Evaluating Initial Breastfeedings

Feedings

Watch baby for light sleep cues: eye movement under closed lids, finger sucking, noises, movement
Wake infant every 2½–3 hours during the day; every 3–4 hours at night for the first two weeks— baby may be sleepy initially so encourage arousal by changing diaper, washing face, tickling feet, rubbing back
8–12 feedings per day lasting 15–20 minutes per breast initiate good milk production, reduce jaundice and prevent low blood sugar

Proper Positioning

Mother should be comfortable in arm chair with knees higher than hips using a foot stool
Baby supported on pillows with body tummy to tummy at breast level
Alternate positions to reduce stress on same area

Proper Latch

Stroke/tickle baby's lips with nipple or finger to stimulate rooting reflex and open mouth
When mouth is open wide quickly pull baby onto areola and nipple with a rapid arm movement
Baby's nose and chin should touch breast
Do NOT use finger to make an air passage which pulls nipple out of infant's mouth
Lips should be flanged with Pac-man like mouth

Effective Sucking

Mother should feel nipple tugging-no pain
Round full cheeks with rhythmic jaw movement and swallowing
Rhythmic sucking with brief pauses

Let Down

Mother may feel sleepy, thirsty, and may have uterine cramping
May feel tingling sensation or notice milk dripping from other breast
After milk supply is well established in 3–5 days will notice breasts are softer after nursing

How to Know if Baby is Getting Enough to Eat

Baby should feed 15–20 minutes per breast at each feeding
Should hear baby swallowing
Baby is satisfied after feeding for 1-3 hours
Inside of mouth is moist

Output

During colostrum stage baby will have 1–2 wet diapers of pale yellow urine
After 48–72 hours when milk transitions, baby will have 6–8 soggy pale yellow wet diapers
Stools will change from black to green to seedy yellow mustard color
May have 3–8 stools per day varying in size to accumulate to be palm size amount in a 24-hour period

Weight gain

Initially infant may lose up 7 to 10 percent of birth weight the first few days
Should be back to original birth weight by two week check up

©1998 Sharon McLaughlin, RN, IBCLC, FACCE