The First 48 Hours After Birth

Top 5 tips for breastfeeding success from Elena Vogel

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As part of our series of live Facebook chats with our favorite breastfeeding experts in celebration of Breastfeeding Awarness Month, we chatted with certified lactation consultant,Elena Vogel. She answered your questions about what's in store for you and your newborn in those first 48 hours of nursing—and how to make sure breastfeeding gets off on the right, er, breast, for both you and your baby.

While there are many important steps in creating a successful breastfeeding experience, here are five valuable tips from Elena to help get off to a great start. And a summary of your questions from our facebook expert day discussion.

Skin to skin As much as you can in the first few days, lay baby on your chest, tummy to tummy, undressed down to the diaper. When baby is skin to skin, he'll cue to breastfeed more often. Additionally, when your baby is close, you'll notice that he's cueing and be able to help him latch before he begins to cry. It's easier for both mom and baby to latch well, when baby is calm.

It's a good thing if your baby wants to eat, "all of the time" A baby who nurses very frequently in the first few days (ie: more than 8 times in 24 hours) will do a great job of bringing in a copious milk supply, will not lose excessive amounts of weight, and is less likely to have issues with jaundice. Don't hesitate to latch your baby whenever she seems interested (ie: sticking out her tongue, putting her hands in his mouth, chewing on the swaddle blanket, or wanting to suck) even if she just ate.

The more you breastfeed, the faster your milk will come in, and frequent feeds in the first days will help you make more milk in the months to come. It can feel exhausting to nurse so frequently, but it is worth it: you will have plenty of milk and a thriving baby.

A good latch While it's common to have some nipple tenderness in the first few days, your nipples should not get damaged. A good latch is what creates comfortable breastfeeding for both mom and baby. If the baby is latched on poorly (just on the nipple, without areola in his mouth too), it will most definitely hurt. Further, when a baby is latched well, he will be able to remove colostrum from the breast much more easily than if he has a poor latch. If it hurts when baby is sucking, get help with your latch, right away! Watch our video with Corky Harvery from The Pump Station for our step-by-step guide fitpregnancy.com/latchvideo.

Keep your baby awake while nursing Babies are often very sleepy eaters in the first few days. It's so comfortable for them to nuzzle in close to mom, and drift off. If baby latches, does a few sucks and falls asleep, she won't be doing her job of drinking colostrum, and your breasts won't be told to make milk. In turn, milk comes in later, baby loses too much weight and may become fussier or sleepier. So, it's important to keep baby awake and encourage her to keep sucking and swallowing (looks like big jaw movement). Rub her head or feet, raise her arm, firmly massage her back; keep her going!

Get help If things aren't going well in the first few days (baby has lost 10% of his birth weight, is very sleepy or very fussy while feeding, or your nipples are very sore), seek out help from a board certified lactation consultant (IBCLC) as soon as possible. Problems are easier to fix if dealt with early, and more difficult to resolve when left for even a couple of days more.

Eleana answered your questions on our facebook fan page. Below a summary of all your real breastfeeding questions plus, real advice from Elena.

Facebook Expert Day Discussion

Q: Will I need to pump during the first few days or week? What are the best bottles to use with a natural feeling nipple? Can I use any brand of bottles regardless of the breast pump brand? Is there a way to know I am successfully lactating before the first feeding?

Elena Vogel: If all is going well, there shouldn't be any need to pump or bottle feed in the first 3-4 weeks. It's recommended to just breastfeed during that time to help establish your supply and help baby latch on properly. If your breasts grew during pregnancy, then milk should come in normally once the baby is born. The way you know that things are going well in the first week are:

1) Poops and pees

2) That baby isn't losing excessive amounts of weight (up to 10% of birth weight is lost and that is normal

3) Baby is latching and sucking and you can hear swallows. Around day 3-4 you will be aware that your breasts feel heavier and fuller, and baby is swallowing more frequently and pooping and peeing more. Those are all signs that it is working.

Q: I am currently 8 months pregnant with my first child and am getting ready for baby to come. I have always been put off by breastfeeding (just something about a baby biting on my boob that I'm just not keen on). After talking things over with my husband and my doctors, we have decided that the best option would be to pump and feed the baby with a bottle instead of trying to latch her on. How is the best way to start out with this method? Should I bring my pump to the hospital with me and try to pump right after she's born? Should I have the hospital give her formula until I get home (or until my milk comes in)? I would love some help/advice. Thanks.

Elena Vogel: I would recommend using a hospital grade pump instead of a consumer grade one. It will be much more effective for you if you're pumping exclusively. Start pumping within 6 hours of having the baby. Pump both sides for about 15 minutes every 2-3 hours. Your colostrum is VERY important for the baby, so you'll want to give her any amount of it that you are able to pump in the first few days. The amounts will be small (or even none at times). I'd suggest taking a syringe (without a needle and sucking it up from the pump flange and then dripping it into baby's mouth. She may need some formula too, but always start with offering her whatever colostrum you can express. Within 3 days or so, you should have enough milk to start just offering her that without formula.

Any bottle with universal threading will attach to most breast pump brands.

Q: My 2-month old baby has no problem latching and feeding, but after about 5 to 15 minutes he sometimes starts grunting and pulling off constantly sometimes hitting me. How do I rectify this?

Elena Vogel: He's either grunting and pulling because he needs to burp, or because he's looking for more flow. I would try burping and re-attaching first. If that doesn't work, you could try switiching sides, perhaps sooner than you normally would, so that he gets a bit more flow.

Q: Hello, I will have a scheduled c-section this month and I wanted to know tips on how to breastfeed my newborn after a surgery. I have one child already who I breastfed for an entire year, but he was delivered vaginally so it was a little different.

Elena Vogel: I think you will find breastfeeding fairly similar to your first experience, even though the birth will be different. The biggest challenge will that you won't be able to move around as easily in the first few days, so you'll need a lot of assistance with getting situated to nurse. Get help getting propped up into position and getting pillows organized before feeding. A football hold may be the most comfortable position for you initially, as it won't put any pressure on your abdomen. Also though, if you're having trouble sitting upright, you may want to look into "laid back" nursing AKA "biological nurturing": http://www.biologicalnurturing.com/ .That may be most comfortable position in the first days.

Q: Hello. I had a c-section 4 weeks ago and this is my 4th child but first to be breastfed. Thus far its been very simple but she nurses what seems to be all day. When she gets done nursing about ten minuets later she's hungry again. Any advice? How do I get her to eat longer..she usually falls asleep. Also what bottles are best to simulate the breast BC my husband helps feed her with the milk I pump?

Elena Vogel: Chances are that your baby is falling asleep at your breast before taking in a full feeding. I'd suggest "switch nursing." Keep her on one side until she slows down in swallowing. Try to stimulate to keep going, nudge her to do breast compressions (with your hand back towards your chest wall, take a good handful of breast tissue, squeeze and hold until she stops swallowing, then squeeze and hold again). When those techniques stop working, switch sides. Plan on doing both sides twice, instead of just once on each. The switching will help to keep her awake and drinking. Aim for keeping her drinking for about 30 minutes. It IS normal for breastfed babies to eat frequently, but she should have at least 45 minutes-1 hour of contentment after a feed is over. As for bottles, I would try not to do too many at this point (once a day at most). Medela Calma is a good option.

Q: I have implants. 3 yrs post op periareolar incision. Worried about being able to breastfeed my daughter that is due any day now? Been told that most likely it'll be a full time 24 hr job nursing and pumping to make enough milk. That sounds real fun. I nursed my other 3 kids. What are your thoughts? Any advice?

Elena Vogel: Actually I think it's likely that you WON'T have challenges breastfeeding this time around. I rarely see an issue with low milk production after breast augmentation, even if periareolar incisions are done. Especially because you've already nursed 3 children, chances are, you will make enough milk, easily. So, I'd just recommend that you start with breastfeeding, exclusively. Watch to see that your baby is having the right amount of poops and pees, and that weight loss is within normal limits. If anything is not looking reassuring, then that would be the time to begin pumping after feedings (and definitely seek out help from a lactation consultant). I have a feeling it will all be okay though—Good luck!

Q: I am pregnant with my second and the first time around I was not successful at breastfeeding. I really want to try again, but am nervous for more disappointment. I attempted to breastfeed for about 10 days but my nipples were in a lot of pain from what I assume is improper latch and i wasn't producing milk yet. We tried the tubes of milk that you attach to the nipple to continue breastfeeding while waiting for the milk to come in, but it was frustrating and very painful still. Any advice on how to learn the proper latch? My community lacks any lactation consultants and tips to use if my milk delays again??? Very excited to finally be getting some advice about this as it is so very important to me. Thank you!

Elena Vogel: In terms of a proper latch, it's tricky to learn unless you have baby right there with you to practice; however, I'd suggest looking at the resources right here (pump station's video on deep latch, etc). You also may want to look into self-attachment AKA biological nurturing: http://www.biologicalnurturing.com/.

It's based on the idea that the baby knows how to latch on, and you don't have to "do" anything. Regarding your low supply the first time around: there are so many different reasons why that can happen. If it's something about you and your hormones, it may happen again. I'd recommend reading the book "Making More Milk". It can help you find the source of the low supply, which may help you be better prepared this time around. The most productive thing you can do this time around though is ask for a hospital grade breast pump to be brought into your room after you have your baby. Be sure to breastfeed at least 8 times in 24 hours, and in addition, after nursing, pump both sides for about 10-15 minutes. Try to start doing that within 12 hours of the birth. The extra stimulation should help your milk come in much faster. Good luck!

Q: Hi, i just had our first baby and he is 2.5 weeks old now. Since birth he has been very gassy and fussy every time he passes gas or has a bowel movement. I know gas is normal but he seems like he is in a lot of pain. I've tried watching what I eat, but I eat tons of fruits and veggies and know these are the biggest offenders. Can you recommend certain foods to definetly avoid. I also have been breastfeeding since day one but he will only latch using a nipple shield which works great. I've tried to nurse without it but he won't latch consistently. Is this something to worry about?

Elena Vogel: Newborn gas is very, very normal. Honestly, most babies do not have issues with foods their moms eat. Veggies and fruits do not pose a problem for babies most of the time. I would just try to burp often, put him in positions that there is pressure on his tummy, lots of walking and bouncing. It will pass as he gets older. If there is a food sensitivity it is usually dairy. So, if you're going to avoid anything, perhaps do less milk and cheese. Regarding the nipple shield: if baby is gaining weight, then there is no problem with using it. Most moms just find it inconvenient if they use it long term (always having to have it around). So, I'd just keep trying without it, but don't stress if it's not happening quickly.

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