The Early Days

What to Expect in the First Few Days

The early days of parenting and learning to breastfeed are both exciting and challenging. Learning to breastfeed is new for both mothers and their babies. With patience and time you will find you start to get the hang of it, but for many women this does not occur instantly and it takes a few days and for some even weeks before breastfeeding runs smoothly.

Some of the reasons for this are:

Mothers are unsure of the amount of milk they are making. A mother’s milk goes through many changes in the first week. Mothers may notice changes in the volume of milk in the breasts and the colour of her milk over time.

Refer to the section The Breast Makes Milk on the How to Breastfeed page for information on colostrum (the first milk in the breast) and how the milk changes over the first week to mature milk (which is higher in volume). Due to these changes, mothers will notice changes in the amount of milk and fullness of their breasts. Some mothers may experience engorgement during the early days as the breasts work to determine how much milk the baby needs. Refer to the Engorgementsection on the Common Concerns page if this is an issue you are experiencing. Be sure to refer to this section if you think you are engorged as it is important that mom is comfortable and that the breasts are not overly full.

Many parents are unsure of how to know the baby is getting enough breast milk.

Although you cannot see the volume of milk the baby is drinking, you will be able to determine that your baby is getting all the colostrum he/she needs in the early days by monitoring wet and dirty diapers. The volume of milk and number of wet and dirty diapers will increase over the first week. In this section, you will find a feeding chart which you can use to track this information. A baby who is breastfeeding well will have energy and will actively feed at the breast. A very sleepy baby may not be getting enough, as they may not have the energy to feed and may fall asleep at the breast.

Mothers may have some initial sensitivity and discomfort as they are learning to breastfeed.

Mothers may have some initial sensitivity and discomfort as they are learning to breastfeed. For many mothers they feel new sensations while breastfeeding. These are usually noticed at the beginning of the feed. It may be related to the nipple stretching or feeling the milk “letting down” during the milk ejection reflex. For most mothers this improves with each breastfeed over the first few days. Refer to the section on How the Baby Latches, Suckles, and Drinkson the “How to Breastfeedpage for information on latching your baby comfortably. Additional information which may be helpful can be found in the Breastfeeding Positions section in the How to Breastfeedpage. If you are experiencing sore nipples be sure to refer to the Sore Nipples section on the Common Concerns page. As well, if you are having difficulty be sure to contact your local health unit or see a lactation professional in your area. Refer to the Getting Help page to find a professional near you.

Leaking breast milk may occur while breastfeeding is being established and this often decreases and stops over time.

It is common for the breasts to leak milk in the early days. Some women may notice leaking before a feed or from the breast not being suckled during a feed. As well, just hearing a baby cry may cause the “the milk ejection reflex” and leaking in some women. When the mature milk comes in over the first weeks, the breast is trying to determine how much milk the baby needs. Over time, as the lactation system matures, many women notice the leaking stops. This is not related to milk supply but is a sign the breast is beginning to know how much milk to make for your baby. If you experience leaking, breast pads may help keep you comfortable. See the Things to Consider section on the “Everyday Life page for information on breast pads. You will want to change the breast pads frequently if you find you are experiencing leaking, as the moist breast pads may contribute to the development of thrush at the breast. See the Thrush section on the Common Concernspage for more information.

Some parents have difficulty determining how often to breastfeed their baby and if they should wake them up to breastfeed.

Many parents are unsure if they should let their baby sleep or wake the baby up for feeds in the first days. Responsive cue-based feeding is suggested for breastfed babies, this refers to watching your baby for feeding cues and feeding your baby when he shows signs of hunger. Most babies will feed 8 or more times in 24 hours which includes day and night feeds.

When to wake your baby for feed:

In the first days, many babies will not wake on their own as they are tired and adjusting to the world outside of the uterus. For this reason it is suggested that if a baby does not wake on his own within 2-3 hours after breastfeeding, all parents should wake their babies. Parents may also have to work to keep their baby awake during feeds. Breast compressions during feeds can be helpful in keeping your baby actively feeding at the breast. To learn how to do breast compression, please watch this video.

When to use responsive cue based feeding:

Responsive cue based feeding can occur when the baby is waking on his own at least 8 times in 24 hours (every 2-3 hours) the baby cues to feed, stays awake at the breast, and shows signs of satisfaction after feeds the baby is having the number of wet and dirty diapers expected for his age (days old) the baby is gaining weight. For more information on responsive cue based feeding, refer to the section “Reading Babies Cues”.

The baby may cluster feed and may seem to be feeding “all the time” or for hours at a time.

During the early days there is colostrum in the breast. This milk is very nutritious. It comes in smaller quantities, is thicker and removed slower from the breast than mature milk. For this reason, it may seem that babies feed more frequently during the first few days. This frequent feeding may be referred to as cluster feeding. This can also occur during growth spurts as the baby gets older. With cluster feeding, the frequent breast simulation helps increase a mother’s milk supply. Refer to the The Breast Makes Milksection on the How to Breastfeedpage for more information.

Mothers need rest as they are recovering from birth and getting their breastfeeding established.

The early days can be overwhelming for many new mothers. Be sure to rest and relax with your baby. Refer to the Supporting Mom page for tips on how friends and family can help. It is normal for mothers to experience a variety of emotions in the first few days. Refer to the Feeling Down section on the Everyday Life page if you are feeling down, stressed, or overwhelmed. Remember to take care of yourself and ask for help from others as you rest, recover, and learn to breastfeed.

Getting off to a Good Start

You can help your baby learn to breastfeed by using these key skills right from the start:

  • Holding your baby skin-to-skin often.
  • Practice baby-led latching.
  • Respond to your baby’s cues.
  • Breastfeed early after birth and breastfeed often.
  • Learn how to hand express colostrum.
  • Avoid soothers and bottles, which may affect the baby’s suckle.

Here is a video to watch on breastfeeding in the first few hours.

Please contact your local health unit for more information on breastfeeding services and resources.

Responding to Baby Cues

Responsive Cue-based Feeding

Breastfeed your baby early after birth and often. Most babies will feed at least 8 times in 24 hours. Watch for and follow your baby’s cues. Your baby will tell you when he is ready and eager to feed. Your baby will show some signs called “feeding cues.”

This image is used with permission from Best Start by Health Nexus.

If your baby shows late feeding cues, it is time to calm your baby before feeding him.

At the start of the feed, your baby will have shallow and quick sucks. When your milk starts to flow, the sucks will become deep and slow. You will notice a pause during the suck when your baby’s mouth opens the widest. Your baby will drink milk during this pause and you will probably hear or see his swallowing.

To view a chart depicting what baby’s feeding cues look like, click here.

Learn How to Hand Express

Hand expressing colostrum or breast milk is important because it helps you to:

  • Express a few drops of milk to get your baby interested in latching.
  • Gently rub a few drops of milk into your nipples to prevent soreness.
  • Soften your breasts near your nipples before latching the baby if your breasts are very full.
  • Make your breasts comfortable if they are full and the baby is not feeding.
  • Express milk for your baby if you are going to be away from him or need to feed him other than directly at the breast.

Hand Expression is a painless, convenient way of removing milk from the breast. You can practice expressing breast milk as soon as your baby is born or even a week or two before your baby is born. In the first 2 to 3 days after birth, you will get a small amount of colostrum, maybe 5 to 10 ml (1-2 teaspoons) or less. Colostrum, a yellowish fluid, is the first milk. It is important for your baby to get your colostrum because it helps your baby’s immune system. It is also very rich in nutrients.

To express colostrum for your baby:

  • Wash your hands well.
  • Find a place where you are comfortable and relaxed.
  • Gently massage your breasts from the outside towards the nipple. Roll your nipple between your fingers.
  • Hold your breast with one hand, not too close to the nipple. The thumb and fingers of your hand should be opposite each other and about 2 ½ to 4 cm (1 to 1½ inches) back from your nipple. Lift your breast slightly and gently press the breast in towards your chest.
  • Lightly compress your thumb and fingers together in a rolling motion towards the nipple.
  • Relax your fingers for a couple of seconds then repeat the same motion. Do not squeeze the base of your nipple, as this will stop the flow of milk.
  • Move around your breast so you are expressing from the entire breast. Continue this until the flow of milk has completely stopped. You may want to switch hands and switch from one breast to the other.
  • Collect the milk on a teaspoon or in a container with a wide mouth if your baby has not latched on and fed. You can then feed your baby the colostrum using a cup or spoon.
  • Ask your health care provider, hospital nurse, or public health nurse to show you how to do this. If necessary, your partner can help you hand express.

If you are separated from your baby after birth or if your baby is not able to breastfeed right away, it is important to establish and maintain your milk supply. If your baby is not taking milk directly from your breast, you can establish your milk supply by hand expressing or pumping. You should remove milk as many times as your baby would feed, at least 8 times in 24 hours.

Below is a graphic on how to hand express:

Click here for a video on hand expression.

Please review the Expressing & Storing Breast Milk Fact Sheet provided by Best Start for more information.

How to Know if your Baby is Getting Enough

Signs your baby is getting enough milk…

  • Your baby feeds at least 8 times every 24 hours.
  • Your baby cues to feed, stays awake while feeding, and is full and relaxed after feeds.
  • Your baby has enough wet and dirty diapers according to his age.
  • Your baby is active and energetic and has a strong cry.
  • Your baby will find your nipple. He may touch it with his hands first.
  • Your baby has a wet, pink mouth, and bright eyes.

If you unsure of when to get help, please visit the When to Get Help section on this page. For assistance in increasing milk supply, please view the Not Enough Milk section within Common Concerns.

Monitoring Diapers

Although you cannot see the amount of milk the baby drinks, you can see what is coming out, so tracking wet and dirty diapers is a great way to see how much milk your baby is getting.

To make sure your baby is getting enough milk, keep track of the number of wet and dirty diapers in a 24¬hour period.

  • In the beginning, it can be hard for new parents to know if their baby has a wet diaper. A very wet diaper is heavier than a dry diaper. If you want to know what a very wet diaper feels like, pour 30 ml (2 tablespoons) of water on a dry diaper. Your baby’s urine (pee) should be clear or pale yellow, and it should have no smell. If a dirty diaper is heavy, count it as both a wet diaper and a stool (poo).
  • After baby is 2 days old expect your breastfed baby to have 3 or more large, soft, usually seedy poops per day. By three to four weeks, some babies will have only 1 – 2 poops per day. Some have one large poop every few days. This is normal as long as your baby is feeding well, seems content and their poops are soft.
  • If your baby does not have enough wet and dirty diapers for their age (see below), get help right away!

Here is a chart with information on monitoring wet and dirty diapers:

Monitoring Weight Gain

  • Most babies lose a bit of weight in the first 3 days after birth. From day 4 onward, most babies gain weight regularly. Weight is just one part of a larger picture of how a baby is doing.
  • During the first 3-4 months, your baby’s health care provider will check their growth regularly.
  • If your baby is gaining more slowly, be sure you are responding quickly to early feeding cues and wake your baby to feed if necessary. You can also use breast compressions and have your baby feed from both breasts more than once (switch nursing). After a feeding you can express some milk and feed the milk to your baby using a spoon, dropper or small cup.
  • Be sure to get help from your health care provider and have them watch a feeding so they can see your baby feeding.

Monitoring Growth Spurts

Babies have some days when they seem hungrier than usual. These times are called growth
spurts. When this happens, some parents worry that they do not have enough milk. There is no need to worry if your baby is growing and gaining well. Feeding your baby more often during this time will stimulate increased milk production to meet his growing need. The more you feed your baby, the more milk you will produce.

Skin-to-Skin

Skin-to-skin is a way of holding your baby that both babies and parents find enjoyable. The baby wears only a diaper and is held in an upright position on the mother’s or father’s bare chest.

A light blanket can be draped across the baby’s back. When babies are held skin-to-skin, they can hear their mothers’ or fathers’ heartbeat and breathing, and smell and feel their skin. This is familiar and comforting to babies.

Benefits of Skin-to-Skin

  • Stabilizes your baby’s heart rate, breathing, and blood sugar.
  • Keeps your baby warm through your body heat.
  • Promotes bonding and getting to know your baby.
  • Helps your baby to be calmer and cry less.
  • Helps you to be more confident and relaxed.
  • Helps the mother’s milk to flow and may improve milk supply.
  • Promotes a good latch. This means that the mother is less likely to develop sore nipples and the baby will get more milk.

Please view the following posters for more benefits and advantages of skin-to-skin contact. An alternative version in French is also available.

Remember to make sure your baby is warm when you remove him from your chest by using a blanket or dressing him appropriately.

Hold your baby skin-to-skin as soon as possible after giving birth. Hold your baby skin-to-skin for an hour or more and then, as long as you wish. As your baby grows, continue holding your baby skin-to-skin often and for long periods.

Every newborn baby undergoes painful procedures in the first hours and days of life as part of routine medical care. The good news is parents can make a difference. Researchers have found that parents can use breastfeeding and skin-to-skin to help comfort their newborns during these procedures. This helps keep both babies and their parents more comfortable.

Premature babies benefit from skin-to-skin. Sometimes this is called Kangaroo Care.

Fathers, partners or another person you are close to can also provide skin-to-skin care to comfort and nurture your baby anytime.

Safe Positioning for Skin-to-Skin Contact

  • Getting ready for skin-to-skin:
  • Take off you baby’s blankets and clothing. Leave a diaper on.
  • Move your clothing away from your chest and tummy.
  • Hold your baby, facing you, against your chest or tummy
  • Position yourself a little upright, not flat.
  • Position your baby so that your baby’s:
    • Face can be seen.
    • Head can move freely at all times.
    • Nose and mouth are not covered.
    • Head is turned to one side.
    • Neck is straight, not bent.
    • Shoulders are flat against you, chest to chest.
    • Arms are spread outward and not curled under the baby’s body.

In the first few days after birth when holding skin-to-skin, watch your baby’s face. See that the colour remains normal, breathing is regular, and baby reacts to your touch.

For safe sleep, if you are feeling sleepy and no one can watch you and your baby, put your baby in their own crib, positioned on their back.

Avoid swaddling or tightly bundling your baby. This can prevent them from showing you feeding cues, can cause your baby to become overheated, and can increase the risk of problems with the development of baby’s hips.

Burping Your Baby

A breastfed baby does not swallow much air. It is still a good idea to try to burp your baby.
Some babies fuss if they need to burp. Watch your baby to see how often they need to be burped.
• Some babies need to be burped during a feeding and again at the end.
• Some babies burp on their own, while feeding or when they are done.
• Some babies may not burp every time.
• Some babies spit up after feedings. As long as your baby appears content and gains weight
as the weeks go on, don’t worry about spitting up mouthfuls of milk.

To burp, simply hold your baby in a position which supports their head and bottom. Hold them upright and gently pat their back. A bubble of air can come up more easily if their back is straight.

This image is used with permission from Best Start by Health Nexus.

When to Get Help

Breastfeeding is natural, but it can take time to learn. There are times when you may need to get help from a professional.

Be sure to get help right away if you notice any of these signs:

  • Your nipples or breasts hurt.
  • You have a fever or feel sick.
  • Your baby reaches 4 days of age and is having fewer than 6 very wet diapers or is having fewer than 3 poopy diapers in 24 hours
  • Your baby is having black poops after they are 4 days old.
  • Your baby is very sleepy and always has to be woken up to eat.
  • You are thinking about weaning.
  • You are feeling worried about breastfeeding.
  • You are worried about yourself or your baby for any reason.

For breastfeeding resources and help in your area visit: OntarioBreastfeeds.ca

Click here to visit our Getting Help page for more details.