Don’t worry that there is no milk at first. Colostrum is there and that is just what your baby needs for a good start. Expect your milk to come in within 36-72 hours after delivery. You will usually be aware the milk is there and you may be sore. This will pass with nursing, warm showers, and compresses. Remember, when the milk arrives, your baby’s nursing is what stimulates breast milk production. Interrupting nursing with supplements and pacifiers will delay breast milk production.

Take care of yourself. Eat well, drink plenty of fluids, and stay rested.

Open the baby’s mouth to ensure contact with the whole areola, not just the nipple.

Ask for help from the staff, doctors, and your family.

Feeding and preparation for feeding will occupy a lot of time with your baby over the first month. Once you have begun breastfeeding, it is helpful to establish a routine for getting ready to nurse. Prior to nursing, wash your hands, gather whatever you need during nursing (a beverage, burp cloth, reading material), and consider turning off your phone so you can nurse undisturbed.

It is important that you alternate the position used for nursing so you drain all the milk sinuses regularly. Properly distribute pressure on the areola and nipple to avoid soreness.

The following are common positions for breastfeeding:

• The Madonna: Traditional sitting position. Sit with the baby’s body across your abdomen, supporting her with the same arm as your breast.
• Cross-Cradle: Hold your baby across your lap, using the opposite arm to the breast she is feeding from to support her.
• Football Hold: With pillows positioned along the side of your body, hold your baby under your arm, much as a football player holds a football.
• Lying Down: Lie on your side with knees bent. Lay baby on his or her side facing you, bringing the face toward your breast. Use pillows for comfort or support if needed.
• Laid-back: Semi-reclined, with your baby lying across your stomach or shoulder.

Improper positioning of the baby at the breast is a major cause of nipple soreness. The baby should be held closely enough so the tip of the nose touches the breast. The chin should press against the breast as well. The mouth should be opened widely and positioned slightly below the center of the breast. This will result in the lower lip covering more of the areola than the upper lip. The baby’s mouth should cover much of the areola, not just attach to the nipple.

During the first few weeks, it is important to provide some support for the breasts during feeding. The preferred method of supporting the breast is the C-hold. Cup your free hand to form the letter C with your thumb on top and your fingers curved below the breast. You can then gently guide the breast so that the nipple is centered in the baby’s mouth. This technique helps keep the breasts from obstructing the baby’s breathing and is especially useful for large-breasted women.

If the baby is allowed to determine the length of the feeding, his or her mouth will gently release the nipple when finished. If you wish to remove your baby from the nipple before this occurs, break the suction by inserting your finger gently into the corner of your infant’s mouth and pressing your finger against your breast near the corner of the baby’s mouth. The nipple should then slip easily out of the baby’s mouth.

To produce equal amounts of milk in each breast, ensure that both breasts receive the same amount of stimulation. They must also be emptied regularly to avoid problems with plugged ducts, engorgement, or breast infections. Routinely offer both breasts at every nursing and alternate the breast you begin with at each feeding. Encourage your baby to take the second breast after burping and stimulation. If you end with the left breast at a nursing, begin the next nursing with the left breast.

After nursing, let your nipples air-dry. Moisture can lead to tender and sore nipples. You can pat the nipples dry with a soft cloth or leave the bra flap down for a few minutes. Air-drying is especially important if you plan to apply a lubricant such as lanolin, since this lubricant can trap moisture.

The supply of breast milk is determined by the amount of nipple stimulation that you receive from your baby. When the baby nurses frequently, there is greater nipple stimulation and greater milk production. Nursing makes milk. To help ensure that you have enough breast milk, nurse your baby frequently and offer both breasts at each feeding.

In the first few days, nursing times are generally short, about 10 to 15 minutes. Your baby may nurse only on one breast each feeding and then drift off to sleep. The second breast should be offered each time. As the days pass and your baby becomes more alert, nursing times usually increase. In general, feeding length should be determined by your baby’s needs. When the flow of milk diminishes from your first breast and the rich hind milk has been extracted, the baby will release the nipple. You can then offer the second breast and again permit sufficient nursing time for the baby to receive the hind milk.

Unlimited suckling time beginning directly after birth improves breastfeeding. There is no reason to restrict feeding frequency or duration when you first begin breastfeeding. Unlimited nursing time has been shown to help decrease breast engorgement for mothers and jaundice in babies. Some initial nipple discomfort is expected around the third postpartum day. Proper positioning and correct feeding techniques are the most effective prevention for sore nipples.

During the first month, nursing frequency for your healthy baby may range from 8 to 14 feedings per day, with most babies requiring 10 to 12. Some breastfed babies nurse as often as every two hours for part of the day, with other feedings spaced four to five hours apart. Generally, nurse your baby every two to three hours during the day and try not to allow more than three hours between daytime feedings. You do not need to wake your baby at night unless your baby has not nursed enough during the day or has poor weight gain. Every baby’s needs are different, so remain flexible. By about six weeks of age, your baby will usually have developed a pattern of nursing every two to three hours with a longer stretch at night.

Almost all medications taken by a breastfeeding mother are passed to the baby through the milk. Check with your physician before taking any medications. Avoid cigarette smoking. Nicotine is excreted in breast milk and has been found to decrease breast milk supply.

Breastfeeding works best if you remain relaxed and let nature take its course. Knowing what to do can help prevent problems. Please call our office or the hospital lactation consultant if you have any questions about breastfeeding.

Infant formulas are sold in three forms: ready-to-use, concentrated liquid, and powder. There are differences in cost and convenience between the types. Keep bottles and nipples clean. Wash in a dishwasher or scrub bottles. Wash nipples and caps with hot, soapy water and a bottle brush, squeezing water through the holes in the nipples. Rinse, dry, and place in a protected location until use.

We do not recommend one brand of nipple or bottle over another. Nipple holes should be the correct size. Milk should drop at a rate of 1-2 drops per second. If holes are too large, discard the nipple. Formula may be mixed as you go or mixed in advance and stored for up to 48 hours in the refrigerator.

Offer formula at room temperature. We do not recommend using a microwave to heat formula because the milk can become very hot in places and scald the baby’s mouth. A refrigerated bottle can be warmed under warm running water or with a bottle warmer.

Sit comfortably and hold your baby with the head slightly elevated. Hold the bottle so that its neck and nipple are always filled with formula. Never prop the bottle.

Burping helps remove swallowed air. Both breast- and bottle-fed babies swallow air. Sit your baby in your lap with the head supported, hold the baby upright over your shoulder, or place the baby face down over your lap, and pat the back. Burp your baby frequently during the feeding as well as at the end.

Feed on demand whenever your baby seems hungry, usually every 2-4 hours. Begin by placing 2-3 oz. of formula in the bottle. If it is not finished, discard the remainder immediately. When your baby finishes the amount offered, increase the amount in the bottle by one-half to 1 oz. If the baby is sucking fingers and smacking and it has not been two hours since the last feeding, the baby may be suckling for comfort and a pacifier may be tried.

Sucking comforts babies. Even when not hungry, babies often suckle fingers and thumbs for comfort. You will learn the difference between hungry behavior and comfort behavior. For formula-fed babies, a pacifier is fine. Breastfeeding mothers may want to limit pacifiers until milk supply is well established. Allowing frequent nursing will meet your baby’s comfort needs.

At bedtime and naptime, prepare your baby by making sure the baby is warm, dry, and not hungry. It is fine to rock for comfort and then place the baby in bed to sleep. Babies should sleep on their backs with no pillows or soft bedding. Babies who are put in bed awake, sleepy, and satisfied and allowed to go to sleep on their own are better sleepers in the long run.

Items needed:

• A warm room
• A table or countertop at a comfortable height
• A soft washcloth
• No-tears shampoo
• Rubbing alcohol
• Cotton balls and cotton swabs
• A full-sized towel

Your baby may be washed in a dishpan or in the sink. Always check the water temperature. The baby may not be placed in water before the cord is off. Daily baths are fine but are not necessary. Wash the face and head first and the diaper area last. After bathing, rinse and dry. If the skin is too dry, you may use baby lotion or hand cream. We don’t recommend baby oil or powder.

The umbilical cord should dry and fall off in 1-3 weeks. After bathing, clean the cord with alcohol using cotton balls or cotton swabs. Lift the cord so the base can be cleaned and dried. When the cord drops off, clean the base with alcohol until the area completely heals. Position the diaper below the cord and leave the cord uncovered. Some bleeding, green or yellow discharge, or odor is common as the cord separates. If the skin around the cord is warm or red, call our office.

Gently wash the penis with a cotton ball and mild soap, rinse, and pat dry. Apply petroleum jelly until healed.

Don’t try to pull the foreskin back over the head of the penis. As your child grows, the foreskin will gradually loosen and the child will be able to retract it more over time.

Babies need very basic clothing for the first month of life. They should be dressed comfortably for their environment. A cotton gown and diaper will be sufficient for several weeks. A light blanket for sleeping will be needed. Do not overdress. Either cloth or disposable diapers may be used.

Squeeze the bulb syringe. Insert it into each nostril or the sides of the baby’s mouth. Release the syringe compression and suction mucus out of the nose or mouth. Clean the bulb often with soap and water.

Newborn screening for hearing loss, PKU, congenital heart disease, congenital hypothyroidism, low thyroid hormone, congenital adrenal hyperplasia, galactosemia, sickle cell disease and related red blood cell disorders, biotinidase deficiency, amino acid disorders, fatty acid oxidation disorders, organic acid disorders, and cystic fibrosis are routine in Alabama. Testing starts in the hospital, and results are usually available at the two-week checkup. Newborn screening tests and abnormal hearing tests are repeated at the two-week checkup.

An abnormal screen DOES NOT MEAN something is wrong with your baby, only that follow-up is important to make sure the test is normal. All of these conditions can be treated if detected early, giving babies the best outcomes. That is why we screen.

If you do not see the physicians at Fort Payne Pediatrics for your two-week checkup, make sure your baby’s doctor follows up on these screenings and gives your baby a Hepatitis B vaccination at two weeks of age if it was not received in the hospital.

You should be notified of your infant’s hearing screen results before leaving the hospital. These screens are often abnormal because infants have fluid in the middle ear space. This does not mean your child has hearing problems. Follow-up is very important.