From You and Your New BabyBy Christine and Peter Hill

The whole topic of breast-feeding generates a staggering amount of contradictory advice from all quarters, professional and lay. Everyone considers themselves an expert. In fact, all professionals have the same objectives in mind: your baby should receive some colostrum in the first three days, and he should be sucking enough to keep him settled and content whilst lactation gets underway as soon and as easily as possible. Thereafter he should have enough milk to put on about an ounce a day so that he regains his birth weight somewhere between the tenth and 14th day (or even before). It is in the details of feeding practice that advice varies and this can be confusing. Don’t panic — these details aren’t that important.

Babies don’t need milk (they only need fluid) for the first three days. They are designed to go without, being born with a good reserve supply of nutrition. It is quite usual for them to lose up to 10 per cent of their birth weight in the first five days. Some are very sleepy and seem to be quite uninterested in feeding whilst others are keen to suckle immediately and seem to be starving. Unfortunately, you are likely to worry on both accounts.

Your milk won’t begin to come through until three to four days after delivery. You do, however, need to put your baby to the breast before then. Start as soon as you and your baby feel up to it but in general terms don’t leave it longer than 12 hours after delivery. Before they start giving milk — in fact before your baby is born — your breasts produce a small amount of a cloudy fluid called colostrum. This contains antibodies against infection as well as other goodies and is, from the baby’s point of view, well worth having. The suckling of your baby will also help stimulate the release of hormones which kick-start the lactation process (though if for any reason you can’t put your baby to the breast the milk will still come through).

If at all possible, your first try at breast-feeding should be supervised by an experienced midwife. The midwife who delivered you is often the best person, if she is available. You know and trust her, and she will be keen to help you over this first hurdle. Whoever you are able to enlist needs to be there to ensure your baby is latching on properly, taking both the nipple and the areola (brown area round it) into his mouth rather than hanging on to the nipple only, which will make it sore. You will also get sore if you try and pull off your baby whilst he is still sucking, so she will show you how to get him to release your nipple as well. You do this by parting his gums with your finger.
If your baby is uninterested in feeding you may be told (or threatened!) that your milk won’t come in unless he suckles all the time. In fact it will — in some cultures the baby is never put to the breast until the mother begins to lactate.

You are also likely to worry if he wants to suckle all the time, in case he isn’t getting enough. Breast-feeding babies do not normally need bottles of formula milk in the first three days — nature tends to get things right and provide enough colostrum to keep him going until your milk comes through. You don’t have to be browbeaten into giving a bottle of formula milk in the first 72 hours by someone saying that your baby is hungry, unless this is on the specific advice of a paediatrician. There is a risk that giving an impatient baby a bottle of formula milk when it is not nutritionally required will fill him up and make him less prepared to suckle at the breast when your milk does come through. It is also the case that formula milk (even a few grammes) may trigger allergies in certain babies.

There are three exceptions to all this:

1. Babies who have not grown adequately during pregnancy are sometimes initially unable to regulate their own blood sugar level well enough and need extra feeding.
2. Very big babies sometimes can’t settle at all because they are genuinely starving hungry. Your paediatrician will tell you if this is the case.
3. If you have already developed horribly sore nipples you may have no alternative but to rest them for a feed or two.

During the first three days you and your baby start to get into the swing of things as far as breast-feeding is concerned. This is the practice time for both of you before the real thing. Most babies will be able to take all the colostrum they need by suckling five to 10 minutes on each breast every three hours or so. (Using only one breast at this stage is a nonsense as there is no ‘hind’ colostrum.)

If he seems to want to suckle for much longer periods, hear warning bells. It’s probable that he’s not getting the colostrum because his positioning is incorrect. This means that although he may be properly latched on to the nipple and areola he is not on at the correct angle to the breast. This results in kinking of the tiny ducts inside the nipple, which blocks the flow of the colostrum.

Ask a senior midwife to check his feeding position. This is very important, as if he suckles vigorously but is not properly latched on and at the correct angle you will get sore nipples before you have even started to lactate.