The first 40 days: practical breastfeeding tips

The first 40 days after birth are a time of learning for both you and your baby. For some mothers and babies breastfeeding clicks right away, for others it takes time, but nearly all mothers can make enough milk for their baby.

The first hour and colostrum

Holding your baby naked against your skin right after birth (skin-to-skin contact) keeps them warm and calm, helps steady their breathing and is a good start for the first feed. The World Health Organization recommends starting breastfeeding within the first hour after birth. Skin-to-skin is usually possible after a cesarean too.

The thick, golden-yellow milk of the first few days is called colostrum. It is so concentrated that your baby only needs about a teaspoonful at each feed. Your milk usually increases 2 to 4 days after birth, and you may notice your breasts feeling fuller.

How often should you feed?

In the first weeks, feed your baby as often and for as long as they want. As a rough guide, expect at least 8 to 12 feeds or more in 24 hours; in the first days your baby may want to feed every 1 to 3 hours. Try to catch early hunger cues such as restlessness, sucking on fists, murmuring sounds, or turning the head and opening the mouth; a crying baby is harder to feed. Night feeds matter too, because you make more prolactin, the hormone that builds your milk supply, at night.

How to tell your baby is latched on well

• Your baby's head and body are in a straight line, facing your breast.
• Bring your baby to the breast rather than leaning your breast toward them; start with their nose level with your nipple so they open their mouth wide.
• Their chin touches your breast, their lower lip is rolled down, and you can see more of the dark skin around your nipple (areola) above their top lip than below.
• After the first few strong sucks, feeding should not hurt.
• Quick sucks change to long, rhythmic sucks and swallows with occasional pauses.

If your nipples hurt at every feed, crack or bleed, it is usually a latch problem. Don't stop breastfeeding; ask your midwife, a breastfeeding counselor or your doctor for help early.

Is your baby getting enough milk?

• In the first 48 hours, 2 or 3 wet diapers are usual; from day 5, expect at least 6 heavy wet diapers every 24 hours.
• After most feeds your baby seems calm and satisfied, and your breasts feel softer.
• It is normal for babies to lose a little weight in the first 3 to 4 days; most are back to their birth weight by about 2 weeks.

Until breastfeeding is established, giving formula in a bottle or a pacifier can reduce your milk supply. Decide together with your healthcare team whether your baby needs anything extra. The World Health Organization recommends breast milk only for the first 6 months.

“Breastfeeding is a skill you and your baby learn together, and asking for help is part of learning it.”

Look after yourself and ask for help when you need it

Make time to rest and ask for help around the house. Alcohol and smoking can interfere with milk production. Before taking any medicine, tell your doctor or pharmacist that you are breastfeeding. If you started vitamin D and iron supplements in pregnancy, they continue for a while after birth; check with your doctor how long to take them. And in these situations, don't put off getting help:

• A red, hot and painful area or a hard spot in your breast, along with flu-like symptoms such as fever and chills, may be mastitis. Keep breastfeeding, and see your doctor if it does not improve within 12 to 24 hours.
• If your baby has fewer wet diapers than expected, does not want to feed or is not gaining weight, talk to your midwife or doctor.
• If your baby's skin or the whites of their eyes turn yellow, see a doctor. If the jaundice started in the first 24 hours, or if a baby with jaundice is very sleepy or hard to wake, is not feeding, has a temperature of 38°C or more or 36°C or less, or is struggling to breathe, call your local emergency number or go to the emergency department right away.