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What to Expect During the Early Weeks of Breastfeeding

Breastfed newborns should latch on correctly to both breasts and suck rhythmically for at least ten minutes per breast at each feeding. By the time you arrive home, you should be comfortable latching your baby on to each breast. It's not uncommon for a baby to prefer one side or to have an easier time latching on to one breast. However, you need to keep trying to get the baby to take both breasts well. Unsuccessful attempts to nurse don't count as a feeding.

Once your baby is latched correctly, allow her to suck for as long as she wants. She may pause periodically and need some gentle prodding, but, in general, she should suck rhythmically throughout most of the feeding. Allow her ample time at the first breast to help assure that she gets the rich, high-fat hindmilk. She'll probably start sucking less vigorously, fall asleep, or come off the first breast after ten to fifteen minutes. This is a good time to burp her, change her diaper, and help arouse her to take the second side. A baby usually obtains more milk by nursing at both breasts than by taking one side only. Thus, it's generally preferable to nurse from both breasts at each feeding whenever possible. Allow her to stay at the second side as long as she wants, although a baby may nurse only five minutes at this breast, which will probably be less well drained than the first. An infant nurses more vigorously at the first breast and usually takes more milk from that side. Thus, you should alternate the side on which you start feedings, so both breasts receive about the same stimulation and emptying. A lopsided milk supply can develop in a matter of days if you consistently start feedings on the same breast.

WHEN TO SEEK HELP: If your baby is unable to latch on to one or both breasts or latches briefly but does not suck effectively, try the these strategies. If these techniques don't remedy the problem promptly and allow your baby to start feeding well, seek assistance right away. It's not only distressing and frustrating to have a newborn who doesn't feed well, but it can place your baby's welfare at risk. Furthermore, if your breasts don't get drained sufficiently, they can become uncomfortably engorged, and your milk supply may be jeopardized. Don't allow your baby to miss feedings and don't allow your breasts to go without regular stimulation and removal of milk. If the latch-on problem can't be remedied quickly, your baby will need to be fed by another method until she learns to breastfeed effectively. In addition, your breasts will need to be pumped at regular intervals in order to keep your supply from declining. The expressed milk can be fed to your baby.

Both very short or extremely long nursing sessions can signal a feeding problem. If a baby suckles too briefly (less than ten minutes per feeding), she probably won't receive enough milk. On the other hand, if nursings last more than about fifty minutes, or if your baby often seems hungry again shortly after feeding, it could mean that she is not being satisfied. Infants who need to nurse almost continually may not be obtaining adequate volumes of milk. The problem can be due to either ineffective breastfeeding technique or low milk production. Often it is a combination of both. Contact your baby's doctor and have your infant weighed promptly.

Breastfed babies should swallow regularly while nursing. A baby first starts nursing with short, fast bursts of sucking. As milk flow begins, the sucks get longer and slower. Swallowing is triggered when the mouth fills with milk. Before your milk comes in abundantly, your baby may not swallow often during nursing, as the volume of colostrum is rather low. Once your milk starts increasing in volume (usually on the second to fourth day), you should start to hear your baby swallow after every one or two sucks. Swallowing is indicated by a soft "kaa, kaa, kaa" sound when a baby exhales. When your milk ejection reflex is triggered, your baby may swallow after every suck in order to handle the rapid flow of milk. You should hear suck, swallow, pause, suck, swallow, pause. Audible swallowing after every couple of sucks should continue for about ten minutes. As milk flow slows down, the frequency of swallowing will decrease. When your baby goes to the second breast, rapid swallowing should begin again. Other signs that your baby is getting milk include seeing milk in her mouth or dripping from the opposite breast while she nurses.

WHEN TO SEEK HELP: You should be concerned if you don't hear frequent swallowing when your baby nurses, especially when you have other reasons to suspect your baby isn't feeding well. Infrequent swallowing may be due to a low milk supply or ineffective sucking that prevents your baby from obtaining adequate milk. Signs that your baby is sucking incorrectly include opening and closing her mouth in rapid tremorlike movements, making a clicking sound or dimpling her cheeks while nursing, or frequently coming off the breast. Contact your baby's doctor if you think your infant is not swallowing much milk. The problem needs to be remedied quickly.

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From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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