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Facts and advice about getting started with breastfeeding Written by pediatricians for parents. When does the milk come? That seems to be the most common question mothers ask pediatricians on their maternity round. The baby has been sucking and sucking for two days and the mothers have noticed that there is not much milk, perhaps hardly any at all. Families ask: how long does a baby last without milk?
Read more about the having your first baby
Breast milk comes on the third day
Healthy, full-term, moderately large babies usually survive for three to four days on very small amounts of milk (I will get back to those who don’t). But most babies will survive until the milk comes on the third or fourth day. This does not apply later in the baby’s life. Babies cannot survive more than 3-4 days without milk later in life. This just applies in the very first days of life.
A healthy baby lives on sugar that it makes from its own body fat. The baby does not pee so much, and loses weight when the fluid content in the body decreases.
During pregnancy, colostrum (aka first milk) is formed. It is sticky and translucent-yellowish in color and comes in small amounts. Colostrum contains more protein and antibodies, less sugar and much less liquid than milk. It is quite clever. The baby drinks concentrated mucosal antibodies (IgA antibodies) for the first 24 hours. The antibodies that bind to the baby’s mucous membranes of the mouth and intestines, provides some protection against infections.
In countries with dirty water and a high risk of bacterial infections, this protection is important. In countries such as Sweden with clean water and little disease- causing bacteria, it has very little impact on infant health.
Second day of life – breastfeeding marathon
The first day of life, the baby is often pretty tired. No wonder! Having gone through childbirth. The second day of life, on the other hand, is the breastfeeding marathon day and it is important to get breastfeeding started.
The baby sucks and sucks and never gets full. The baby’s sucking is the signal to the mother’s breasts to start producing milk. As it is important to have the baby lie skin-to-skin and look for the mother’s breasts on the first day of life, it is just as important that the baby gets to suck as often as it wants on the second day of life. Feel free to let the baby remain skin to skin even on the second day of life!
Newborns’ hunger signals
Newborns have hunger signals that I’d recommend you learn to recognize. They turn their heads towards the breast and peck like a chick with an open mouth. If the parents doesn’t understand, the baby becomes a little clearer. They smack their lips and bring their hand to their mouth and starts sucking on it. If, again, the parents still don’t understand, then they scream.
Take care of mom when she’s getting started with breastfeeding
24hrs after childbirth, when emotions are all over the place, the mother should breastfeed the baby almost continuously. Often it hurts the genital area, there is pain in the buttocks, pain in the uterus (after aches) and sore nipples when the baby breastfeeds.
The newly delivered mother needs to be cared for and supported to cope with this. Put her on a couch. Make smoothies, cookies, sandwiches, coffee and anything she could possibly need. Find a good TV series for her if she wants. And who will do this? The other parent, a best friend or new grandparents if the mother wishes to have them in her home.
Getting a good latch
The most important thing in this situation, is that the baby gets the right hold of the breast. In order to stimulate the expulsion of milk, the baby’s back palate needs to be massaged by the mother’s areola. The baby should have their mouth full of breast. The nipple top itself is then far back in the baby’s palate.
This is not only effective for milk stimulation, but it is also the most gentle for the mother’s nipples. If the baby doesn’t have a good hold, they can suck and grip the nipple. This hurts a lot and makes the nipple very sore.
To get the baby to take a big enough hold – wait until the mouth opens fully. Then help them get a large part (as large as they can) of the breast into the baby’s mouth. Are you experiencing difficulties? Ask a midwife or nurse at a breastfeeding clinic for help.
You might be concerned that the baby cannot breathe properly when so much of the breast is in the mouth. ‘Chin in, nose free’ is a good rule. The baby breathes through the nose.
Which babies won’t make it until the 3rd day, when the milk comes?
There are a few different groups of babies who are at high risk of not being able to keep their blood sugar at a normal level until the milk comes. They need formula for the first days of life, until the milk comes. Then it increases slowly. This causes a delay to the start of breastfeeding and increases the risk of delayed milk formation. So if the mother wants to breastfeed, it is important not to give formula to those who do not need it.
Babies to mothers with gestational diabetes are one such group. The mother has had high blood sugar levels during pregnancy. Sugar in the blood has passed to the baby via the placenta. So, to balance it out, the baby’s pancreas has gone into high gear to produce lots of insulin to lower the baby’s blood sugar to a normal level. Smart. However, when the baby comes out, it will continue to produce lots of insulin and the baby will have too low blood sugar levels if it is not fed formula on their first day of life. And sometimes, not so rarely, those babies may need to have a sugar drip for a few days.
Sometimes no diabetes has been diagnosed in the mother, but babies that are very heavy compared to their birth length also have a risk of low blood sugar levels. They are treated like babies to mothers with diabetes.
Premature babies don’t have much body fat to convert into sugar, and are also not very good at converting their fat. This becomes clearer when your baby is born. In addition, it often takes longer before they can suck. So, a mother’s milk formation can also be delayed. Children born before week 37(+0 days) therefore receive extra food from birth.
Babies that are too small in relation to the length of pregnancy, just like premature babies, do not have so much body fat to form sugar from. Therefore, they also receive formula until the breastmilk comes.
Babies who are sick or very affected at birth (eg. from an infection, lack of oxygen or respiratory disorder) need extra food because they do away with more than normal to fight their disease.
Babies who have jaundice need extra food to get the stools started. It is in the stools that the yellow substance, bilirubin, comes out.
Make sure you get an explanation of why and, if in doubt, ask for a medical assessment of your child’s particular needs. In Sweden, you will likely meet with a midwife who consults a doctor on the phone. But there are doctors every day at the children’s medical clinic, so ask to you see the doctor the morning after.
Third day, the milk comes
Not entirely true for everybody!
No 24 hours in life is like the second day of the baby’s life. Babies who marathon breastfeed will breastfeed less frequently and become satiated when the milk flows. This normally happens on days three to four. The mother’s emotional hormones will stabilize at more normal levels. The nipples will get used to it and not hurt as much going forward (usually not hurting at all after a few days to a few weeks actually).
If you need to give formula even though you don’t want to, you probably won’t have to do it forever. It may only take a longer time before breastfeeding gets started.
(And don’t worry, the breasts are getting smaller again, they are at their largest and swollen third day of life)
Babies can’t do without milk after four or five days
For most mothers, milk comes on the third day of life. It is noticeable as the baby begins to fill its mouth and swallows, often falling asleep at the chest and becoming satisfied by breastfeeding. But it’s not like that for everyone. For some, the milk does not actually flow at all in sufficient quantities. So if you don’t think your milk comes on the fourth day of life, call the children’s medical center. Tell them you’re going there for a breastfeeding and weight control assessment!
It’s important to seek help with breastfeeding or formula feeding (depending on individual assessment) to avoid ‘dried babies’ on the fifth-sixth day of life in the children’s emergency room. We see this quite often. Which is why I emphasize that not everyone’s milk actually comes, at least not on the third day of life.
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