Breastfeeding in the days following birth is characterised by frequent feedings (often every 1-2 hours). This is absolutely normal and desirable. Here's why:


Breastmilk is very rapidly digested.

From birth to about 5-6 days, the baby's stomach can only contain 5-7 ml of milk at a time (the size of a marble). Perfectly in tune with her baby's needs, the mother produces about 30-100 ml of colostrum per 24 hours. It is therefore perfectly normal from a physiological standpoint that the baby takes in relatively little quantities on a frequent basis.

Frequent, efficient stimulation of the breasts contributes to the milk « coming in » within a normal time period, and without pronounced discomfort.

When breastfeeding is optimal (baby feeds frequently and efficiently), the milk « comes in » around day 3-5 after birth. The mother's breasts will feel warm to the touch with perhaps some engorgement, but this is tolerable and is relieved by the baby feeding. This is called « physiologic engorgement », and it generally does not last more than 48 hours.

"How much does he/she weigh?"
Weight loss of up to 7 to 10% of the baby's birth weight occurs during the first days after birth. This is normal, and there is no reason to worry or supplement the baby. A skilled professional should assess the situation as a whole as well as breastfeeding, observe the baby and intervene only if weight loss is important or continues for several days. Continue to breastfeed frequently.

Beware! Some babies born by induction, cesarian or whose mother received IV medication (no matter what type) during labour retain fluids and therefore seem to lose a lot of weight rapidly after birth. However, this is probably mostly water loss and there is no need to worry if the baby is doing well.

Remember that each baby (like each adult) is unique and that weight is only one of many parameters to assess his/her status.

Baby's behaviour: normal or not?
In the first hours after birth, the baby is generally awake, alert and eager to feed. During the 24 to 48 hours that follow, the complete opposite can happen, and the baby may be very sleepy and show little or no interest in feeding. Don't worry. Room in with your baby 24 hours per day. Have lots of skin-to-skin contact, and offer the breast frequently, taking advantage of wakeful moments (even though they may be very short and fleeting). The stores the baby has accumulated during gestation will ensure that he will sail through this transition period without problem. However, he may be subject to more pronounced jaundice or to hypoglycemia (especially if there are other risk factors). Observe the baby and intervene only if necessary. In most cases, everything gets back to normal within 24-48 hours, when the baby starts being more alert and the mother's milk production naturally increases.

Jaundice
Jaundice is the result of the normal process of elimination of surplus bilirubin in the baby's circulation. This is why it is called physiological jaundice, not to be confused with pathological jaundice, which is a serious medical condition. Physiological jaundice peaks between days 3 and 5. It manifests itself by a yellow pigmentation of the baby's skin. Since bilirubin is eliminated mainly in stool, the best « remedy » to lower bilirubin levels is to increase the volume of breastmilk ingested by the baby. Breastmilk is a natural laxative, and it is especially effective in accomplishing this. When jaundice is managed appropriately, it rarely reaches toxic levels. Water or formula supplements are not indicated in this situation. Assess breastfeeding, increase feeding frequency and monitor the baby's output.

See also Dr. Jack Newman's article "Breastfeeding and Jaundice"

5 days to 6 months
From about day 5, and until the age of 6 months, the baby's stomach can contain 50-60 ml of milk at a time (the size of a golf ball), and the mother produces between 500-750 ml of milk per 24 hours. As breastfeeding is established, feedings become relatively longer and less frequent compared to during the first days (every 1½-3 hours).

« Growth spurts »
At certain times, the baby may seem to cluster feed 24 hours a day. As the baby's needs increase, these «growth spurts» are his/her natural way of increasing the mother's milk supply. They can last 2 to 3 days, and in no way means that your milk supply is inadequate. The solution is not to supplement the baby, but rather to breastfeed more frequently. The more the baby drinks, the more milk you make.

"Growth spurts" also seem to coincide with periods of rapid neurological development, which leads us to believe they are probably a manifestation of many important changes in your baby and not only a question of feeding or weight gain. This is a good sign! Your baby is meeting his/her developmental milestones!

Expressing breastmilk
During the first days, if there is a need to express breastmilk, the most simple and efficient way to do so is hand expression. This is an easily acquired skill that is free and always accessible, and there is less waste of precious colostrum than with the use of a breast pump.

If you must use a breast pump at any time during the breastfeeding period, be sure to chose one that is appropriate for your needs. All breast pumps are not equal, and the type of pump chosen will vary depending on the use you will make of it.

What you need to know before buying a breast pump

Be vigilant! Here are certain pitfalls (some avoidable, some not) and the breastfeeding problems that can be associated with them:

It has been shown that pain medication and epidurals given during labour can have an impact on breastfeeding initiation, and this undesirable effect may last from a few hours to a few weeks (delayed first breastfeed, sleepy baby, disorganised suction, supplementation, breast refusal...)

If you have a history of yeast infections and/or you have had antibiotic therapy during the perinatal period, this is an additional risk factor for yeast infections of the nipples and/or thrush in the baby. There are several ways to prevent yeast infections. Ask your Lactation Consultant.

Use of artificial nipples (pacifiers/dummies, bottles) can interfere with the establishment and/or maintenance of your milk supply, as well as the baby's suckle and latch.

Unnecessary supplementation (there are very few medical reasons to supplement a baby with formula) can interfere with the establishment and/or maintenance of your milk supply, disturb the breastfeeding routine and affect the baby's appetite. Unnecessary supplementation causes more problems than it fixes.

Incorrect latch causing pain and inefficient drainage of the breasts (can lead to nipple damage, cracks, engorgement, blocked ducts, mastitis, yeast infections, low milk supply, slow weight gain...)

Infrequent or scheduled feedings, or limiting the duration of feedings. Follow your baby, not the clock.

Infant-mother separation can affect bonding, and prevents the mother from responding quickly to her baby's needs and learning to recognise her baby's hunger cues. When mother and baby are healthy, they should room in together 24 hours a day.

Here are some easily recognised signs that your baby is doing well:

A breastfed baby feeds frequently: at least 8-12 times per 24 hours, with intervals ranging from 1½ to 3 hours between the beginning of a feeding and the beginning of the next feeding. During the early weeks, feedings (including burping, diaper changes, etc.) may last up to 1 hour. Most babies cluster feed at one point or another during the day (or night), often before sleeping for a longer period.

Day 1: 1 stool, 1 urine minimum
Day 2: 2 stools, 2 urines minimum
Brick red traces in the diaper are not worrisome at this stage.

From day 4 onwards, the baby should no longer be passing meconium. From this age until about 4 to 6 weeks, the baby passes at least 2-3 liquid, yellowish stools, or more, per 24 hours, and at least 6 wet diapers (beware of disposable diapers that are very absorbent and may seem dry even though they are not. Notice the diaper's weight when it is dry compared to when it is wet.) Urine should be clear and with no strong odour.

After 6 weeks, some babies decrease the frequency of their stools, to the point that they may stool only once every 10 days. If the baby is doing well, this is not a cause for concern.

The baby has a sustained, regular suction at the breast: there is audible/visible swallowing (suction-pause-swallow)

The baby has regained his birth weight by 2 weeks, 3 weeks maximum. If, however, initial weight loss was greater than expected, or breastfeeding was slow to start, the baby may take longer to regain birth weight. His growth corresponds to about 15 to 30 gr (½ to 1 ounce) per day, or 105 to 210 gr (3.5 to 7 ounces) per week until the age of about 4 months, calculating from the baby's lowest weight (not birth weight). Weekly weight checks are sufficient, as too-frequent weighing is very imprecise, and rarely gives an accurate indication of the baby's well-being, as well as being very stressful for everyone involved. Get help from a skilled breastfeeding professional to follow the baby closely and intervene only if necessary.

The baby is active, alert, has good skin tone/colour and seems generally healthy.