What are the most important things to remember as my due date nears?
There is a lot to learn and prepare for with breastfeeding and parenting, but let’s focus on the basics! Successful breastfeeding can be summed up using the ABCs of breastfeeding and is most effective for healthy, full-term infants. Click here to read about the breastfeeding basics regarding preterm infants.
The ABCs of Breastfeeding
| A | Attach |
Remove Milk Effectively |
| B | Build |
Establish/Maintain Milk Supply by nursing on demand, aiming for 8-12 feedings in 24 hours. |
| C | Calories |
Make Sure Baby is Getting Enough by counting diapers, watching weight gain and contentment. |
A: Attach
How your baby latches onto your breast is vital to your milk supply and comfort.
Why?
When your baby is latched deeply, they can effectively remove milk from the breast. A shallow latch will result in less milk removal, leading to decreased milk production and the risk of the baby not getting enough milk.
Additionally, a deep latch should not be painful. Although some tenderness is common in the first few days after delivery, the pain should not be severe and should not last more than 10-20 seconds into the feeding.
How?
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- Find a comfortable position that allows your baby easy access to the breast (without having to turn their head).
- Baby’s belly should be touching yours and their head, neck, and shoulders in a straight line.
- Bring your baby to your breast, supporting their upper back and neck, but not pushing on the back of their head (which instinctively causes them to push back).
- Support your breast using the “C” or “U” hold, and touch baby’s nose to your nipple.
- Baby should tilt their head back and come onto the breast chin first, with your nipple aimed toward the roof of their mouth.
With a Good Latch:
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- A large portion of the areola is in baby’s mouth—you may see some areola above the lips, but not below.
- Baby’s nose is exposed.
- Lips are flared out (not tucked in).
- A rocking motion is seen at the jaw, making the ear move.
- Swallowing is heard (but no clicking or slurping noises).
- Your nipple is round and looks normal after a feeding (not pointed, white, or irritated looking).
- Your breasts feel softer and lighter after a feeding.
Pro-Tips:
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- Skin-to-skin contact helps with latching. Plan to do it right after delivery and for months to come.
- The laid-back breastfeeding position, coupled with skin-to-skin contact (the magic position), is a go-to for helping baby achieve a good, deep latch.
Amazing Fact: When your baby’s saliva enters your breast, it “communicates” with your body, telling you what your baby needs at that specific time. If more fat, protein, etc. is needed, your body will increase that in your breast milk. If baby gets sick, your body makes antibodies that speed up recovery.
Click here for more amazing breast milk facts.
B: Build
Establish and maintain breast milk supply by latching (or pumping) milk on-demand, aiming for 8-12 times in 24 hours.
Why?
Milk needs to be removed so that more milk can be made. Having empty breasts signal milk to be made and refilled quickly, while milk remaining in the breasts signals milk production to slow or decrease.
How?
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- Watch and respond to baby’s early hunger cues.
- Wake a sleepy baby to nurse if needed.
- Wait to offer pacifiers until breastfeeding is established, as they have the potential to delay or replace breastfeeding sessions.
- Avoid formula supplementation (unless medically necessary), as it replaces feedings at the breast. Make sure to pump anytime a bottle of breast milk or formula is given.
- Talk to your doctor about any prescription or over-the-counter medications, making sure they will not affect milk supply. If there is a threat to milk supply, usually an alternative medication can be used.
Pro-Tips:
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- Add hand expression in the early days if baby is still learning to latch.
- Spend time skin-to-skin with your baby, as it stimulates milk-making hormones and can increase milk supply.
Amazing Fact: Your milk supply adjusts to your baby’s needs. During growth spurts, when babies need more calories to grow, they will instinctively breastfeed more often. This causes your milk supply to increase temporarily, until the spurt is over.
C: Calories
Track baby’s weight gain and watch for other signs that they are getting enough milk.
Why?
Since we can’t see exactly how much breast milk baby is getting while nursing at the breast, we rely on the following clues, which show they are getting all they need.
How?
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- Keep follow-up appointments with your baby’s doctor. Baby should be back up to their 24 hour weight by 2 weeks and gaining 4-7 ounces a week thereafter.
- Count wet and dirty diapers: On day 1, your baby should have 1 dirty diaper (1-2 wet). On day 2, 2 dirty diapers (2-3 wet). On day 3, 3 dirty diapers (3-5 wet from days 3 to 5). After day 4, there should be 4 or more dirty diapers, each at least the size of a quarter. By day 6, your baby should have 6-8 or more wet diapers each day, and their urine should be clear to light yellow.
- Feed on demand (8-12 times in 24 hours).
- Watch for contentment. Baby’s arms and hands should be relaxed after a feeding.
Pro-Tips:
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- Breast compressions can increase how much milk baby drinks at a feeding.
- Nurse on the first breast until baby comes off on their own, then offer the second. If baby finishes the second breast and is still hungry, go back to the first, as they can get an ounce or so more. Your body is continually making milk and empty breasts refill quickly!
Amazing Fact: After about one month of breastfeeding, your milk supply will no longer need to increase. Your breast milk becomes more nutrient-dense, so the same amount still fills your baby up.
Premature Babies
When babies are born early, we often reverse the ABCs of breastfeeding to CBA. While extremely premature babies will likely spend time in the NICU and not immediately latch at the breast, babies who are considered late preterm (born between 34 and 36 weeks gestation) should not be treated as full-term infants and may need extra breastfeeding support.
The CBAs of Breastfeeding
| C | Calories |
Make Sure Baby is Getting Enough |
| B | Build |
Establish/Maintain Milk Supply |
| A | Attach |
Practice Latching |
C: Calories
The main focus is ensuring that baby is getting all the calories they need.
Pay close attention to milk transfer by:
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Watching for signs that baby is getting enough to eat. Your doctor’s office or WIC office can do a weighted feeding to get an idea of how much milk baby received while breastfeeding.
- If there are milk transfer issues, baby should get expressed breast milk in a bottle first, so they don’t tire out at the breast and lack energy to drink milk from a bottle. Use paced bottle-feeding with a slow-flow preemie nipple until baby’s due date.
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Watching for signs that baby is getting enough to eat. Your doctor’s office or WIC office can do a weighted feeding to get an idea of how much milk baby received while breastfeeding.
B: Build
The next focus is building milk supply.
When baby isn’t latching effectively, you will need to:
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Hand express or pump on a schedule of every 2-3 hours (ideally using a hospital-grade double electric breast pump).
- Hand express to remove colostrum and use a pump once milk “comes in.” Begin removing milk in the first hour after birth.
- The correct flange size is almost as important as the pump you choose when it comes to pumping success.
- Hands-on pumping will increase milk output and fat content.
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Hand express or pump on a schedule of every 2-3 hours (ideally using a hospital-grade double electric breast pump).
A: Attach
The last (but important) step is attaching baby to the breast.
Remember, if milk transfer is a concern, latch your baby after they have received expressed breast milk to ensure they get the calories they need.
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- Letting your baby nurse for 5–10 minutes after bottle-feeding keeps them familiar with breastfeeding and acts as a "dessert" to finish the feeding.
- Nipple shields are a short-term solution that may make latching easier for your baby.
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Once your baby is gaining weight well, shows signs of getting enough milk (which are the same as those we look for in full-term babies), and has a strong enough suck to effectively remove milk from the breast, latching can become more primary.
Additional Information & Suggestions:
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- Preterm babies have a harder time maintaining their body temperature, blood sugar and experience higher levels of stress, so skin-to-skin contact is very important for them.
- Preterm babies are at higher risk for developing jaundice, and it may not be discovered until after hospital discharge. Know what to look for and contact your doctor if baby shows signs of jaundice.
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Preterm babies are often sleepier and need to be woken to feed every 2 hours during the day and every 3 hours at night.
- Even when awake, preterm babies may not show clear hunger cues, such as bringing their hands to their mouths, as this action requires coordination that they may not have developed yet.
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Preterm babies can have “confusing” behavior and are often:
- Less alert, make less eye contact and make less “cooing” noises.
- Easily overstimulated, causing them to tire out quickly.
- Move through stages of sleep and alertness very quickly without much warning.
Learn more about newborn stages and how to recognize and respond to signs of overstimulation here.
Please let your peer counselor know when you deliver your baby! When babies are born early, there are often additional challenges with breastfeeding and getting help as early as possible makes those challenges easier to overcome.
Source/Resources:
HUG Your Baby