Breastfeeding Your Newborn

Signs of Milk Transfer (the breastmilk is getting from the breast into the baby)

  • The baby moves from short rapid sucks to slow deep sucks early in the feeding
  • The mother notices her milk letting down
  • No smacking or clicking sounds are evident with sucking
  • Audible swallows
  • The mother’s breast softens as the feeding progresses
  • The mother’s nipple does not appear blanched or compressed when the baby unlatches.
  • Voiding and stooling are appropriate for age (after day 4: minimum of 3 stools and 6-8  wet diapers/day)
  • The baby spontaneously unlatches and is satiated (open hands and relaxed arms)
  • Weight gain of ½ to 1 oz (15-30 grams) per day and back to birth weight by 10-14 days

What to Do For Sore Nipples

  • Wash hands first.
  • Air blocking products may increase the mother’s comfort.
  • First, apply breast milk to your nipples. Apply a thin coat of extra virgin olive oil, Aquaphor, Vaseline or virgin coconut oil.
  • Hydrogel pads may be used. Discard if they become cloudy and follow cleaning instructions. Nipple creams or oils should not be applied while using.

 

What to Do For Damaged Nipples– cracked/abraded/wounded:

  • Wash hands first.
  • Rinse nipple skin with clean water after every feed.
  • Rub breast milk in the nipple.
  • Apply a thin coat of Polysporin (topical Abx) non-neomycin-based to prevent infection (ensure thoroughly soaked in prior to feeding/pumping).
  • Avoid lanolin and hydrogels.
  • Lots of air exposure can help the healing process.

 

Engorgement

Engorgement describes the painful swelling that occurs when the breasts become overfull from failure to remove milk adequately or frequently enough.  The most common time for engorgement to occur is in the early days postpartum when breastfeeding is beginning and feeding patterns are irregular.

  • Normal fullness usually occurs between 3-5 days after delivery. Some mothers’ breasts get very hot, hard, and swollen.
  • Frequent feedings will help minimize engorgement. It is recommended that you breastfeed your infant, 8-12 x in 24 hrs. Keep your baby close and watch for hunger cues.
  • If you miss any feedings or have difficulty latching, you may want to use a pump to express your milk.
  • Apply a cold compress to the breast for no longer than 15-minute intervals. If cold compresses are kept on too long this could increase swelling.
  • The use of green cabbage leaves to the breasts for about 5-10 minutes may help with swelling as well. Leaving cabbage on too long without a break can lower your milk supply.
  • Typically heat will make swelling worse, but it is recommended if you cannot get your milk to letdown before feeding or pumping. You may use a warm compress for 5-10 minutes before nursing.
  • Use gentle breast massage before and during breastfeeding. Massage different areas of your breast in a circular motion. You can also massage from your breast towards your armpit to help remove lymphatic fluid which contributes to swelling.
  • If your infant is not latching, try pumping to remove some milk and then attempt to latch.
  • Renting a hospital-grade pump or purchasing an electric top-of-the-line pump is recommended over a hand pump.
  • Try to avoid bottles and pacifiers as it may cause nipple and flow confusion/preference.

If your symptoms do not improve in 24-48 hours or worsen, notify your Lactation Specialist or MD.

 

Proper Handling and Storage of Breast Milk

  • Be sure to wash your hands before expressing or handling breast milk.
  • When collecting milk, be sure to store it in clean containers, such as screw cap bottles, hard plastic cups, with tight caps, or heavy-duty bags.
  • Clearly label the milk with the date it was expressed to facilitate using the oldest milk first.
  • Do not add fresh milk to already frozen milk within a storage container.  It is best not to mix the two.
  • Do not save milk from a used bottle for use at another feeding time.

Safely Thawing Breast Milk

  • As time permits, thaw frozen breast milk by transferring it to the refrigerator for thawing or by swirling it in a bowl of warm water.
  • Avoid using a microwave oven to thaw or heat bottles of breast milk.
  • Excess heat can destroy the nutrient quality of the expressed milk.
  • Do not re-freeze breast milk once it has been thawed.

 

Human Milk Storage Guidelines

Location Temperature Duration Comments
Freshly expressed breast milk Countertop
25°C (77°F) or colder
(room temperature)		  

Up to 4 hours

 

  

Containers should be covered and kept as cool as possible

 
Refrigerator Refrigerator 4°C (39.2°F) Up to 4 days  

Store milk in the back of the main body of the refrigerator

 
Freezer

Deep Freezer

 18°C (0°F) or colder

-20°C (-4°F)

 3-6 months

6-12 months

  

Store milk toward the back of the freezer where the temperature is most constant

 
Insulated cooler bag 15°C (59°F) 24 hours  

Always keep icepacks in contact with the milk containers, limit opening cooler bag

 

 

Reference: Academy of Breastfeeding Medicine. (2017). Clinical Protocol # 8: Human Milk Storage Information for Home Use

for Healthy Full-Term Infants.

Centers for Disease Control and Prevention. (2017). Proper Handling and Storage of Human Milk.

 

Expected Milk Intake and Associated Voids and Stools

 

Days of Life Volume of Breastmilk per feed Minimum wet diapers Stool Characteristics
1 5-15 mL 1 1 black tarry stool (meconium)
2 15-20 mL 2 1-3 dark blackish brown or green stools
3 20-40 mL’s (1oz) 3 Transitioning stools: softer and more green/brown
4 40-50 mL’s (1.5oz) 4 3-5 transitioning stools of seedy yellow stools
5 45-75 mL’s (1.5-2.5oz) 6 3-5 transitioning or seedy yellow stools
6 and up

(until 1 month)

 60-90 mL’s (2-3oz) 6 3-8 loose yellow stools

 

 

  • During the first 2 weeks, the minimum daily suckling time should be at least 150 – 180 minutes (2.5 – 3 hours). Watch for signs of hunger: frequent crying, restlessness, irritability, sucking hands or fingers, detaching from the nipple frequently, falling asleep without releasing the breast, or moving the head while feeding. Also, a very long feeding (more than 30 minutes), or short feedings (less than 5 minutes), may indicate a milk supply problem or ineffective milk transfer.
  • Estimate your baby’s daily breast milk or formula requirements by using this formula:
    • Baby’s weight in kilograms (kg) multiplied by 100. Divide by the number of feedings in a 24-hour period (at least 8). Then multiply by 20. This will give you the number of ounces required per feeding.
    • Example: 7lb 8oz baby is 3.40 kg. Multiply by 100 is 340. Divide by the number of feedings in 24 hours, so 340 divided by 8 is 42.5. Divided by 20 is 2.125. So, a little over 2oz per feeding. You can multiply the ounces by 30 to figure of the number of mLs per feed. This would be ~64mL per feed.
  • Pump when your breasts are full (prior to a feeding), you can feed this pumped milk to your baby via spoon, syringe, or bottle. At the next feeding, feed your baby at the breast first. Pump after breastfeeding to see how much milk volume is left after the baby has had a successful feed, ~20-30 minutes. This will give you an estimate of the total milk volume per feeding.
  • Breast milk must be removed frequently (at least every 2 – 4 hours) for your body to keep up with your baby’s demands. If your baby is not going to the breast, pump or use hand expression to sufficiently remove milk and maintain your milk supply. Make sure pumping is comfortable and that your flanges fit correctly.
  • Most newborns lose an average of 8% of their birth weight in the first week of life. Most will regain their lost weight by 2 weeks old. We expect an average of ½ – 1oz of weight gain per day after your “milk comes in” (usually between days 3 – 5).