We support you the way you want to be supported. And we want to provide the guidance you need to meet your breastfeeding goals with health and happiness.
So here’s some great information to help with your breastfeeding, and baby feeding, journey – prepared for us by our friends at the Breastfeeding Center of Pittsburgh.
Stay tuned for more, including virtual breastfeeding classes and other methods of support!
BREASTFEEDING BASICS
By: The Breastfeeding Center of Pittsburgh
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Newborn babies need to feed an average of 8 to 12 times in 24 hours. While frequency of feeding is important, so is the quality of the feeding. Here are a few tips to help you determine how well your baby is feeding at the breast.
Active Feeding (Look and Listen)
Ideally, baby should be active while they are breastfeeding. When baby is drinking at the breast, their chin will drop down and pause for a swallow. Observe the pouch under their chin. You should see it drop down toward their chest during a swallow. Swallows can usually be heard. Sometimes they are described as a “puh” or “kuh” sound. They typically increase with milk let-down and you may even hear baby “gulping” at the breast. In the early days of milk production, it may be difficult to tell if baby is drinking. Swallows will be less frequent with colostrum than mature milk due to the volume. This is where it can be helpful to look for swallows by observing for that longer drop in the chin. If they are active with the feeding, you will be able to see or hear swallows.
Passive Feeding
Even though baby may be at the breast every few hours (or more), it doesn’t necessarily mean they are drinking. Babies can be latched and sucking at the breast, but not drinking any milk. Sucking can be observed by the chin moving up and down in quick little bursts – but if the chin is not dropping down to pause for a swallow, there is no drinking. If baby is being passive with feeds, they may fall asleep at the breast, which can result in a shallow latch and sore nipples. A baby who has fallen asleep at the breast will not drink. They will need stimulated to stay awake and active with the feeding.
Encouraging Active Feeds
Offer both breasts per feeding. Try to switch sides before the baby gets too sleepy or fussy at the first breast. Feeding from both breasts promotes milk production and helps the baby to get more milk with each feeding. Use breast compressions when baby becomes passive. Compressing the breast with gentle pressure to help move the milk toward the areola and encourage baby to drink.
By: The Breastfeeding Center of Pittsburgh
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Breastfeed your baby often, about every 2 to 3 hours. Aim for 8-12 feedings in 24 hours. Offer both breasts per feed. This helps milk supply get off to a good start.
Plenty of skin to skin contact can help establish good breastfeeding. Provide plenty of safe, skin-to-skin contact with baby as often as able.
Babies may lose up to up to 10% of their birth weight by discharge from the hospital. They should regain their birth weight by 7-14 days. Once milk supply increases, baby should start gaining ½ to 1 oz. per day.
1 wet diaper per day of life, increasing to 6-8 wet diapers after day 5. Meconium, (dark, tarry stools) on days 1 and 2, changing to loose brownish green by day 3-4, then to loose yellow/seedy by day 4-5. Some infants pass a lot of meconium while in the hospital and may take a break from stooling for the first 24 hours. Expect at least 2 to 4 dirty diapers per day; some stool every time they are breastfed. Babies will develop their own stooling patterns beginning around 6 weeks.
Breasts typically become very full as milk volume increases, anywhere from day 3 to 5. Breasts can become engorged. This swelling usually goes away within 48 hours. Empty the breasts often to help prevent/relieve engorgement and get milk supply off to a good start.
Wake your baby to feed every 2 to 3 hours during the day if they are still sleeping. Allow for no more than one, 4 hour stretch without a feeding in 24 hours. Babies will have periods of cluster feeding, nursing about every 1 to 1.5 hours.
Know how to tell if your baby is actively swallowing/drinking at the breast. Many babies will latch and suck at the breast, but do not swallow. Baby’s jaw will drop and hold for a second with swallows. You can hear a “kuh” sound with swallows. You should feel a pulling or tugging sensation on the areola. Latch should be comfortable.
Initially, quick sucks occur to stimulate the initial let down. You should be able to hear your baby swallow after every 1 or 2 sucks. Sucks are interspersed with swallows and swallows increase with milk let-down. As the feeding progresses, the baby will be swallowing less. This pattern may last an average of 10-15-20 minutes on each breast. Feedings should not take more than 30-40 minutes total time of active sucking/swallowing. As breastfeeding becomes more established, some babies may only nurse on one breast per feeding.
If needed, undress sleepy baby to a diaper for feedings. If too warm, he or she may fall asleep at the breast. Use breast compressions to encourage baby to be active. Compress the breast with your whole hand or fingertips when sucking is noted, but not swallowing. Once swallows are noted, release the compression. Compressing the breast when baby has an extended pause during feedings can also be helpful. Stimulate baby to keep awake by talking, rubbing his/her palm, tickling chin.
By: The Breastfeeding Center of Pittsburgh
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How do I know my baby is hungry?
As a new parent, you will soon learn to recognize early signs of hunger in your baby. It’s best to breastfeed your baby before they start to cry. Soon, you will begin to feel comfortable and confident with breastfeeding your baby.
Newborns instinctively let us know when they are ready to feed. In most cases healthy newborns will wake for feedings on their own, however some babies may be sleepy at first and it may be necessary to wake them for feedings. This is helpful to ensure that they are getting enough milk.
Below are some of the newborn behavioral states and the hunger cues shown during each state. With their eyes closed, infants will demonstrate REM (rapid eye movement) in the Active Sleep state, along with increased body activity and facial movements. Though slightly difficult to waken in this state, parents can begin to prepare baby for feeding. Babies respond and learn best in the Quiet Alert state. This is a good time to feed, talk to and engage with baby. Keep in mind that babies usually progress from one state to the next very quickly.
The Quiet Alert State
- This is the best time to initiate breastfeeding
- Minimal body activity
- Regular breathing pattern
- Face is bright, eyes are wide and bright
- Most attentive to stimuli and their environment
Early Hunger Cues
- Eyes may be open or closed
- Licking or smacking of the lips, sticking tongue in and out
- Opening & closing mouth, sucking on hands, fingers, fists or anything else they can reach!
Active Hunger Cues
- Squirming movements of the body
- Rooting at the chest of the caregiver, eagerly searching for the breast
- May begin to grunt and fuss
Late Hunger Cues
- Fussiness turns into sustained crying
- Face can turn red, facial expressions become tense
- Irregular breathing pattern
- Baby has reached their limit, needs consoling
If you find that your baby is showing late signs of hunger, it is important to calm your baby before attempting to breastfeed. Try skin-to-skin, swaddling or other soothing techniques. A crying baby can have difficulty latching, which can be stressful for parent and baby.
By: The Breastfeeding Center of Pittsburgh
Breast compressions are a simple strategy to increase the flow of milk while baby is feeding at the breast, which can be helpful in the early days of breastfeeding.
WHEN BREAST COMPRESSIONS CAN BE HELPFUL
- To encourage a baby who is sucking without drinking to transfer milk from the breast
- To assist a premature baby, sleepy baby, or baby with slow weight gain to feed more actively at the breast
- To assist an older nursling if they are distracted while feeding
- To make feedings more efficient and effective, which can helpful if nipples are sore
- To help manage plugged ducts
- To maximize milk production when pumping
HOW TO DO BREAST COMPRESSIONS
- Apply firm, yet gentle pressure to the breast with either the whole hand or fingertips; similar to the pressure when applying moisturizer to the skin
- Gently compress the breast tissue with your hand or fingertips, release and compress. Repeat.
- Compress the breast when baby is sucking, but not drinking (listen for swallows and observe for a longer dip in the chin)
- Once swallows are noted, hold the compression until swallows slow, then release and observe baby’s activity
- Compress the breast when baby has an extended pause during a feeding
For more information, we also recommend this excellent video that demonstrates breast compressions.
By: The Breastfeeding Center of Pittsburgh
As a new parent, you will find that breastfeeding is a combination of practice and patience. Your milk is the perfect first food for your baby and has all the nutrients your baby needs to grow healthy and strong.
Breastmilk digests easily, and is naturally gentle on your baby’s digestive tract. Breastmilk is high in antibodies protecting your baby against illness and allergies. Breastfeeding also helps the uterus return to a non-pregnant size sooner so there is less blood loss after your baby is born. Breastfeeding may even protect you against certain cancers.
Getting Started
Early and frequent breastfeeding helps make milk. It is important to understand that the more the baby nurses, and if they are nursing well, the more milk you make. If very little milk is taken from the breast or if a bottle is offered on a regular basis, instead of a breastfeeding, the breast will make less milk. To make plenty of milk, nurse your baby every 2 – 3 hours during the day with one longer stretch at night, about 4 hours, when your baby sleeps. Time the feeding from the beginning of one feeding to the beginning of the next feeding. On the average, babies need 8 – 12 feedings in 24 hours. In the early days after birth, babies are often sleepy. Please wake your baby for feedings every 2 – 3 hours until you baby regains birth weight, at about one to two weeks of age.
Babies are ready for feeding when they place their fists to their mouth, pucker/smack their lips and turn their head/root. Crying is a late hunger cue. These are all signs your baby is ready to eat.
POSITIONING
To help your baby get plenty of milk, it is important that you hold your baby so that his whole body faces the breast. He should not have to turn his head into the breast or over his shoulder to nurse. When you’re in the hospital, don’t hesitate to ask for help from a lactation consultant or a knowledgeable nurse to make sure that you have your baby positioned well. Good positioning can help your baby achieve a good latch. This is especially important if you’re experiencing soreness that lasts beyond the initial latch on. There are many different positions in which to breastfeed, such as cross cradle, football and laid back. For information on laid back breastfeeding, see our article here Laid Back Breastfeeding
LATCH
Your baby should be latched onto your breast (areola) tissue, not your nipple. The areola is the darker portion of breast tissue that encircles the nipple. Some have very large areola, some small. Your baby does not need to take in all of the areola tissue. In general, a “good” latch is one where baby’s latch is asymmetric, meaning they have taken in most of the bottom portion of the areola, leaving more of the top portion of areola tissue more visible. This enables their chin to be placed on the breast, with their nose tilted up. Ideally, the corner of their mouth should be wide, not narrow, as this often means they are latching just on the nipple. However, try not to worry about what the latch looks like. If breastfeeding is comfortable, and baby is transferring milk well and gaining appropriately, there is no need to be concerned if your baby’s latch doesn’t look “perfect.” Comfortable breastfeeding, along with good milk removal and well gaining baby are what matter most!
BOTTLE FEEDING, MILK EXPRESSION AND STORAGE
By: The Breastfeeding Center of Pittsburgh
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While babies are born to breastfeed, breastfeeding is a skill that for most families, often takes some time to learn. Bottle feeding also takes practice, as it’s a completely different mode of food delivery for the breastfed baby.
We suggest introducing practice bottles around 3 to 4 weeks of age. This will give the family plenty of time to hone breastfeeding skills and establish a good milk supply. Some families may choose to wait longer to introduce that first bottle, but if returning to work is anticipated, practice bottles should begin well before heading back to work. There are many approaches to bottle introduction, but staying consistent with practice is often the best way to help baby accept a bottle.
Ideally, expressed milk should be offered in the bottle. This helps keep the taste familiar, and baby continues to receive the benefits of human milk. A strategy that’s often recommended is to have the parent pump after the morning breastfeed and use this milk for later in the day/evening for the practice bottle. Keep in mind that a practice bottle does not need to be a full feed of 3 or 4 oz. Baby can be given a small amount of pumped milk, about ½ to 1 oz., by bottle and can return to the breast to finish feeding.
A slow-flow nipple is a good way to begin with young babies, however all slow flow nipples are not the same. Signs your baby may be having a hard time with the flow include leaking around the mouth and possibly choking, if too fast. If flow is too slow, baby may become frustrated, with feeds taking a long time. A nipple that is tapered or graduated, somewhat narrow at the tip, gradually widening at the base, can help promote responsive feeding or paced bottle feeing. Here’s an excellent video on paced bottle feeding.
Offer the bottle in a relaxed environment and when baby is not overly hungry. Baby should be calm when drinking from the bottle. They shouldn’t guzzle, nor should they take an excessively long time to drink. Keep baby upright, chin off their chest. Never prop a bottle or leave baby unattended while feeding.
Keeping the bottle feeding attempts low stress and relaxing. Provide baby lots of positive feedback and most importantly, enjoy this time with your baby as you learn something new together!
By: The Breastfeeding Center of Pittsburgh
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When you first bring your new baby home, the days (and nights!) seem very long. Soon however, you will find yourself falling into a more predictable and comfortable breastfeeding pattern. For many mothers, they will be returning to work within a few months after baby is born.
Questions about when to start pumping and introducing a bottle are normal. A great place to begin is by listening to our Working and Breastfeeding podcast. In the meantime, here are a few steps to set your mind at ease as you consider preparing for your return to work.
Generally, we recommend beginning to pump and offer bottles about four to six weeks after breastfeeding is well established and at least three weeks before you return to work. If you are returning to work at six weeks, you may want to start pumping at about three weeks. If you are returning at eight weeks or beyond, consider beginning to establish a pumping routine around one month. Should you plan to return to work when your baby is older than six months, consider if baby will be taking a cup and the introduction of solid foods. If you have not already discussed pumping at work with your employer, it is never too early to do so. Here is some information about pumping rights in the workplace.
Begin by selecting a regular time to pump once a day. Many mothers choose right after the first morning feed because they haven’t yet started a busy day and milk tends to be plentiful in the morning. Initially, you may not obtain a significant amount when pumping. Don’t worry. After a few days, your pumping yield will become more predictable.
Once you have milk stored, begin by offering your baby a practice bottle. This does not need to be a full feeding, or done every day. Choose a time when both you and baby are calm and alert, so you are prepared to follow each other’s cues and learn how to work together. As tempting as it may be, offering the first few bottles in the middle of the night often creates more stress than relief. To begin, try offering a half-ounce after breastfeeding. You can also offer a small amount prior to breastfeeding, and finish at the breast. Whenever baby is offered a full bottle in place of a feed, mom should pump. This helps maintain supply and avoid uncomfortably full breasts.
As you become more experienced with pumping and bottle feeding, you can start to think about how much milk you will need to store for your return to work. At the minimum, you need enough milk for your first work day, as you will then pump at work for the following day. If pumping once a day does not seem sufficient, you may find adding more pumping sessions helps you to have more stored milk. Try not to have a very large quantity of stored milk. This can lead to problems with oversupply in mom, dependence on the pump and it takes up valuable freezer space! Freeze milk in 2-3 oz. quantities. Smaller amounts defrost more quickly and there’s less chance of wasting unused breastmilk once its been thawed. A few one ounce bags of frozen milk allows you to have a “back up” and enables you to adjust the amount offered. Breastmilk handling and storage guidelines are available here https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
Every mother’s return to work will be different. Speaking with co-workers who have already navigated the pumping scene at your office can be very helpful. Connecting with other working and breastfeeding moms in the community is invaluable.
By: The Breastfeeding Center of Pittsburgh
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Whether out of necessity for return to work or desire for flexibility with feeds, most parents at some point will express their milk and introduce bottles.
It’s important to correctly store pumped milk to protect its biological properties and reduce the risk of contamination. Human milk is a living, dynamic food, even when not available directly at the breast. It is the gold standard for infant nutrition.
Prior to expressing milk by hand, manual pump or double electric pump, parents should wash their hands thoroughly with soap and water. The pump itself should be clean. Milk should be collected in clean containers that were washed in hot, soapy water, thoroughly rinsed and air dried, or dried with a paper towel. Milk can be expressed/stored in glass bottles, bottles that are BPA free or plastic storage bags specifically designed for human milk.
Guidelines below are based on healthy, full-term infants. Milk storage guidelines differ for infants that are are preterm, ill or in the NICU.
- All milk should be dated before storing. Be mindful of expiration dates. Use the oldest fresh or frozen milk first. Avoid accumulating a large freezer stash.
- If freezing, leave about 1 inch at the top to allow for expansion. To take up less space, lay milk flat in human milk storage bags and stack on top of each other. The bags can be contained in a large, plastic freezer bag, which adds an extra layer of protection.
- Thaw milk overnight in refrigerator or by placing in a bowl of lukewarm water. Never refreeze thawed milk.
- To avoid waste and for easier thawing, store milk in portions of 1-4 oz. (30-120 ml). to previously expressed milk.
For current human milk storage guidelines, per the CDC, check here https://www.cdc.gov/breastfeeding/pdf/humanmilk-en-4×6-508.pdf