Breastfeeding and establishing your milk supply

Being prepared
In the old days, young women grew up seeing their family members and friends nurse. In today's society, many women have never seen anyone nurse a baby. The idea of taking classes or reading books to learn about breastfeeding would have made our great-grandmothers laugh, but in today's world, it makes sense to learn as much as you can about breastfeeding before your baby is born. If possible, attend a prenatal breastfeeding class and attend La Leche League meetings during your pregnancy.

One thing is for sure: childbirth and breastfeeding are two experiences that no amount of reading, attending classes or watching videos can really prepare you for. What they mostly do is tell you about what the "average" birth experience or the "average" breastfeeding experience will be like. You need to remember that your baby hasn't read those books or taken those classes," and he doesn't have a clue that he is supposed to behave like the "average" baby.

In fact, there is no such thing as an "average" baby. Each baby is unique, and so each nursing experience will be different. Often the mothers who have done the most intensive prenatal preparation are the ones who have problems adapting when things don't go 'right by the book.'

There are some basic things you can do from the beginning to help get breastfeeding off to a good start.

Breastfeed early
Put your baby to the breast as soon as possible after birth, while his sucking instincts are strongest. Babies are most alert during the first hour after birth, and soon settle into a sleepy stage than can last for hours or even days. Try to take advantage of this early alert period. Early nursings, before your milk comes in, let him practice while your nipple is soft and easy to grasp. His sucking helps contract your uterus, reduces bleeding and helps speed up delivery of the placenta.

Nurse often
Room in with your baby, and learn to recognize his feeding cues -- such as wriggling around, rapid eye movements, putting his hands in his mouth. Try not to wait until he is crying before you offer the breast. When he is crying and upset, he is less likely to be willing to settle down and nurse, and may respond by shutting down and falling asleep. Crying is a late feeding cue -- learn to recognize the early ones. Newborns usually need to nurse 10 to 12 times or more in 24 hours. The more he nurses, the sooner your milk will come in, and the more milk your body will produce. Make sure that you offer the breast at least every two to three hours during the day, with no more than one four-hour stretch during the night. Since newborns tend to be sleepy, you may have to wake him up for feedings.

If you are separated from your baby after birth, or if he doesn't nurse well, use a hospital or professional grade pump to stimulate and maintain your milk supply.

Nurse for comfort as well as nourishment
Plan to spend most of your time nursing in the early weeks. Babies nurse for lots of reasons, and they are all valid. You really can't overfeed him, so put him on the breast whenever he fusses. One of the greatest things about nursing is that you always have a built in pacifier -- it works if he's hungry, tired, lonely, sick or scared. Don't be afraid to use the breast as a pacifier -- it works, makes your baby happier, builds your milk supply and forces you to stop and rest. If friends and family members want to help, let them take care of you while you take care of the baby.

While everyone wants to hold the baby and give you a break, the most helpful thing they can do at this stage while you're resting and building your milk supply is to cook, clean, run errands, entertain older children, etc. There will be plenty of opportunities later on for them to play with the baby.

Set up a "nursing station" in the living room and the bedroom
Get all the supplies you will need together so you don't have to move once you get settled: pillows, diapers, change of clothes, towel or cloth diaper for leaks or spit up, nursing pads, wipes, change of crib linens, bottle of water, remote control, book to read, etc.

Don't limit the time he spends at the breast. Let him nurse as long as he seems interested. He needs to nurse long enough to get the high calorie hindmilk that comes later in the feeding, after the milk lets down. Especially in the early days of nursing, it may take several minutes for the let down reflex to "kick in."

Offer both breasts at a feeding
Nurse him at least 10 to 15 minutes on the first side, then burp and change him and offer the other breast. Next feeding, begin with the breast he nursed on last. Many babies will only take one breast at a feeding once your supply is well established, especially if you have a plentiful supply, but in the beginning, you need to stimulate both breasts.

Don't be surprised if your baby "cluster feeds." This means that he may nurse constantly for several hours, then conk out and sleep so soundly you can't wake him up for four or five hours. It really doesn't matter, as long as he is getting enough to eat. For most babies, this means nursing at least eight times in 24 hours.

However, if your baby has regained his birth weight by day three, there is no reason to set your alarm and wake him up every two hours to nurse. As long as you keep track of his urine and stool output and his weight gain, it really doesn't matter whether he nurses every one and a half hours or every four hours, whether he took both breasts or one, or whether he nursed for five minutes or 30. Remember that the mythical "average" baby doesn't really exist.

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