cluster feeds your body is alerted that your milk production has to increase to meet your baby’s growing needs. Day three, if you are home, can also feel quite scary because now you and your partner, if you have one, will be fully responsible for your baby’s care without the support of healthcare providers trained in normal newborn behaviors. However, it is important to know that you are CAPABLE of providing optimal, nurturing care for your baby without healthcare experts. You and your baby will quickly learn to communicate especially if you do all of the care for your baby, with the support of others to take care of you and any household chores. The more time you spend with your baby the quicker you will learn your baby’s unique “language.”
Because babies can cluster feed on day three of life and they are likely still experiencing some weight loss, it is very common for pediatricians to suggest you supplement, typically with artificial infant milk. It is important for you to understand that if your baby has lost 10 percent or more of their birth weight and or your baby is showing signs of dehydration (low urine output and or crystals in the urine) that you MUST in fact ensure that your baby gets more milk volume. More often than not, you can provide supplemental human milk feedings by a combination of either hand expressing and or hand expressing and pumping after breastfeeds to collect additional milk to use to feed baby extra calories and achieve adequate hydration. Because you want to make sure that you do not inadvertently cause over stimulation that can lead to over production, it is important to work closely with an experienced IBCLC to ensure an optimal infant feeding and milk production plan. For more information on my recommendations for infant feeding and milk production during the hospital stay or in the first 2 to 3 days after birth, you can read my post Human Milk for Human Babies!!!! STOP Telling Birth Parents, As A Matter of Routine To NOT Pump After Birth.
Even just a few more teaspoons of human milk a day, in those early days, can be enough to stop further weight loss and ensure sufficient caloric intake and proper hydration. Most babies do not need the larger quantities of supplementation that many pediatricians often recommend. Your baby’s stomach at birth is about the size of a marble then it grows in the first few days until about day seven where it is about the size of an average apricot and requires about 45 to 60 MLs (or 1.5 to 2 ounces) per feed with still as many as 8 to 12 feeds per day. At around a month of age, your baby’s stomach will be about the size of an average egg and will require about 2.5 to up to 4+ ounces depending on the individual baby, but the average at this age and beyond is more like 2.5 to 3.5 ounces per feed with feeds spread out throughout an entire 24 hour period. The physiological norm for babies is to eat smaller more frequent meals even up to the age of one.
Early Feedings Are Challenging But You CAN Do It!
Breast or chest feeding is definitely challenging, especially in a society like ours that does not value families and does not provide any paid federal family leave to care for our children. With the right information, support and a clear understanding of what is normal infant behavior, you CAN succeed in reaching your infant feeding goals. ASK for and ACCEPT help!!! In the first 4 to 6 weeks post birth, insist on at least a quick weight check appointment at your pediatrician’s office once a week. Keep track of urine and poop output. If your baby needs extra calories, get expert support to create a milk production plan that will provide the extra milk volume your baby is not yet able to get directly at the breast or chest. As long as your baby is not continuing to lose weight, it is okay for your baby to take up to two weeks or a little more to get back up to birth weight. It is normal to have breast fullness and heaviness in the first week or so but you need to get help if your breasts are significantly swollen and or painful. Always get help if the latch is painful beyond the first 20 seconds or so. Nipple damage is never normal so be sure to consult with an IBCLC in the event of any damage.
The first six to, sometimes, eight weeks of breast or chest feeding can be quite challenging and exhausting. You should get help by either hiring an IBCLC, if you can manage it financially, calling your local La Leche League leader or attending a meeting if possible, or if you qualify by getting assistance from an IBCLC at your local WIC program.
Breast is physiologically normal. Fed is required. Informed is BEST!!!!