Let me start by saying that I am no lactation consultant, although I would like to become one, it’s 1000 hours of hands on experience that doesn’t count as my own so it’s put on the back burner for now. I have however, been breastfeeding my babies for 3+ years now and intend to breastfeed the next one so I like to think of myself as an experienced milk producer. About a month ago, I attended a conference called 10 steps to successful breastfeeding. It was 15 hours long and yes we did just talk about breastfeeding the ENTIRE time.
I’m very passionate about breastfeeding, it wasn’t always easy for me, but over time I grew to love it more and more and couldn’t imagine our life without that time with each child. I love helping mothers start their breastfeeding journey and enjoy giving what advice/info I have learned along the way. One of my most asked questions as a mom is when to start pumping, and all the details in between. So, between my personal experience, experience helping mothers as a NICU nurse, and knowledge I have gained along the way, I thought I would share my most helpful tips for starting to breastfeed once coming home from the hospital.
THE NUMBER ONE thing you can do to get a successful milk production is STIMULATE YOUR BREAST WITHIN the FIRST HOUR after birth! This is key and truly the most important thing you can do to not only get your milk supply in, but set your supply up for the future. If you have a normal/healthy pregnancy in which you can do the golden hour after you deliver, immediately get your baby sucking on your breast. Stimulation is key to signaling your breast that it’s time to start producing.
At the conference I attended, the instructor shared a story of a mother who was put under in a high risk delivery and the nurse that was caring for her knew that her plan was to breastfeed, so even though the mother was “out of it” for several hours after she delivered, that nurse went above and beyond her duties and put that baby to breast within the first hour so that the mother would get the best start to her breastfeeding journey. Isn't that amazing? I did learn that up to 6 hours is ideal to get the first feeding in/stimulation of your breast but it is most beneficial to start within that first hour which is probably why they call it the golden hour, huh?
Hand expression can be useful. If you don’t know what this is, it is where you basically massage your breast to get milk out. You cup your hand in a C shape, and gently squeeze your breast down towards the nipple to release milk. This can be very beneficial in those first few days when your nipples are so sore and the sight of your baby or your pump makes you cringe. You can hand express to get milk out, it works wonders. It is also super helpful while you are pumping because it helps get all those milk ducts released so that you express all the milk in your breast. The pump can only do so much and this is a great way to get more out of it.
If you have a healthy newborn baby and breastfeeding is initiated within the first hour and you are exclusively breastfeeding with each feed, then there is no reason to start pumping in the hospital. There really isn't any reason to start pumping at all unless you want to start building a freezer supply. For me, I like to start pumping when I get home from the hospital which is two times a day. Once right away in the morning (when your milk supply is at it's best) and before bed. Obviously I nurse exclusively throughout the day and night, but these pump sessions are just a way to start building that freezer stash for when I want to leave my baby for a couple hours or for when I return to work.
Side Story: What NOT to do!
After Oliver I starting pumping right away in the hospital to try and get my supply in which meant I was pumping every 2-3 hours, on top of him nursing on demand so I signaled to my breast that I basically had quadruplets and needed like 5 gallons of milk in each breast at all times! I do not recommend this approach as it is painful to be that engorged, you don’t need that much milk for only one baby, and it’s a vicious cycle to try and get your breast to stop producing that much because you want to relieve your breast because they are painfully large and full of milk, but you don’t want to keep stimulating them otherwise it keeps telling them to make more!! See… a vicious cycle!
A good Latch
A good latch is also key to successful breastfeeding. You may think it’s pretty easy.. put the baby to the breast, but you’d be surprised at how many women struggle with a successful latch. The main points are making sure your baby latches onto your entire areola.. not just your nipple! The best way to do this is stroking the sides of babes cheeks to get them to open up all the way and then they will take “mouthful” of your breast. You want your nipple to be in the back of their throat while sucking. If not, they are only sucking on your nipple and it will become very sore very quickly!
Below is an example of a good latch that I took from pinterest.
The use of a nipple shield
People have different opinions on the use of nipple shields, but for the most part you only need a nipple shield if you have a premature baby or if your anatomy of your breast is not ideal for baby to latch onto. What I mean by this is that if you have inverted nipples or flat nipples, you may want to try a nipple shield to help your baby get a better latch. Using a nipple shield for premature babies is great for them because it allows them a longer, more stable teat, reduces milk fatigue, and the baby can pull milk at a rate that is more comfortable for them so if they need a break it will pool in the nipple shield rather than drowning them. Always consult a lactation consultant when determining if you need this or not.
How often to feed
I have never used a strict schedule for feeding times, but there are many people that do. Know that in the beginning your baby should be eating every 2-3 hours and will usually go through cluster feedings where they can eat every 15-30 minutes for up to a couple hours. If your baby does go a longer stretch of time, you can always pump or hand express in between that time to help alleviate your breast.
Let your baby fully nurse on one breast before switching them over to the other side. This is something I wasn't very good at in the beginning, and I would switch Oliver over half way through the feed because I thought he needed the other breast. This didn't allow my breast to ever fully drain and I was constantly feeling full, let alone he wasn't getting the "hindmilk" as they call it, which is the fatty part of your milk supply and usually happens towards the end of your feeding.
Think of your milk supply as a supply and demand. The more frequent you stimulate your breast (hand expression, pump, or nursing) the more it signals your body to produce more milk. Your baby will guide that and eventually your breast will produce what he needs based on how often he eats and how much he takes at each feeding. So if your baby only wants to nurse on one breast for 30 minutes and then is done, that's okay. Let them be done. It's up to you if you want to pump or hand express the other side or just wait until the next feed to nurse him on the breast he didn’t eat from.
If pumping and bottling is your plan, which I know of many women and friends that choose to do this here are some helpful tips that I’ve learned along the way!
Pump as often as you would nurse your baby which is usually every 2-3 hours so that you gain a good milk supply and stash for your baby to eat.
When freezing your milk, I buy the breastmilk storage bags from target or walmart or you can buy them HERE, lay them flat in your freezer to freeze so that it’s easier for you to store afterwards. This will make it more compact and less bulky.
Sterilization: You can buy sterilizing bags that I do right when I open new bottles or pump parts and then I usually try and sterilize all my parts once a day or even once a week. If I am able to wash them in warm soapy water, that’s enough for me. This task is a bit daunting and takes up more time than you think!
What Bottles to use: I’ve asked our occupational specialist that works in our NICU this question in the past and what she said was to just buy one type of bottle and stick with that. Any bottle/foreign nipple is going to be new to the baby and will take time for them to get use to. So in most cases you are better off just sticking to one brand (obviously starting with a 0 or 1 nipple in the very beginning) instead of going out and buying all these different kinds of bottles hoping one works. If your babe isn’t taking any of the bottles, chances are they are probably confused because you’ve introduced so many. So stick with one first and see how that goes!
How much do I feed my baby?
The information below is taken from the Excellence in care with the ten steps conference I attended.
First 24 hours —> 2-10mls per feed
24-48 hours —> 5-15mls per feed
48-72 hours —> 15-30mls per feed
72-96 hours —> 30-60mls per feed
Keep in mind that at the time of delivery a baby’s stomach is the size of a marble, which means they do not need very much! As they grow, each baby will determine how much and how often they need, so listen to your baby and pay attention to how much milk your giving them so that for future feeds you can warm that amount up.
Below is a helpful chart to help you determine how much you feed your baby that I just found on pinterest, but I would say that it’s pretty accurate and is relatively similar to the information provided above. Also note the section at the bottom on feeding cures, crying is a late sign of hunger and will usually be harder to get your baby to eat because they are so worked up! It’s best to begin feeding them when they are quiet alert and rooting or sucking on their hands!
Breast milk storage
Fresh pumped breast milk can stay out at room temperature for 4 hours and stay in the fridge for 4 days.
Thawed breast milk should only stay out at room temperature for 1 hour and can stay in the fridge for 1 day (24 hours).
Breast milk can stay in a regular freezer for up to 6 months, and a deep freezer for up to 12 months.
Products I love
Medella pump (I've never used any other pump so I can't speak for any other brand but reasons I love this pump is 1. its free from my insurance, 2. It works really well at getting milk out, 3. the parts are easy to buy if I need more AKA I can run to the store rather than having to buy them online.)
Hands free pump bra, you can be hands free. You can purchase HERE
Heating pack, this is nice when your boobs are engorged because it will help get the milk flowing before you nurse or pump.
High wasted leggings which are great for covering up your belly when out in public and you need to lift your shirt up! My favorite you can buy HERE
HAAKAA: This I’ve not tried before but I’ve heard lots of women rave about it and how much milk don’t waste when using one! How it works is by putting it on the breast that your not nursing your baby on and all that milk that would usually leak into a breast pad during your let down, will be collected into this HAKKAA cup and you will start gaining a supply in no time! A must have for me, I will for sure be using one this time around!
Nursing pads are a must! You will leak, have let downs when you hear your baby cry or even look at them, and they’re just really nice to have! I recently bought these reusable ones off amazon that I’m excited to try with this next babe! You can buy them HERE or these are the Disposable ones I buy!
Creams and ointments are out there but there isn’t any proof that they actually work and I would agree with this. You basically just have to tough through those first couple weeks of painful nipples until they callous over and no longer bother you anymore! If you are experiencing very cracked and bleeding nipples, I would go see your doctor. You may be experiencing a wrong latch in which case your nipples are going to be very sore!
You will also want to keep your breast DRY. Do not leave a wet pad in your bra for hours for many reasons! One, it’s a warm wet place perfect for infection and bacteria to grow. Two, Your nipples will always be wet and soft causing them to be sore. You want those bad boys to stay DRY… just do it!
Engorgement: Reasons for engorgement are restricted feeds or scheduled feeds (meaning you are not releasing milk on demand or when your baby wants to eat) a poor latch (meaning baby is not sucking milk from your breast accurately in which case will also make your nipples extremely painful) and breast augmentation.
The best treatment for engorgement is to MOVE MILK! Massage your breast, hand express, use hot packs to get your boobs leaking, shower, take a warm bath and soften your areola. When you are engorged your nipple and areola are so hard that it is often hard for baby to get a good latch.. this is when hand expression is your best friend!
Things I learned from my Breast feeding course I took
Babies are NOT lactose intolerance, which means mothers do not need to cut out dairy or anything else in their diet. This is just what the instructor from this course said and other professionals may have different opinions on it.
I wish I knew more information on this topic but it wasn’t discussed in detail in this course but what I do know is that what you eat really has no effect on your baby. Your body is producing milk that is rich in vitamins and nutrients specific to your baby including antibodies to help prevent them from getting sick. This is why breastfeeding is soooo good for babies!
What is most likely happening is simply a coincidence that when you eat something you then notice your baby is more fussy or upset. Your baby being uncomfortable after a feed could be many things! They could be reflux in which case you won’t want to lay them down immediately, keep them upright for 30 minutes or so just like an adult would and if the problem occurs take them to see their pediatrician.
Your baby could be over eating, especially if getting a bottle. Breastfeeding is a lot of work for babies, they have to work hard to get the milk out until you have a let down. So, for babies that are bottle fed it is much easier for them to get as much milk as they want without working at all causing them to possibly overeat. Just like adults, when you overeat you feel full, sick and like you want to throw up! That’s probably how your babe is feeling too.
Spit ups: Babies spit up, it’s in their nature. Some more than others but it’s nothing to be concerned about unless they are projectile vomiting or throwing up very large amounts. At this point I would take them to see their pediatrician to see if something else is going on.
It doesn't matter how much water or nutrition you consume, your body will produce the milk that it needs to feed your baby. Don't over stress about not drinking enough water throughout the day. Yes, it is important, but it doesn't determine your milk supply.
Colostrum is "gold" colored because it is dense. All the nutrients are packed into much smaller volumes because babies stomachs at the time of birth are only about a marble size. As they grow the volumes of your milk get larger to accommodate their growing needs so they can take bigger volumes, that doesn't mean your milk is less nutrient. It actually has the same amount of nutrients in it, just dispersed into a larger volume.
Every women has a milk supply at the time of birth, but some women may not get a great supply ever no matter how hard you try.
Whether you choose to breastfeed, pump, or formula feed it really doesn’t matter as long as your baby is being fed! If you are doing this then you are doing a GREAT job. Caring for a baby is not always easy and there are millions of questions you can ask yourself, so I hope that this post provides you some information to help you at ease in your beginning stages of your pumping/breastfeeding journey. I also want to note much of what I wrote is my opinion, personal experience, or past education I have learned and may not be what works for you and your baby. If you ever have questions or concerns, follow your gut and your instincts.. mothers know best and seek additional care.
REMEMBER: FEED EARLY FEED OFTEN!