If it's your first time breastfeeding, you've probably asked yourself about a million times whether or not you're giving your baby what she needs. The good news is, with confidence, support, and this quick assessment, you and your baby will be on your way to a successful breastfeeding experience!
These nine questions are taken from The Well Fed Baby Checklist by Stanford Medicine, one of my favorite resources for Breastfeeding Education. I have added several other links here to some of my favorite internet resources that you will like to go back to again and again!
1. Is the baby having several bowel movements in 24 hours that are mustard yellow with curds in them? ("poop you can scoop", not just a smear)
No doubt some of you will be like... I would definitely say SEVERAL! If your little one is just having a "couple" or "few" scoopy poos in a day, and you're unsure whether its several, keep moving through the nine questions. A couple or few may be as good as several if there are no other concerns.
Speaking of color, you may remember that right after birth, that baby poo was tarry and dark brownish green. As your baby began feeding on colostrum and then your milk came in, the color got lighter and lighter. Exclusively breastfed babies tend around this mustard yellow color, but occasionally the color can change. Want to learn more about color-coding poop (ahhh, the questions you never knew you'd be asked!)?! Read this PBS article or check out this "Gag-Free Baby Poop Color Chart".
2. Is the baby wetting 5 - 7 diapers in 24 hours?
In the first week, babies usually wet a number of diapers equal to the day of life, and by Day 5 or 6, the number plateaus at 5-7 wet diapers in 24 hours. Keep in mind that disposables can hold a higher volume of liquid than cloth. Many disposables have a line that turns blue when the diaper is wet, or over at KellyMom (another great resource for breastfeeding!) they suggest putting a tissue inside the diaper to tell when it's wet.
3. Do the breasts feel full before feeding and softer after feeding?
If you became engorged a couple days ago, you know now what it feels like to have "full", firm breasts. Full breasts feel and look heavy, but when they are drained of milk, they are softer and lighter. Your breasts should not feel full all the time if baby is transferring the milk out with feedings. Feeding on-demand, or whenever your baby shows hunger cues, will help to keep breasts drained and soft. If Baby takes an extra long nap, you might notice that your breasts "refilled" and it's time to empty them again. If you're still in the first couple weeks, have patience with this and don't overanalyze unless you feel like your breasts are sore to touch and never softening. If you answered NO to this question, read more at #8.
4. If the mother had initial nipple soreness, is this resolved?
Nipple soreness can indicate that Baby is having a problem with getting a good latch. A good latch is the foundation of breastfeeding comfort and success, and it is typically an easy problem for a lactation professional to help with. Sometimes, anatomical challenges like inverted nipples for moms or tongue-ties for infants, can make a good latch challenging. Many times, simple positioning adjustments, or using a breastfeeding pillow can make all the difference. Figuring out the latch can mean no more sore nipples, and it can quickly change supply and increase baby weight gain! So, nipple pain is NOT something you should "just suck up" (PUN DEFINITELY INTENDED), taking care of why that is happening can solve several problems down the road, including recurring mastitis. Again, LATCH IS FOUNDATIONAL. Some latch quick tips are that the baby's chin will touch the breast, but probably NOT his nose, that way we know that the nipple is pointing up towards the roof of the mouth and there is not a direct pressure on the nipple of any kind. Most of that pressure happens around the areolar tissue (the dark skin around the nipple), so there should be a significant portion of that dark skin in the mouth with the nipple. If the baby is just sucking on your nipple... OUCH!! and they are probably not getting much milk! Here is a fantastic Jack Newman video to watch over and over again on latching and feeding.
5. Do you hear swallowing when the baby is breastfeeding?
Before your milk came in, it may have taken several sucks before your baby had enough volume to swallow, but now that your milk comes in, you may hear your baby swallow after just 1 - 3 sucks for the first 5 - 10 minutes of breastfeeding. After this, they may slow down or even fall asleep. Some babies are loud and obvious swallowers, sighing a little bit with each swallow, but some are quiet and mysterious. For those discreet swallowers, you can watch that tiny chin move a little deeper every couple of sucks and assume, with a good latch, that they are swallowing.
6. Is the baby eating at least 8 times in 24 hours?
Look, honestly, this is a LOW estimate. I think it comes from older protocols that suggested to parents that we should be feeding babies at least every 3 hours in 24. That's all fine and well, but breastfed babies will probably want to eat more like every 90 - 120 minutes, making that number closer to 12+ times per day in the first few weeks. As babies grow, they will get more efficient at breastfeeding and space some of their feedings out a bit more, or eat more in one part of the day and rest more in another part of the day, which we call cluster feeding.
WHY DO BABIES NEED TO EAT SO DARN OFTEN? Before Baby we had this very externally motivated activity schedule, but now your To-Do List has been minimized to "Sit Down. Feed Baby.", and your Reward System is having a hard time feeling gratified, unless you finally got to binge watch that Netflix series, but when that's over... now what? I get it. I did it four times. Here's the thing: EVERY SINGLE SECOND YOU SIT WITH YOUR BABY THEY LEARN SOMETHING NEW. They can't tell you what it is, but they are learning about dealing with their environment, safety, and trust, which in turn is stimulating their digestive system to build an entire immune system and the central nervous system to wire for dealing with everyday stress. YOU GUYS!!! THESE THINGS DETERMINE YOUR ENTIRE ADULT WELLNESS. This feeding on-demand, every 1.5 - 3 hours is a very important job. It is potentially your Beginner Human not having to deal with diabetes, heart disease, autoimmune diseases, mental health disorders, and cancer!!
7. Does the baby seem satisfied after a feeding?
You know how after Thanksgiving dinner your grandpa sits back in a big recliner and snores to the music of football? After babies are satisfied, a hormone called CCK kicks in and they relax. Their balled little fists open up and their hands are relaxed, and they probably fall asleep. This hormone dips again about 20 minutes after it's peak, so don't be surprised if they seem hungry again in 30 minutes! It doesn't mean you are doing anything wrong or that you don't have enough milk! If they fall asleep at the breast and have eaten a good 5 - 10 minutes, it's a good time to go get a snack or a bathroom break for yourself. Just be ready to feed her again when she's ready to eat.
8. Is there a lack of sore, tender, or red and firm areas in either breast?
If the milk ducts of your breast are regularly, adequately drained, you should not be sore to the touch or constantly tender. If you feel this way after a missed feeding, it is normal, and letting baby feed as soon as possible will prevent the ducts from getting clogged or infected. If that happens, you may notice a particular area of the breast feels like a rock or is red and heated. Find out how to treat a clogged duct here. If you develop a fever, call your doctor for an antibiotic prescription, or a lactation specialist for further assessment or alternative treatments. Taking antibiotics can increase risk for thrush. If you are opposed in general to antibiotic treatment, here are some natural treatment suggestions. Recurring mastitis indicates an ongoing problem with draining the milk ducts, so see a lactation specialist if you just can't kick it!
9. Has the baby started gaining 1/2 - 1 ounce per day?
This is how your pediatrician will evaluate the health of your baby. Doctors like measurements that they can see, and asking you about diapers and feedings is sometimes a little bit subjective to them. If your baby is still just in the first week, you may still be seeing weight loss. It is normal for breastfed babies to lose 7% - 10% in the first week and get back to their birth weight by 2 weeks. If there are concerns about your baby's weight, keep some things in mind: 1) If a mother had IV fluids in labor or for Cesarean, baby may measure at a higher percentage of weight loss (>10%) in the first week. 2) Most pediatricians and lactation specialists offer free weight checks, but if you have answered YES to the other 8 questions, don't add the stress of obsessing over Baby's weight. 3) LOOK AT YOUR BABY, NOT THE SCALE... Trust your instincts! Ask for the help you need when you need it, but don't worry too much. You've got this.
If you answered YES to these 9 questions, you've had a great first week!! If not, don't be overwhelmed, most breastfeeding issues can be worked through with a little support. Call your physician for medical advice for any red flag "No"s you answered here, and seek consulting from a lactation expert.
Need some extra help in the St. Louis area? Call Momentum at (618)401-7434 or write me at Hello@Momentum-Well.com and we'll help you out or send you to a Lactation Professional near you.