• How often to breastfeed?
• The length of each feeding
• Is my baby getting enough breast milk?
• When to call a Lactation Consultant
• When a baby is unable to breastfeed
• Breastfeeding twins or triplets

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Frequency

How often to breastfeed?

Newborn babies want to feed on demand, which is usually every 1 to 3 hours per 24 hours (8-12 times in 24 hours) for the first two to four weeks. While breastfeeding, be cautious of well-meaning family and friends who encourage less frequent feedings. Watch your baby for feeding cues (increased alertness or activity, mouthing, rooting, sucking, etc.). If your baby does not show feeding cues in three hours during the day, attempt to wake him/her up.

• You should feed your baby throughout the day and night.
• For sleepy babies, your health care provider may request that you wake your baby every three hours for feedings until your baby has regained his/her birth weight.
• Pacifiers should not be given to lengthen the time between feedings. Watch for feeding cues (examples listed above).
• Crying is a late sign of hunger and makes breastfeeding much more difficult.

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Duration

The length of each feeding

Whenever possible, offer both breasts during each breastfeeding. Begin the next feeding with the breast with which you finished.

During the newborn period, most breastfeeding sessions will take from 20 to 45 minutes. However, because newborn babies are often sleepy, this length of time may require patience and persistence. Feed on the first side until your baby stops suckling, hands are no longer fisted and you baby appears sleepy and relaxed. When these occur, break the suction, burp the baby, and go to the next side. Continue to feed your baby until he/she stops the feeding at the second breast.

While most babies will feed from both breasts at each feeding, some babies will be satisfied after one breast.

Watch for long, slow sucks with swallows by the baby.
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Is my baby getting enough breast milk?

You will know your baby is getting enough breast milk if:
Your newborn has frequent bowel movements.

• Typically, the stools are loose and change from black to brown to mustard-yellow in color in the FIRST FIVE DAYS
• Breastfed babies vary in stool patterns but typically, by their third day of life, they will have at least two to three in 24 hours. At five days old, most breastfed babies have at least four yellow, seedy stools per day.
• Older babies vary; some stool every day, while other babies will only stool every few days.

There are also wet diaper patterns.

• day 1 = one wet diaper
• day 2 = 2 wet diapers
• day 3 = 3 wet diapers, and so on
• day 6 and older = 6 to 8 wet diapers in a 24-hour period. (After your milk increases, the urine will soak the diaper.)

Other signs that your baby is getting enough breast milk:

• Your baby's urine is pale in color.
• You can hear your baby swallowing the milk.
• Your baby is calm and relaxed after eating.
• Your baby is gaining weight. Many babies may lose up to 10 percent of their birth weight during their first days of life. Babies are born with reserves and usually regain the weight by two weeks of age. However, frequent around-the-clock feedings will help prevent a significant drop in weight. Breastfed babies need to be fed on demand approximately every 1 to 3 hours per 24 hours (8-12 times in 24 hours).
• Newborns should not be allowed to sleep for more than 3-4 hours, unless at night. Wake your baby and offer a feeding at least every 3-4 hours, until your baby regains his/her birth weight.
• Your breasts feel softer after feeding.

Many breastfeeding mothers have found that keeping a diary like the one below can be very helpful in deciding if their baby is receiving enough milk.

Breastfeeding Diary

Breastfeeding start time_______

Date:_____

Midnight	Noon
12 1 2 3 4 5 6 7 8 9 10 11	12 1 2 3 4 5 6 7 8 9 10 11
Bowel Movements 1 2 3 4+		Total number of feedings in 24 hours:_____

Each day circle the hour that is CLOSEST to the time you begin breastfeeding. Mark off the first four bowel movements your baby has during each 24-hour period.

If you are breastfeeding AT LEAST 8 times daily, you hear your baby swallowing, and your baby is having AT LEAST 3-4 bowel movements daily (more than 4 is great!), you can be assured that your baby is receiving enough milk.

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When to call a Lactation Consultant

A Lactation Consultant will be of great help to you for these types of events or feelings:

• By day 4, if you do not feel your milk has increased.
• For treatment of sore nipples.
• Concern about your baby's output (urine and stools).
• If your baby is not feeding 8 to 12 times in 24 hours.
• If your baby is sleeping on the breast, not suckling well, and seems hungry each time you take him/her off.
• Ineffective positioning, latch-on and engorgement.
• Breastfeeding challenges, i.e., twins, premature infants, babies with a slow weight gain, and women who have had breast surgery.
• Advice for the working mother regarding how to continue breastfeeding after returning to work and help with planning a daily routine.
• Advice on the most appropriate nursing bras and clothing items which allow for comfortable breastfeeding.

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When a baby is unable to breastfeed

Occasionally situations occur in which your baby will not be able to breastfeed for a while. Hospital grade electric breast pumps that provide the needed "suckling" stimulus for your milk production are readily available. At first, you may be able to only express a few drops of milk. This is very common, particularly if this is your first baby. Begin double pumping as soon as possible and continue pumping on a regular basis (every 1-3 hours or 8 times in 24 hours for 10-15 minutes), and gradually your milk supply will increase. Do not worry about how much milk you are pumping; when you are able to breastfeed your baby your milk production will be more efficient.
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Breastfeeding twins or triplets

Caring for more than one baby is a challenge that will require a lot of time, energy and patience. Breastfeeding can be an economical and convenient way to feed your babies, once you ease into the routine. Your milk supply will be abundant as long as the babies are nursing frequently. Breastfeeding is a supply and demand process. The greater the demand, the greater the supply. Support groups, such as Mothers of Multiples, are very helpful with tips and techniques for nursing your babies.
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