Exclusive breastfeeding is feeding infants only breastmilk without any other food or drink. To promote exclusive breastfeeding, we recommend keeping your baby in your room with you in the hospital and sharing a room (not a bed) at home, allowing your baby to breastfeed often, responding quickly to baby's early feeding cues, avoiding giving baby formula unless medically necessary, avoiding bottles and pacifiers, hand expressing milk after feedings and contacting a lactation consultant with questions or concerns.
When babies are ready to eat, they will show feeding cues, including rooting (baby will open mouth and search side to side for your breast), putting hands to mouth, stretching, smacking lips, thrusting tongue and fidgeting. Late feeding cues include crying and frantic movement.
There are four main breastfeeding holds — cradle, cross cradle, sidelying and football. To ensure proper positioning, baby should be facing you, chest to chest. Baby should also be properly aligned — baby's ear, shoulder and hip should be in a straight line — and base of baby's head should be supported. Good positioning is an important key to breastfeeding!
In addition to good positioning, a good latch is an important key to breastfeeding! Signs of a good latch include the entire nipple and as much of the areola as possible inside of baby's mouth, lips turned out, tongue over lower gum, baby staying on breast, swallowing and no biting or pinching pain.
Newborn babies are often awake and alert for the first 1-2 hours after birth, and then sleep for many hours at a time. It's best to offer the breast at least eight times in the first day, but they may eat less often in teh first 24 hours. On day two, babies begin to cue and eat more frequently. On day three, babies may begin to "cluster feed," which means he or she may feed many times close together. Cluster feeds often continue until your milk supply increases. On day four and five, your milk supply will likely increase so that baby eats more during each feed.
It is common for new moms to be concerned that they are not producing enough breastmilk and that their baby is not getting enough to eat. Babies have tiny stomachs - from the size of a grape at birth to the size of an apricot at day seven - and do not require a large amount of breastmilk to feel full. Signs that your baby is getting enough to eat are:
- At least 8 feedings in a 24 hour period
- Enough wet and dirty diapers for their age (see resource below)
- Using a deep latch with several periods of sucking and swallowing at each feed
- Satisfied after feeds
- Gaining weight
For the first five days, you should expect at least one wet and one dirty diaper for each day of age (one wet and one dirty on day one, two wet and two dirty on day two, etc.). Baby's stool will change from black meconium on day one, to black or dark green on day two, to brown, green or yellow on day three and by day four or five, will change to yellow, loose seedy stool.
Nipple tenderness is common as you begin breastfeeding; soreness that lasts more than seven days and is accompanied by sores, blisters and/or bruises is not considered normal and could be a sign of poor latch and/or positioning. Please contact our lactation consultant for support.
Engorgement (heavy, swollen breasts caused by increased blood flow) is also common. Engorgement may feel uncomfortable and some moms may feel discomfort as milk begins to flow during feedings. Engorgement typically subsides after 1-2 days. To help with engorgement, breastfeed often, hand express or pump out milk to soften the areola and nipple, if baby has difficulty latching, use massage during the feeding to help milk flow and apply cold compresses to the breasts after a feeding.
Blocked ducts, which may feel like pea-sized lumps or engorged tissue, are often sore and may feel warm. To help relieve blocked ducts, consider taking a warm shower, applying warm or cold compresses to the affected area, feeding baby frequently, massaging the blocked duct toward the nipple during feedings and expressing milk following feedings. Contact your healthcare provider and/or lactation consultant if you are not responding to these relief measures. Blocked ducts can lead to mastitis, which can become serious if not treated quickly. If you have the symptoms of a blocked duct in addition to fever and chills, contact your doctor immediately.
You should eat to hunger and drink to thirst. It's best to try to eat a variety of protein, whole grains, fruits, vegetables and healthy fats. Water, milk, non-caffeinated tea and/or juice are good drink options.
It's best to avoid eating foods high in sugar and saturated fat. It's also advised to limit eating fish that contain high levels of mercury.
Try to limit your intake of caffeinated beverages to 1-2 per day. Coffee, tea, soda, energy drinks and chocolate may all contain caffeine.
Abstaining from alcohol is the safest option for breastfeeding mothers. However, according to the Centers for Disease Control and Prevention, moderate alcohol consumption (up to one drink per day) is not known to be harmful to the infant, especially if the mother waits at least two hours after a single drink before nursing.
Most medicines are safe to take while breastfeeding, but you should always consult your doctor first. Always take medications as prescribed.
If you smoke, quitting is the best option for you and your family, however, breastfeeding is still best for your baby even if you cannot quit smoking. Smoking can lower your milk production. Limit smoking to just after feeding to limit the amount of nicotine that enters your milk. Also avoid smoking while holding your baby or near your baby; many infant health issues, including an increased risk for Sudden Infant Death Syndrome, are linked to second-hand smoke.
You should avoid all illegal substances while breastfeeding. Heroin, methamphetamine, cocaine and other drugs can pass into your milk and harm your baby's brain development. It is not safe to breastfeed your baby while using drugs. While marijuana is legal in some states, it is recommended that you do not use marijuana while breastfeeding.
Nicole Schumm, RN, IBCLC, has been an OB nurse since 1999. In 2017, she became an International Board Certified Lactation Consultant. She is passionate about breastfeeding and helping new moms meet their breastfeeding goals. Nicole is available to answer questions via phone or email before and after baby’s arrival. Contact her at 419-678-5670 or firstname.lastname@example.org.
Breastfeeding services and support include:
Before Baby Arrives
- Breastfeeding classes
- One-on-one consultations
While You’re in the Hospital
- Daily check-ins
- One-on-one breastfeeding education
- Customized plans based on individual needs
- Help with breastfeeding
After You Go Home
- Two-week follow-up phone call
- One-on-one outpatient services
A New Beginning: A Guide for Postpartum and Newborn Care. Arlington, TX. Customized Communications, Incorporated, 2019.
Understanding Breastfeeding: Your Guide to a Healthy Start. InJoy Health Education, 2018.