There are 6 common breastfeeding questions that I get asked often.
As a pediatrician and breastfeeding medicine expert, I answer a variety of breastfeeding questions. These 6 common breastfeeding questions are the most asked by nursing mothers in my practice. I believe that all breastfeeding mothers should have access to evidence based lactation information in order to make informed decisions about their feeding journeys.
If you are in the phase of life, please allow me to help you through my free and paid breastfeeding resources. There are links below.
On the other hand, if you are not in this phase of life and/or didn’t want to or couldn’t breastfeed, skip on by this article. I know that this topic can be triggering for some mothers and I want to acknowledge that. You are a fantastic mother no matter how you choose to feed your child.
In this article, we will answer your top 6 questions about breastfeeding:
- What should I expect during the first two days of life?
- How do I know if my baby is getting enough breast milk?
- How do I know if I need to supplement?
- When will my milk come in?
- How do I know if I should pump?
- Is breastfeeding supposed to hurt?
What Should I Expect During The First Two Days of Life?
All parents want to know what to expect about breastfeeding in the first two days of their new baby’s life.
At the very beginning of breastfeeding, your baby will get small amounts of a thick fluid from your breasts called colostrum. A full term newborn baby has a fluid and fat reserve at birth. This reserve will help them get through the initially small amount of colostrum provided through breast feeding.
It is normal for a new baby to have a short awake period immediately following birth. That time is quickly followed by a more sleepy time period. This makes the first feeding at the breast an important milestone. We don’t expect newborns to eat very well in the first 24 hours of life.
As your baby approaches 48 hours of life, they will frequently wake up more and become alert and often fussy. The baby will demand to be fed every few hours or sooner. The name that we give to this demand for frequent feedings is called cluster feeding. It will often last for a day or two and can be a tiring experience for new mothers.
How Do I Know if My Baby is Getting Enough Breast Milk?
Many parents worry that their babies are not getting enough to eat. There are several ways that you can be reassured that your baby is getting enough milk.
Sucks and Swallows
The main way you can be reassured that your baby is getting enough breast milk is to listen for swallows as the baby is feeding at the breast. If the baby is latching well and feeding, you should be able to hear your baby swallow every few sucks. This can be difficult for first time mothers to discern as often the swallows are very quiet. So, lean in and listen closely.
Initially, the baby’s stomach is very small and the colostrum is enough to meet their needs. As your milk increases in volume, the baby’s needs also increase rapidly. Their stomachs increase in size to accommodate this extra volume.
Counting Diapers
A second way that you can make sure that the baby is getting enough is to count their diapers. As a general rule, a baby should have one wet diaper for each day of age until day 4-5 when they should have > 6 wet diapers per day.
Stool or poop is variable, but babies should have their first stool within 24 hours of birth. After that, their stool should transition from the black, tarry meconium stools to yellow, seedy stools by day 4-5. Next, they should have several stool diapers per day, but often breastfed babies stool after or during each feeding.
Eventually, some breastfeeding babies go on to stool less than every day. However, this generally happens when they are older than one month.
Weight Gain
Lastly, you know if your baby is getting enough breast milk by following their weight gain. Normally, newborns lose weight in the first 3-4 days of life, but should regain all of that weight by two weeks of life. Pediatricians and lactation consultants alike become concerned if a baby does not reach his birth weight again by 2 weeks old. After two weeks, a baby should gain an average of 30 grams (or about 1 ounce) per day until about 4 months of life.
How Do I Know if I Need to Supplement?
Your baby may need supplemental feedings if they are losing too much weight, not gaining weight as expected or have a medical condition that causes them to have increased caloric needs.
Excessive weight loss in the early days of feeding is often caused by a poor latch, poor milk transfer or a combination of both. Often younger gestation babies struggle with sleepiness that can lead to poor performance at the breast. Preterm and early term babies will often need supplemental feedings until they grow strong enough to remove milk from the breast. Additionally. babies who are born full term can have similar issues as well.
You should work with a professional lactation consultant or pediatrician to decide how much to supplement your baby, what to supplement them with and how to do it. Supplemental feedings can consist of your own breast milk, donor breast milk or formula.
As your baby gets older, you may need to supplement if their weight is not tracking well on the growth chart. As we mentioned before, your baby should be gaining about 30 grams per day until 4 months of life and then 15-20 grams per day after that until they reach about 9 months old. Often older babies who are not gaining weight well are not eating enough times per day. Frequently, just adding in an extra nursing session per 24 hours will get their weight back on track.
When Will My Milk Come In?
There are three different stages of milk production for breastfeeding mothers.
- Lactogenesis I- occurs during the second half of pregnancy through about 36- 96 hours after birth
- Lactogenesis II- “copious milk production” or “milk coming in” occurs 36-96 hours after birth- milk regulation is under the control of hormones alone
- Latogenesis III- starts around 9 days after delivery until involution (weaning the baby)- milk regulation is under supply and demand control inside of the breast
For most women, their milk increases by 3-4 days after birth. This means whether you choose to breastfeed or not, you will have breast milk “come in” as it is all under the control of hormones.
There are lots of reasons why a women’s milk does not increase during this expected time frame. Pediatricians recommend that breastfeeding newborns be evaluated in their office in the first 24-48 hours after hospital discharge. This early appointment will allow us to ensure that your baby is gaining weight well and to troubleshoot any problems.
How Do I Know if I Should Pump?
In general, if your baby is doing well at the breast, we recommend waiting until several weeks after delivery to think about using a breast pump.
On the other hand, if your baby is not gaining weight as expected, it is most advisable to give your own breast milk as much as possible. This involves the use of a manual or electric breast pump and/or hand expression of breast milk.
A different reason that you may need to pump is if you are experiencing painful engorgement. While I often discourage mothers from using their breast pumps for this reason, sometimes it is necessary in order to move some milk out of the breast. Your breasts may become engorged when your milk first comes in. This fullness often makes it difficult for the baby to latch on to the breast. You may want to use your electric, manual pump or hand expression to relieve some of the pressure in your breasts.
Be very cautious when using your pump for this reason because the increased stimulation to your breast will cause them to produce more milk. This can lead to oversupply which leads to other problems. Only pump for the shortest amount of time that is needed to relieve your pain and fullness.
Is Breastfeeding Supposed to Hurt?
The thought of pain with breastfeeding is one of the main reasons why many women choose not to breastfeed. While extreme pain is rare and often indicates a problem, some mild discomfort can accompany the early days of breastfeeding.
While breastfeeding is natural and beautiful, it is not without hard work and sometimes pain. As you and your baby are both learning this new biological process, the steep learning curve can lead to some complications.
There are many reasons for breastfeeding pain. Poor latch, breast engorgement, nipple pain, and breast infection are just a few causes. As you and your baby master the skill of breastfeeding, your problems will get less and your pain should improve.
You can read more about breastfeeding pain here.
How Can 127 Pediatrics Help You?
At 127 Pediatrics, we offer concierge level pediatric and breastfeeding care. If you are near Colleyville, Texas and would like to know more about our in person services, fill out a contact form on our website for a free meet and greet. If you are not close to our practice, but would like breastfeeding support, we offer an array of services. From free resources like this blog or our YouTube channel all the way up to paid resources such as our online breastfeeding overview course. We would be honored to be part of your breastfeeding journey.
© 127 Pediatrics, written April 2023, updated January 2024
Please note that this article is purely for informational purposes and should not be interpreted as medical advice.
Dr. Andrea Wadley owns and operates 127 Pediatrics, a pediatric and lactation practice in Colleyville, TX. She specializes in pediatrics, breastfeeding medicine and offers house calls only. Additionally, Dr. Wadley is the owner of the 127 Pediatrics Online Breastfeeding Medicine and Education Center. We have many free resources for breastfeeding mothers. Subscribe to our YouTube channel or download a free breastfeeding checklist.
