No one warned you: Week one breastfeeding
Congratulations! You delivered your baby! You’re now holding that nearly 40-week surprise in your arms and the hospital is preparing to send you home, but your milk isn’t fully in yet, and you’re wondering what’s taking so long. You arrive home and the baby was latching fine in the hospital, but now each latch makes your eyes want to roll back in your head with a new kind of stinging pain you’ve never felt before. Your baby who was so calm and sleepy in the hospital is suddenly very loud and seems hungry. You’ve been mentally preparing for labor and delivery for months, but nobody warned you about the first week postpartum, and you’re finding yourself feeling weepy and overwhelmed. Sound familiar?
As a pediatric nurse practitioner, lactation consultant, and mother of two, I have come to realize that as a society we don’t talk a lot about the first week postpartum. My mother doesn’t even remember any trouble during this time. I think a lot of this is because a generation ago it was common to spend the first week postpartum in the hospital with lots of hands-on nursing support and rest. Now you are discharged from the hospital between 2-4 days after delivery, depending on the method of birth, before your milk supply is in, and certainly before you’re physically recovered from delivery.
My mother-in-law calls this stage the “earthy phase”. I didn’t understand what she meant until I was swimming in all sorts of bodily fluids made from both my baby and me, and my newborn was waking up around the clock every 2-3 hrs (even in the dead of night when everyone else in the house was sleeping so peacefully). I think what she meant was that this is the time in life when we can’t deny that we’re mammals.
Part of the very definition of a mammal is that we feed our young milk. Breastmilk is human milk designed for human babies. It has the perfect ratio of protein, fat, and carbohydrate that our babies need to grow (formula is made from cow’s milk and is designed to emulate this ratio). It is also packed full of immune supporting antibodies for our babies to thrive. Human milk actually has a relatively low protein and fat content and a high carbohydrate content in comparison to other mammal milk. This low protein and fat content helps to explain why babies need to feed every 2-3 hours or 8-12 times per day. Our milk isn’t designed to allow babies to sleep through the night from day one! Some theorize that this frequent night waking of exclusively breastfed babies may be protective against SIDS.
The process of making milk, officially called lactogenesis, is also perfectly designed, but often feels frustrating for first- time mothers because it isn’t instantaneous upon delivery. The first part of the process begins in pregnancy when all of the groundwork for milk production is laid down in the breast and lasts until two days postpartum or through colostrum production. Many families are getting discharged from the hospital before the second stage of lactogenesis, or production of milk, has begun. The first one to two days at home can be frustrating because you’re still waiting for your milk to come in and your baby is getting increasingly hungrier. The delay between colostrum and milk production seems cruel to some, and can lead to thinking that a supplement is needed when it’s not, but this delay is actually helping a baby's digestive tract get ready to digest milk. Colostrum is produced in very small amounts (only 15 mls. in the first 24 hrs.!), but it’s densely packed with proteins, antibodies, growth factors, and vitamins that give newborns the first immune protection from pathogens and stimulates the development of the gut for future milk digestion. It also has a mild laxative effect that helps to pass meconium, or the babies' first stool.
Sore nipples are very common in the first week postpartum. In fact, it doesn’t matter how many children you have breastfed before, the first week will be an adjustment period because there is suddenly a warm, wet vacuum suctioning on your nipples. Newborn babies have an incredible ability to suction onto the breast because they lack a lot of the oral coordination that they will learn as they become older infants. This suction allows them to maintain a latch, but an imperfect latch can quickly cause damage and you may find yourself with cracks and bleeding nipples. Pain that persists beyond the first week or after the initial several seconds of the latch often means the latch may need to be evaluated and lactation support will be needed.
With each day your body will start to feel like your own again, but healing from delivery takes time. Often I hear women report they don’t feel like themselves again until the 4-6 week mark. In a lot of other cultures around the world that is exactly the time frame that moms are given to stay home with their babies and bond in seclusion. Though this first week may be the hardest adjustment period, remember to be easy on yourself for the next several weeks. The new painful physical sensations will decrease with time, but hopefully in their place will be felt an even deeper love for this new little being in your life.
What else do you need to know?
Learn the basics from Everett Clinic pediatric providers in a free class: New Born Basics
DISCLAIMER: The contents and opinions expressed by Everett Clinic teammates and providers on “A Healthier You” blog and those providing comments are theirs alone and are not a substitute for medical advice. Consult your own provider for personal health recommendations.
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