Your beautiful baby has been born, and now you step into the mysterious realm of parenting a newborn – the biggest step in life most of us take. More than likely, your focus has been your pregnancy – staying healthy, counting off the months, wondering what this new little person looks like… But now, it’s time to get down to business of caring for this precious little person who will depend on you for everything for a while. We begin with breastfeeding your newborn.

What is breast milk?
Most of us didn’t grow up in a culture where nursing babies are everywhere, nursing openly where we could watch and learn. Because we didn’t have that opportunity to learn, as we grew from little girls and boys to women and men, it can be a bit daunting to look at our newborns and wonder where to start. How does this whole process of breastfeeding work? How does the body make this wonderful milk that will sustain a baby for many months? What’s so special about our milk versus other baby milk?

Actually, a woman’s body is preparing to make milk during pregnancy. The first milk, called colostrum, is present by the fourth to fifth month of pregnancy. Colostrum is a thick, yellowish pre-milk that is high in immunoglobulins (anti-infective agents that coat the intestines to protect against bad bacteria), antibodies (baby’s first “immunization”) and is a laxative that cleans out the tar-like stool, meconium, in the first few days. The concentration of other components helps to prepare the newborn’s intestines for digestion.

Transitional milk and engorgement
Usually around day two to five days after your baby is born, the breasts begin to feel firmer, warmer and perhaps a bit tender and this signals the shift from colostrum to the transitional milk. The milk begins to increase in volume, it becomes more liquid, the color of the milk begins to change and the composition of the milk also shifts, providing the perfect food for the newborn human infant. But breastmilk is more than food because it also contains hormones, enzymes, growth factors, stem cells, white blood cells, beneficial bacteria; more than 200 components have been identified, all important for the growth and development of our babies!

During the time when the breasts begin to produce transitional milk, some, but not all, mothers experience engorgement – the breasts become very firm and uncomfortable. This usually can be avoided by nursing as soon as possible after birth and often after that. Relieving this engorgement is important, not only for comfort, but also for preserving good milk production. If, for some reason, baby is not nursing well, a hospital grade pump should be used in addition to nursing. Frequent nursing is important to give the breasts the signal to make more milk. This is not the time to worry about over-stimulating the production. If you are nursing often and the engorgement still occurs, cold packs on the breasts for 15-20 minutes before nursing may reduce discomfort and the swelling. In addition, some mothers find relief by using chilled cabbage leaves on the breasts, changing them when the leaves wilt. Heat on the breasts for one to two minutes immediately before nursing may help the milk to flow.

How much milk do our babies need?
In order to provide plenty of milk for our babies as well as to provide frequent physical contact, our babies, as newborns, typically nurse eight to twelve times per 24 hours. Some babies are more alert and aware and wake themselves often to feed. Others are a bit sleepy in the first two weeks and might need to be nudged to nurse often in the beginning. These sleepyheads usually begin to wake themselves by the end of the second week.

So how much milk do our babies need? In the first 24 hours, newborns take an average of one ounce in the whole first 24 hours – so tiny amounts. In the second 24 hours, that amount increases to about an average of two ounces per 24 hours. By day three the average intake is about one ounce per feeding or eight to twelve ounces per 24 hours. By day four the amount increases to one and a half to two ounces per feeding and ultimately, by the third week, some babies take in as much as twenty-five ounces per 24 hours.

You’ll know your baby wants to nurse if he is rooting around on your (or your partner’s) chest, putting his hands to his mouth, making smacking motions, is actively moving his arms and legs. This is the time to offer the breast – crying is the late stage signal that he is hungry – no need for him to get upset to tell you he’s hungry – watch for his early feeding signals. After nursing, if he has taken the amount of milk he needs and wants, his body will usually relax and he will appear peaceful and content.

Counting his wet diapers and bowel movements is a rough way to see if he is getting enough milk, but the most reliable way to know is to see if he is gaining weight. Most babies up to about 3 months of age will gain about one ounce per day. While it is normal for babies to lose about 7% of birth weight in the first three to four days of life, they begin to gain soon after the transitional milk comes in and regain to birth weight in the first seven to ten days. If a baby is not back to birth weight by two weeks, it’s important to investigate. (Recent research has determined that excessive IV fluids must be accounted for when determining infant weight loss in the first 24 hours).

Getting professional help
If you need to find breastfeeding help, contact the postpartum floor of your hospital to see if there is an outpatient lactation clinic available; ask your pediatrician or obstetrician for a referral to an International Board Certified Lactation Consultant (IBCLC); or log on to www.ILCA.org.

For help from a professional lactation consultant or volunteer, contact La Leche League (www.LLLI.org) for assistance from a La Leche League Leader. WIC and non-WIC mothers can get assistance by calling the Lactation Care Center on N. Stemmons – (214)670-7222.