Breastfeeding Basics for New Families

During the first few days after your baby is born, breastfeeding can be daunting and confusing. Many new parents are haunted by questions of whether their baby is getting enough milk and "are we doing it right?" Successful breastfeeding relationships are establish in an atmosphere of trust, support and knowledgeable guidance.  Harmony at Home is here to help if you have any questions or problems.

Here are some of our basic guidelines to keep in mind for the first few weeks.

Whether or not baby is getting enough milk is one of the most common concerns of new moms. Since we don't have measurement markers on our breasts, we can't initially "see" that our babies are really getting the milk they need. You can tell baby is getting enough milk, however, by keeping track of dirty diapers, weight gain, and appearance.

Diapers Counting your baby's diapers can be a helpful indicator as to whether or not he is getting enough of your milk. baby's age mother's milk wet diapers/24 hrs dirty diapers/24 hrs 1-2 days colostrum (provides immunities and helps with jaundice) 1-2 greenish-black tarry meconium 2-6 days milk "comes in"; bluish color 5-6 wet disposable diapers (6-8 wet cloth diapers) At least 3 greenish transitional stools 6+ days milk supply adjusts to suit your baby's needs Same as 2-6 days At least 3-5 very loose stools; bright yellow color that are about 2.5 cm 6 weeks milk supply established Same as 2-6 days Some babies switch to less frequent but large bowel movements

Signs of poor feedings

• Feeling pain during feedings
• Sleepy baby
• Inconsistent, flutter (weak) sucking
• Difficulty latching-on and staying on
• Clicking or popping sounds in your baby’s mouth
• Prolonged nursing (more than 20-25 minutes on each side)
• Infrequent nursing (baby does not wake to feed at least every 3 hours)
• Frequent nursing (more than 12 per day)
• Baby is not satisfied at the end of the feeding
• Engorgement
• Inadequate wet diapers and stools
• Rapid or excessive weight loss (more than 7-10%) during the first few days
• Has not regained birth weight by 2 weeks
• Slow weight gain thereafter (less than 1/2 – 3/4 oz per day)

Signs of good feedings

• Feeling a deep, strong pulling sensation without sharp pain
• Consistent sucking with only brief pauses
• Hearing swallowing (after the milk comes in)
• Latch-on is easy
• 15-20 minutes of vigorous sucking per breast (20-30 minutes for one breast feedings)
• Breasts are softer after the feeding
• Seeing milk in your baby’s mouth
• Feeling a let-down reflex or seeing a change in the baby’s feeding rhythm
• Adequate wet diapers and stools
• Minimal weight loss during first few days
• Regain birth weight by 2 weeks and gains ¾ to 1 oz thereafter

Breastfeed Often

A baby needs to breastfeed frequently. Your milk is digested quickly and easily, sometimes in as little as 60 minutes, and small amounts are perfect for baby's tiny stomach. These frequent feedings also help to establish your milk supply. In simple terms, the more milk that is removed from your breasts, the more milk your body will produce. Frequent feedings are good for both of you!  Keep in mind that some babies "cluster nurse," which means that they nurse very often for a few hours and then sleep for several hours. The number of feedings in a 24-hour period is more important than the spacing of feedings.  A sleepy baby may need to be wakened every two to three hours to feed, particularly if he has jaundice. Talk with your health care provider if baby is lethargic and difficult to wake for feedings.

Watch Baby, Not the Clock
Watch your baby for signs of hunger, not the clock. Follow baby's feeding cues and do not try to schedule feedings or limit feedings. Early hunger cues include:

Baby opening his mouth and moving his head side to side (known as the rooting reflex).
Baby making sucking motions with his mouth.
Baby begins to chew or suck on his hands or fingers.

Don't wait for your baby to cry to let you know he is hunger. Crying is a very late hunger cue.

Increasing Your Supply

Mothers throughout the ages have been able to produce plenty of milk for their babies. In certain situations because of a health problem or other complication, a mother may have a reason to be concerned and may need to carefully monitor her baby's weight gain in order to be sure he is getting enough milk. If baby is not gaining well or he is losing weight after the first few days, contact baby's health care provider. Slow weight gain may indicate a serious health problem. If you're concerned about your milk supply, get help. Being in touch with a Postpartum Doula, La Leche League Leader, or Lactation Consultant can often provide the information, support, and encouragement that mothers need to be reassured that they are providing plenty of milk for their babies. 

Steps that will help your baby get as much of your milk as possible include:

Nurse often for as long as your baby will nurse. The more milk that is removed from the breast, the more milk the breast will make to replace it. Frequent breastfeeding helps to establish a plentiful milk supply. A sleepy baby may need to be awakened and encouraged to nurse more frequently. A baby who nurses for excessively long periods may not be nursing efficiently.

Offer both breasts at each feeding. This will ensure that your baby gets all the milk available and that both breasts are stimulated frequently. Allow your baby to indicate he is finished on the first breast, then offer the other breast.

Check baby's positioning and latch. Breastfeeding should not hurt. Hold baby close with his whole body facing you so he does not have to turn his head. When he opens his mouth wide, his head should be slightly tilted back with his nose at the level of your nipple. As he approaches the breast with his head slightly tilted back, this will bring him to the breast chin first. This will help you better aim his lower jaw so that he covers more of your breast with his lower jaw than with his upper mouth. As you bring baby onto the breast, aim your nipple toward the roof of his mouth. If you feel comfortable and baby is nursing actively, the latch is good.

Try breast compression to keep your baby interested in breastfeeding. Squeeze the breast firmly with your thumb on one side and fingers on the other to increase milk flow. Keep squeezing until baby is no longer actively sucking, then release. Rotate fingers around the breast and squeeze again. Then switch to the other breast, using both breasts twice at each feeding. Squeeze firmly but be careful not to cause injury to your breast tissue.

Feed your baby only your milk. If your baby has been receiving formula supplements, do not cut these out abruptly. As you improve your breastfeeding techniques with the help of a lactation professional, and as your milk supply increases, you will be able to gradually reduce the amount of supplement. Monitor baby's weight gain and stay in touch with your baby's health care provider during this transition.

All your baby's sucking should be at the breast. If some supplement is necessary, it can be given by spoon, cup, or with a nursing supplementer. Be aware that a pacifier can create more problems than it solves. If you decide to give your baby a pacifier, wait until he is nursing effectively and gaining well.

Use skin-to-skin contact. It may encourage your baby to nurse more often. Skin-to-skin means that baby will be nestled upright between your breasts, clad only in his diaper directly against your skin. Your warmth, smell, and heartbeat will also soothe baby, which in turn aids in his development.

Try to relax. Paying attention to your need for rest, relaxation, and proper diet will help your milk supply and improve your general sense of well-being.

Talk to your health care provider about diet, medicinal herbs or prescription medications to increase your milk supply.



If you have concerns...

Some mothers think their babies are not getting enough milk when they are actually getting plenty of milk. Some "false alarms" that worry mothers include:

Your breasts feel different. If your breasts suddenly feel softer or your breasts no longer leak between feedings, it does not mean that you are producing less milk; it simply means that your supply has adjusted to your baby's needs.

Baby seems fussy. Many babies have a fussy time every day that is not related to hunger. Some babies need lots of stimulation and activity; others need soothing. You will learn how to respond to your baby as you find the ways that comfort him. If your fussy baby settles down when you offer him the breast, go ahead and breastfeed. But don't take this as a sign that he is not getting enough to eat.

Baby suddenly wants to feed more often, or seems hungry again soon after being fed. Babies often go through "growth spurts" when they are two to three weeks old and again at six weeks and three months. At these times, breastfeed as often as possible as your supply catches up with baby's demand.

Baby decreases his nursing time, perhaps down to five minutes or so at each breast. As babies get older, they become very efficient at taking the milk so this is a positive sign that breastfeeding is going well, not something to worry about.

La Leche League Leaders are accredited volunteers who are available to help with breastfeeding questions in person, over the phone, or online. Locate an LLL Leader near you at www.llli.org.

Please be aware that the information provided is intended solely for general educational and informational purposes only. It is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician for any questions you may have regarding your or your infant’s medical condition. Never disregard professional medical advice or delay in seeking it because of something you have received in this information.

Breast Milk Storage 101 - Safe handling of human milk

Breast milk handling and storage can be confusing. Follow these practical guidelines for safe handling of your expressed milk.

What kind of container should I use to store expressed breast milk?

Before expressing or handling breast milk, wash your hands with soap and water. 

Store expressed milk in a clean, capped glass or hard plastic container (long term storage).

You can also use special plastic bags designed for milk collection and storage. Keep in mind that breast milk storage bags aren't recommended for long-term storage; certain components of breast milk might adhere to the soft plastic bags during long-term breast milk storage, which could deprive your baby of essential nutrients.

Don't store breast milk in disposable bottle liners or plastic bags designed for general household use.


What's the best way to store expressed breast milk?

Using waterproof labels and ink, label each container with the date you expressed the breast milk. If you're storing expressed milk at your baby's child care facility, add your baby's name to the label. 

Place the containers in the back of the refrigerator or freezer, where the temperature is the coolest. If you don't have access to a refrigerator or freezer, store the milk in a cooler or insulated bag until you can transfer the milk to the refrigerator or freezer.

To minimize waste, fill individual containers with the amount of milk your baby will need for one feeding. You might start with 2 to 4 ounces, and then adjust as needed as your baby grows. Also consider storing some smaller portions — 1 to 2 ounces — for unexpected situations or delays in regular feedings. 

Breast milk expands as it freezes, so don't fill containers to the brim.


Can I add freshly expressed breast milk to already stored milk?

You can add freshly expressed breast milk to refrigerated or frozen milk you expressed earlier in the same day. Be sure to thoroughly cool the freshly expressed breast milk in the refrigerator or a cooler with ice packs before adding it to previously chilled or frozen milk. 

Don't add warm breast milk to frozen breast milk because it will cause the frozen milk to partially thaw.

Keep milk expressed on different days in separate containers.

How long does expressed breast milk keep?

In general, we recommend following the "rule of four's" for breast milk storage.  4 hours, 4 days, 4 weeks, 4 months.

Room temperature. Freshly expressed breast milk can be kept at room temperature for up to 3-4 hours. If you won't use the milk that quickly or the room is especially warm, transfer the milk to an insulated cooler, refrigerator or freezer.

Insulated cooler. Freshly expressed breast milk can be stored in an insulated cooler with ice packs for up to one day. Then use the milk or transfer the containers to the refrigerator or freezer.

Refrigerator. Freshly expressed breast milk can be stored in the back of the refrigerator — not the door — for up to 4-7  days.

Freezer. Freshly expressed breast milk can be stored in a standard refrigerator freezer for up to 3-4 weeks and in a chest/deep freezer for up to 4-6 months. Place the milk in the back of the freezer — not the door.

Keep in mind that storage guidelines might differ for preterm, sick or hospitalized infants.


How do I thaw frozen breast milk?

Thaw the oldest milk first. 

Place the frozen container in the refrigerator the night before you intend to use it. 

You can also gently warm the milk by placing it under warm running water or in a bowl of warm water. 

Before offering the milk to your baby, gently swirl it to evenly distribute the creamy portion of the milk that rises to the top of the container during storage. Don't vigorously shake the container or stir the milk.

Never thaw frozen breast milk at room temperature, which enables bacteria to multiply in the milk. 

Don't heat a frozen bottle in the microwave or very quickly on the stove. Some parts of the milk might be too hot, and others too cold. Some research suggests that rapid heating can affect the milk's antibodies as well.

Use thawed breast milk within 24 hours. Discard any remaining milk. Don't refreeze thawed or partially thawed breast milk.

Does thawed breast milk smell or look different from fresh breast milk?

The color and consistency of your breast milk might vary, depending on your diet. Also, thawed breast milk might appear different than freshly expressed milk. It's still safe to feed to your baby. If your baby refuses the thawed milk, it might help to shorten the storage time.