Breastfeeding from day one to day one: a complete guide

La Breastfeeding is possibly the biggest challenge which many mothers encounter after giving birth. postpartum it is a moment complicated, By the hormonal changeThe accumulated fatigue from pregnancy and childbirth itself, combined with breastfeeding, poses a challenge. added concern by questions which it generates. Furthermore, there are numerous Myths around them, and there will almost always be people determined to give us tips that No. they are always successful nor adequate.

La OMS recommended exclusive breastfeeding until the 6 months and subsequently Breastfeeding with complementary feeding until the two years or more...as long as both mother and baby wish. This recommendation remains consistent and has become a cornerstone of infant health.

How our body prepares

On pregnancy, the hormones begin to prepare the breast for milk productionWe usually notice changes in size and the sensitivity from the principleand sometimes they are the first symptoms that make us suspect we are pregnant. This sensitivity is mainly due to the increase in estrogen y progesterone, which promote the growth of mammary ducts and lobes.

From the fourth or fifth month pregnancy we manufacture colostrum, although we do not always realize it. If you are one of those who notices secretion From a few yellowish or transparent drops, there is no need to nothing special: one is enough normal hygiene and especially never squeeze Do not squeeze the nipple to get more colostrum, because this can irritate the skin and provides no benefit.

To him end of pregnancy we will notice more changes In the chest: it may increase in size, become heavier, and small veins may become more visible due to increased blood flow. This is important. adjust the bra to these changes. It's worth investing in a specific maternity and nursing bra, without underwire, with good support. wrist support and from one suitable sizeto avoid discomfort and promote good circulation.

This entire process of breast maturation means that, after childbirth, the breasts are ready to produce and expel milk. Even so, the effective production The amount of milk will depend largely on the baby's suckingThe more the baby nurses, the more milk your body will produce.

First contact with our baby

When the placenta during labor, a hormonal change Very important: estrogen and progesterone levels decrease, and this allows the prolactin and oxytocin act more intensely to initiate and maintain lactation.

El first contact with our son is fundamental. The first hour of life It is often known as the “magic hour”And ideally, we should spend it skin to skin with the baby. The rest of the family will have time to meet him later; now it is especially important that the baby recognize your smell, your voice and stay warm next to you.

Place it on your abdomen, both unclothed at the top, and let it gradually look for your chestMany babies make a movement called “crawling to breast": They propel themselves with their legs and advance until they find the nipple." Don't lose sight of him, But Don't force him And don't let anyone try to force your nipple into their mouth. When you're prepared, he will do it on his own selfThis spontaneous grip usually favors a most effective posture and comfortable.

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Enjoy this moment and make sure there is tranquility around you. Dad, the baby, and you are the essentialThis skin-to-skin contact promotes oxytocin release, the call “love hormone”which, in addition to strengthening the bond, helps the uterus to... contractreduce the Bleeding and facilitate the delivery of the placenta when it has not yet done so.

If the birth was by Caesarean section or there has been complications And if you can't hold the baby immediately, it's very helpful for your partner or another trusted person to do it. skin to skin with the newborn. The baby will feel more Safety, hot y accompanied until you are able to pick him up and offer him your breast. As soon as you are ready, you can also begin skin-to-skin contact and first take.

The feedings: frequency, duration and alternation of breasts

Es important that to give the Tomas Let's have a flexible systematic But clear. The current recommendation is to offer the breast. requestThat is, every time the baby shows signs of hungerwithout necessarily waiting for crying. These signs include the baby stir, open the eyesturn the cabeza looking, take out the language, make little noises, suck the hands to lips.

On first month of lifeMost newborns need to be fed between 8 and 12 times a dayBreast milk is easily digestedTherefore, babies are hungry frequently. Furthermore, frequent feedings promote a good milk production in the first weeks.

To organize the shots, you can follow this general guideline:

Put the baby in the first breast and let suck all you want. Don't look at the time obsessively; if the baby He doesn't sleep y suctions effectively, will release the chest as soon as I notice that There is not enough milk left West satiated.
It's a good idea to take them out gases at that moment, between a chest and othernot only to expel the air it has swallowed, but also to stimulate and awaken himChange the diaper at that time it is also usually very effective all with awakening to sleepy babies.
Then offer him the second breastMaybe so want or can notIf you don't want it, Don't get overwhelmedThe important thing is that, throughout the day, both breasts empty with some regularity.
Start each feeding with the breast you use to You finished the previous take. Does not matter The important thing is to alternate what the baby ate from that breast. For example: if this feeding starts with the right breastThe next one starts with the left, then again by the right and so on.

With regards to duration Newborns may take up to [number] feedings to complete. 20 minutes or more in each breast. As they grow and their coordination improves, they can become much more efficient and take only 5 to 10 minutes in emptying each breast. The duration will also depend on factors such as your milk flow, the ejection reflex, the grip of the baby or if it is more sleepy or distracted.

To calculate the intervals between shots, it is counted from the moment when a shot begins until the start of the next feeding. That is, if your baby starts breastfeeding at 6 a.m. and the next feeding begins at 8 a.m., we would say that the feedings are separated by about two hoursThis is important when the pediatrician asks you how often your baby breastfeeds.

If you offer both breasts at each feeding, it's advisable to try to make burp When switching breasts and also at the end of a feeding. Some babies need to burp more and others less, and this can vary from feeding to feeding. If your baby regurgitates a lotIt is helpful to take more frequent breaks to help him exhale.

First days: from colostrum to milk coming in

In her first day of lifethe baby is usually very asleep and sometimes it turns out difficult to feedHe's tired of the birthing process too. Even so, we must try to make it work. don't spend too many hours without him eating. This may clash with the idea of “feed on demandBecause the newborn may take too long to ask for food. In these first few hours, it is recommended not to leave the baby for more than three or four hours without offering the breast, even if the baby does not ask for it clearly.

So, how many shots must do a newbornAccording to most experts, between 9 and 12 takes in 24 hours. That means you can eat every two or three hours, always counting since begin one take until begin The next one. The first 24 hours are for adaptation and difficult sometimes wake him up, so stimulate him Gently place it skin to skin and have patience.

Beginning second day of lifeThe baby's behavior often changes: wake up more and start ask frequentlysometimes every an hour and a half or two hoursAt this point, the first ones may begin to emerge. criticism around us:asks all the time","You don't have milk","Your milk is not nutritious.In many occasions They will recommend that we give it a feeding bottle so that it "lasts longer".

Don't let yourself be convincedThese days you have colostrum, with all the nutrients and defenses that your baby needs, even with little fatThat's why the baby asks for it more often: that frequent sucking favors that "raise the price of milk"That is, that you start manufacturing a transition milk and then a mature milk with the appropriate percentage of fat according to the baby's age.

El colostrum It also acts as a natural laxative that helps to expel the meconiumThe first stools are blackish-green and sticky. This is important to reduce the risk of jaundiceAlthough the amount is small, colostrum is very important. concentrated in proteins, vitamins and antibodies.

We arrived home: the milk coming in and engorgement

Usually coming home match with the milk price increaseIt's usually a very delicate: on the one hand, the hormonal swing normal after childbirth makes us feel very vulnerableOn the other hand, many arise questions about our son. The return home easily becomes a moment of anxiety and worries.

You will notice that you milk price risesIt's a very... feeling intenseIt usually happens between second and fourth day after childbirth. Many women notice it, especially after nightbecause the prolactin, hormone that stimulates milk production, increases its levels in absence of natural lightYou may wake up with your chest inflamed, hard and even with some discomfort or pain. This is called "Breast engorgement" or congestion.

Al principlethe baby may be unable to hook on well y empty one breast completelybecause your breast is very tense. Before putting your baby to the breast, you can take a... gentle massage And apply a bit of local heat (a warm shower or a hot compress) for soften lightly the breast. Then, offer her your breast And be patient, it might be a little difficult for him at first.

If your breasts are very hard and the baby is having difficulty latching on, it can help to express some milk. small amount of milk by hand or with a breast pump until the areola is somewhat more mildNext, try the latch again. Frequent breastfeeding at this stage is the best way to avoid severe engorgement and prevent problems and mastitis.

It is common for the baby to continue making the You take photos in a somewhat disorganized way and that he asks more often at night After spending part of the day sleeping, it's important that you give yourselves tiempothat you rest when the baby sleeps and that the other household chores have them done by someone else if possible. Let yourself be helped and prioritize rest and breastfeeding.

With the passing of the days, the feeling of fullness in the breasts decreases and can even disappearYou barely notice the rise (sometimes only a slight one). tingle on the nipple) and the baby takes less in doing the takesIt's very common to wonder if your milk production it is still propertyThe fact that breasts are not as full does not mean they produce less milk, but rather that they have adapted better to the baby's needs.

Peaceful: the amount of milk you produce it fits to what your baby requireIf the baby is quiet between takes, my enough diapers, defecates regularly y gain weight If everything goes well, then everything will be fine. carefully.

Established breastfeeding

When breastfeeding is already established establishedMany mothers experience it as the best moment of the upbringingThe baby becomes very effective sucking and the shots are usually quite QuickLittle by little the baby acquires a shooting rhythm more predictable and begins to space you take them nocturnalHowever, he will continue to wake up to eat for quite some time, which is completely normal.

There is no one Fixed date for babies to reach this routine: some do it before month of life and others acquire it after the two months or more. If in the periodic reviews Check with your pediatrician or nurse to ensure your baby's growth and health are adequate. there is no cause for concern. Go ahead tiempo And, little by little, it will organize itself.

At this stage, many mothers begin to notice more clearly the opposed between milk from the beginning of the take (more watery and rich in lactose) And milk from the end (plus fat and satiating). Allow the baby Empty the first breast completely Before offering the second one, it helps him receive all that high-fat milk which promotes a good weight gain and more satiety.

At this point, the pacifier use or notIf you decide to use it, it is recommended that you insert it when the breastfeeding is well establishedThat is, when the baby latches on well, gains weight, and you feel comfortablePrudent use of a pacifier can help to calm to the baby, but it shouldn't replace sockets when there is hunger.

Returning to work and maintaining breastfeeding

La incorporation to work It is usually a very delicateIt often coincides with that breastfeeding period. established y satisfactorysince maternity leave in many countries is about 16 weeks, in front of 6 months exclusive breastfeeding recommended by the WHO.

Continue breastfeeding after returning to work is possiblebut it usually requires a planThe most common thing is to organize a partial weaning and combine breastfeeding when you're with the baby with expressed breast milk when you are absent.

Some practical recommendations:

Some weeks before To return to work, you can start doing a small “pantry” of breast milk in the freezer, preferably extracting milk after a feeding when you notice your breast is still full.
At work, try to have a quiet and hygienic place to express milk and from a refrigerated space (refrigerator or insulated bag with ice) to keep it fresh until you get home.
While you're away, someone else can offer the breastmilk Feed the baby with a bottle, cup or spoon, depending on the age and what best suits your family.
Morning, noon, night, and weekends, you can continue breastfeeding directwhich helps to maintain the production and the link.

Query with your matronaConsult your pediatrician or breastfeeding support groups about how to organize pumping sessions, how to store milk, and what type of planning might best suit your work situation.

Extended breastfeeding and tandem breastfeeding

Is called prolonged lactation when breastfeeding It has maintained for more than two years.. Not only It is not contraindicatedbut is considered beneficial for the health of the child and the mother. Milk continues to provide defensesnutrients and, above all, consuelo y emotional link.

The duration of breastfeeding is a personal decision of the two people directly involved in breastfeeding: mom and baby. The moment of definitive weaning They both decide; There is no time limit established for breastfeeding as long as both parties agree and breastfeeding proceeds without medical problems.

Possible maintain breastfeeding durante a new pregnancyprovided that it is normal and without complications. After the birth of the next baby, some mothers choose to have another procedure. "tandem breastfeeding"That is, breastfeeding the newborn and older brother at once.

When tandem breastfeeding, it is advisable to take some Precautions:

During the First days, the newborn should have preference in the shots to ensure a good supply of colostrumwhich is especially valuable for your immune and digestive systems.
It agrees observe The weight gain of both children should be monitored by the pediatrician to ensure that milk production is sufficient.
It is important that the mother takes care of her eating, its rest and Emotional Supportsince tandem breastfeeding can be physically demanding.

Photograph. "Attachment parenting", rest via Flickr

Growth crisis

The calls growth crisis These are moments critics in which the baby sticks a "stretch" and your body needs a extra energy and nutrients. During these periods the quantity and composition of breast milk should change all with adapt to your new needsThe only way the baby has to stimulate the breast to increase production eat more often and for a longer time.

These are usually babies who already had a established shooting rhythm and that, suddenlyThey start asking every 30-60 minutes and they cry continuously if they are not breastfeeding. This phase usually lasts between two and four daysalthough it may take a little longer.

These are very long periods exhausting for the parents, but as soon as the milk is adapts to what the baby needs, the feedings return to get organizedSome typical stages of increased demand are located around the third weekBetween the second and sixth week, towards the three months and again around the six monthsAlthough each baby has their own rhythm and they may appear at other times.

While the baby not be sick, wets diapers, defecates y gain weight properly, It is not necessary Introduce Supplements of formula. What is needed is patience, tiempoAnd, if possible, support from the partner and the environment so that the mother can rest and dedicate herself to breastfeeding.

Breastfeeding strikes

The breastfeeding strikes are Periodically in which the baby is refuses to breastfeed suddenly, even though she had been breastfeeding normally until that moment. These occur more frequently in babies. older kids, from the 3 or 4 months.

For parents, these can be moments of great anxietybecause it gives the impression that the baby is literally refusing to eating. Can reject both breasts or alone a, maybe you don't want to grab on or do it and release the chest heaves, cries, or arches back.

The causes are very varied:

The baby begins to show interest so you see your around and easily distracting during the filming.
It may have some physical discomfortAs an tooth bud, a mouth infection (thrush), a cold or ear pain.
You may notice a change in the taste of milkFor example, if the mother has changed medication, has had a fever, or has become pregnant again.
Some babies react to changes in routine, the mother's return to work, a move, or stressful situations at home.

As in growth crises, the key is patienceIt is helpful to offer it to the baby. skin to skinan atmosphere quiet With minimal stimulation, and allow the baby to approach the breast when they are more relaxed, for example, half asleep. Many feeding strikes are more easily overcome with nighttime feedings or feedings in dim light.

If you suspect any obvious cause (pain, infection, fever, significant nasal congestion, etc.), it is advisable consult with the pediatrician to address the underlying problem. So that the milk production Do not decrease sharply during the strike, you can stimulate the breast with a breast pump or manual extraction. It is also recommended. on request with your matrona or a lactation consultant.

Common problems and solutions

Don't always wait for tearsCrying is a late sign of hungerOffer her your breast frequently and responds to the first signs of searching. Encourage him gently so that it hook and suck before it gets too upset.
Initial weight loss: all newborns They lose some of weight in the first hours or days of life. It's a phenomenon normal As long as it remains within expected limits and the pediatrician doesn't advise otherwise, there's no need to worry if the baby seems fine and starts to... gain weight when milk production increases.
Newborn fecesThe baby should defecate in the first 24 hours of lifeThe first poops are the meconium, very colorful dark y stickyproduced by the amniotic fluid and other substances the baby swallowed in the womb. Gradually, its appearance changesand as soon as we have mature milk they turn yellow and lumpy, like mustard with small granules. They can defecate in all the takes And that's still normal. What should alert us is that a newborn do not defecate within 24 hours or that the stools present blood or a very anomalous appearance.
Wet diapersWe will change the baby's diaper with the Tomas and we must verify that It's wetA newborn who He doesn't pee regularly it may be indicating that is not well hydrated. From fifth day of life, at least are expected five or six wet diapers every 24 hours, with colored urine light yellow.
Ineffective suction: Yes we didn't notice That the child sucks strongly we didn't even hear him swallow When eating, or if the grip is very superficial, we will have to correct the gripIf changes in posture don't correct it, we should consult a doctor. with a specialist (midwife, pediatrician, lactation consultant) who can help us improve techniqueSometimes that's enough. change posture so that the baby takes more tissue from the areola and sucks better.
A chest that doesn't soften after the intake: if we didn't notice that the breasts are softer after feeding (especially at the beginning, even if the baby doesn't empty them completely, they should soften), or if the baby does not gain weight properly once home, it is likely that It doesn't suction well and comma less of what you need.
Dry mucous membranesIf we observe that the baby has the mucous (mouth, tongue) dry, or the fontanelle is very sunken, We consult without delaybecause they can be signs of dehydration.
Signs that everything is going wellIf we notice that the baby suck, we heard him swallow, we see that move your jaw when eating (look at the earlobe and you'll see how it move when sucking), does pee and defecate frequently, softens the chest in the shots and alternative periods of dream to cries to order food, we are facing a healthy baby that will grow to its rhythm.

How to start breastfeeding after childbirth: positions and latch

The marketing process includesseveral phases that are reflected below: lactation is a skill that is learnedfor both mother and baby. It carries tiempo y AreasSo don't be too hard on yourself in these first few days.

looking for a quiet place and a sofa or armchair comfortable where you can take your time and relax. If you are tenseThe milk may come out with more difficulty, so try to breathe. deep and profound, change position or ask for help to position the baby correctly.

The breastfeeding positions These are crucial for successful breastfeeding. It's helpful to learn about them: position lying on side, cradle, rugby ball, vertical, etc. On this same page you can find resources on positions, tips and answers to frequently asked questions.

My baby was just born, how do I start breastfeeding?

Your baby has just been born and you have him above youEnjoy this special moment with your baby in your arms. Don't worry about anything else. If you stay in that position, your baby will probably start to... "crawl" until it gets close to your breast, and it can start nursing. If it doesn't, that's okay.

Once the professionals who are attending to the delivery They finish their work (delivering the placenta, checking the perineum, etc.) and help you get comfortable in bed; it's time to start breastfeedingYou can maintain the previous position and let your baby continue the process of to hook itselfAnother comfortable position at this time is lying on sidewith your baby lying parallel to and facing you. You should both be completely on your sides,tripe to tripeso your child doesn't have to turn the head to eat

Place the nipple at the height of the nose or upper lip of the baby, so that when you latch on, you don't flex your neck forwards, but extend slightlyThat small extension makes it easier for swallow the milk and that the suction is effective.

This position makes it easier to start breastfeeding because your baby is near the nippleLet him be approach graduallysmelling the colostrum and stimulating the nipple with small movements of the lipsIt can be like this. few or many minutesDon't worry. There will come a time when it will hitchAfter a few minutes, if he doesn't do it on his own, you can help him by bringing him closer. from the back (not from the head, to avoid a “rebound effect”), placing a finger on his chin so that he opens his mouth wider.

If you still can't manage it, you can gently insert a clean finger in his mouth for stimulate sucking and offer her your breast again. matrona It will help you start breastfeeding; therefore, don't hesitate to ask for help whenever you need it.

My baby has latched on to my breast, but it hurts. Is this normal? What should I do?

El pain with sucking es frecuente in the first few days, but it's not normal that it is intense or prolonged. Breastfeeding can be upset or “strange” at first, but it shouldn’t be painful constantly. If it hurts, it's a sign that something in the grip or posture This is incorrect, and therefore the suction may be less. effective.

Often the pain occurs because the baby has not opened its mouth wide enough and is sucking almost exclusively on the nipple. nipple, instead of covering a significant part of the areolaThis causes injury (cracks) and does not stimulate well the milk ducts, which makes it difficult to raise and empty the breast.

Effective sucking occurs when the baby takes nipple and areolaMost of the... are located below the areola ductsAnd when stimulated, the colostrum and then the milk begin to flow more easily. It's normal for the baby to take more areola into the nipple area. lower lip than in the upper one, adopting a slightly asymmetrical position.

Si it hurt, must correct posture Attach the harness as many times as necessary. Do not detach your baby. pulling the body While she's sucking, because it would stretch the nipple and cause more pain. Insert a clean finger through the corner of his mouth to break the void and remove it then. After that, start againstimulating her cheek with the nipple and allowing her to search and latch on when she opens her mouth wide.

Do I have milk when my baby is just born?

El colostrum It has been present in the chest since approximately the seventh month of pregnancyTherefore, when your child is born, There is already milk in the breast.Colostrum is the milk of the First daysexactly what your baby needs at that moment: it provides defenses (immunoglobulins), proteinsvitamins and facilitates the expulsion of meconium.

Little by little, with the frequent suckingProduction is stimulated, and the amount and it occurs milk price increase, which is the transition from colostrum to the transition milk and then to mature milkDuring pregnancy, the breasts mature due to the effect of... hormones and produces colostrum, but after birth there is a hormonal change which promotes breastfeeding. Even so, for milk to be produced in sufficient quantity, the baby needs to... suck often.

Through sucking, the baby stimulates the release of oxytocin (which causes the milk to come out) and of prolactin (which ensures the production of new milk). Frequent suckling, especially in the first few weeks, is the most effective mechanism. important to regulate milk production, therefore, start breastfeeding in a early and frequent It greatly contributes to their success.

What is oxytocin used for?

La oxytocin is released by the nipple stimulation but also by other sensory stimuli, such as see babylisten to him cry or during the orgasmTherefore, milk may leak between feedings and it may be necessary to use a breast pump. absorbent discs.
At the postpartumoxytocin also makes the uterus contracts, which reduces the BleedingThese contractions are called afterpainsWith breastfeeding, because more oxytocin is produced, afterpains can be more frequent. intensebut the bleeding is less and promotes recovery of the mother.

What is prolactin used for?

La prolactin is segregated into wrists in response to various stimuli, the most effective being baby's suckingIt is also influenced by the Cardiac rhtyms, with increased secretion during the nightTherefore, milk production often occurs at night, and frequent nighttime feedings help maintain a abundant production.

Can I breastfeed after a cesarean section?

If your baby was born through Caesarean sectionYou can also get one Successful breastfeedingMore and more centers are trying to ensure that, after the intervention, the mother and newborn are in a comfortable environment. as little time as possible separatedOnce they are together and the mother has recovered, the ideal thing to do is to start the skin to skin contact and breastfeeding as soon as possible.
Find the more comfortable position for you: for example, lying on side with the baby next to you on a pillow, so you don't have to turn around too much, or in rugby ball position, placing the baby next to you.
Do not doubt ask for painkillers If you need them; pain shouldn't be an obstacle to breastfeeding, and it's important that you are comfortable.
La milk price increase It may be slightly delayed because feedings started hours after birth, but by continuing to feed .the baby will be fed with colostrum until the rise. This usually happens, in many cases, towards the fourth day of lifealthough every body has its own rhythm.

Contraception during breastfeeding

La choice of contraceptive method after childbirth it should be done in such a way that do not harm to the mother or the infant and that do not interfere with breastfeeding.

Amongst the natural methods, the APPLE The Lactational Amenorrhea Method (LAM) is one of the most effective methods if used correctly. vision, with an effectiveness close to 98% under optimal conditions. For it to be valid, the following must be met todas These conditions:

Exclusive or almost exclusive breastfeeding (without regular formula feedings or long intervals without breastfeeding).
Frequent doses day and night, without long periods of more than 4-6 hours without suction.
Menstruation has not resumed.
Baby under six months.

Amongst the barrier methods, the condom It is an ideal option for the postpartum and breastfeeding, as it does not affect milk production or composition. spermicides They can be used, but always in conjunction with another barrier method to increase its effectiveness.

As for hormonal contraceptives:

Those containing estrogens and progesterone combined during breastfeeding, because estrogens can decrease the milk productionespecially in the first few weeks.
The progesterone-only contraceptives (progestin-only pills, implants, some injectables) are the ones of election during breastfeeding, as they do not usually significantly affect the quantity or quality of milk when properly prescribed.
It can also be used morning-after pill based solely on progesterone as emergency contraception, when necessary, without being contraindicated by breastfeeding.

El IUDBoth copper and some hormonal types are considered compatible with breastfeedingIt is generally recommended. placement A few weeks after delivery, once the uterus has regained size and tone, except for specific protocols for immediate insertion.

In any case, it is essential on request with your gynecologist or midwife to choose the most suitable method according to your medical history, your preferences and the postpartum period.

Breastfeeding Committee
José Manuel Martín Morales

Breastfeeding is a journey that begins in the first hour of life and can accompany your child for months or years, full of changes, doubts and learning; having good information, professional and emotional support and trusting in your ability will help you enjoy every stage, from the first day to the last.