The First 100 Hours – Getting Breastfeeding Off the Ground

Research shows that the number one reason for moms not meeting their breastfeeding goals is low supply. Research shows that milk supply is heavily dependent on what happens in the first 3 days.  Here are a few tips that will protect your supply and ease baby’s transition from womb to world.

What To Know:

  1. Babies are not born knowing that sucking is related to hunger satiation. Sucking is a reflex that brings comfort first, food second. Babies do not know hunger before birth.
  2. Caring for babies skin to skin provides warmth, moisture and transfer of protective good bacteria from mom to baby. Research has shown that babies cared for this way have less jaundice, better sugar levels, better temperature maintenance and fewer infections than those cared for away from mom’s skin. Delaying bathing to allow time for vernix (the thick creamy coating in skinfolds and coating skin) helps baby absorb good bacteria from mom. This is especially important for babies who have delivered by Cesarean Section.
  3. Most babies, when placed on mom’s chest immediately after birth, will begin crawling, searching and rooting activities within the first hour after delivery. Interestingly, mother’s milk is most readily available at that time due to birth hormones. Babies who get this early dose of colostrum are protected from low blood sugar and the gut is provided a protective layer of mother’s helpful bacteria. This early latch also starts the milk production process and helps prevent delays in milk coming in.
  4. Baby’s first sucking experiences help develop baby’s sucking behavior. Finding the breast for herself while crawling on her belly encourages a wide-open mouth and tongue forward. Repeated practice sessions – offering the breast with early feeding cues whenever baby demonstrates those – helps the imprinting process. Leaving baby’s hands unwashed and uncovered helps baby find her way to the breast.
  5. Frequent feedings in the first 100 hours (10-12 per 24 hours) encourages a more rapid transition from colostrum to milk production. Tight swaddling may interfere with natural feeding rhythms.
  6. Feeding both breasts, and repeating as necessary, helps a baby associate sucking with obtaining milk.
  7. IV fluids, blood pressure issues etc. can cause the areola around the nipple to be firm and make latching more difficult for the baby. Reverse pressure softening and areolar expression can remedy this and make latching easier.
  8. When babies are latched well, you should be able to hear a few swallows, even in the first day of nursing.
  9. What goes in must come out: that means a baby who is getting milk from the breast will have wet diapers and poop. This starts at one a day and increases by an additional wet and poop for each day of life. By 5 days, a baby should be wetting 6-8 times and pooping 3-5 times per day.
  10. Nipple tenderness should be resolved by day 5.

What To Expect:

First 24 Hours: Baby should nurse within two hours, if placed skin to skin with mom and allowed to remain there.  Some babies will sleep 4-6 hours and then begin nursing every 1.5-3 hours.  Some babies do not take the recovery sleep. Babies may nurse for a few minutes, others for half an hour.

Second 24 Hours: Babies should start waking up more, nursing for longer periods. During the second night of life, babies may nurse more frequently and seem hungrier, wanting to nurse off and on all night. Milk often comes in after this frequent nursing period. Switching breasts frequently and breast compression helps protect nipples and improves supply.

Third 24 Hours:  Milk volumes increase, breasts become firmer. Nursing sessions should last 10-30 minutes. Be sure to nurse both breasts, changing breasts whenever baby starts to fall asleep.

What To Do:

  1. Keep mother and baby together, 24 hours a day. Do not separate unless medically necessary.
  2. Put baby on mom’s chest immediately after birth. Mom’s head should be raised so she can see and follow her instincts to help baby with latch. Delay bathing for at least the first 24 hours. When bath is done, leave hands unwashed.
  3. GIVE THE BABY TIME. Don’t worry if baby doesn’t immediately latch to the nipple. Let her fuss a bit, move back and forth to seek the nipple and find it herself. Do not force the nipple into her mouth or push her head onto the nipple. Do not push on her back. Baby has natural instincts to feed that are most active when he is on his belly and feels supported by mom’s body.
  4. If mom’s areola is firm or nipple appears flattened, perform Reverse Pressure Softening and/or Areolar Expression to help baby draw nipple far back onto his tongue. 
  5. Use breast compression to keep milk flowing if baby seems to fall asleep quickly after latching. This is a firm but gentle squeezing of the breast a few inches back from the nipple. Squeeze and hold while baby is drinking; release while he rests and repeat until baby is not swallowing.
  6. Change breasts every few minutes when baby slows down on sucking and swallowing. Repeat breasts until baby is satisfied and asleep.
  1. If your baby is too sleepy to latch (this can happen from medications mom is given during labor), express directly into baby’s mouth or hand-express colostrum and syringe or spoon feed to baby. This will help prevent low blood sugar for the baby and prevent unnecessary formula supplementation. Breast milk is more effective at increasing baby’s blood sugar than formula because it is self-digesting. Do this every 2 hours until baby shows interest and starts latching by himself. 
  2. If your baby has not started latching by 12 hours after birth, ask for a hospital breast pump and begin pumping as well as manual expression to give your supply a jump start. If your baby begins latching but is still having difficulty after 24 hours (causing nipple pain, no swallowing), start pumping. Pump 10 times/day the first three days, then 8 times/day after that until baby is doing well.  Research shows that moms who begin hand-expressing AND pumping in the first two hours when baby is unable to nurse well, have twice as much milk at 10 days as those who delay.  WATCH THIS VIDEO:
  3. Avoid pacifiers and bottles until baby is latching well. It usually takes about 2 weeks for babies to imprint at the breast.
  4. Keep track of baby’s output. The My Medela App is free and will help you keep track of feedings and baby’s wets and poops.
  5. If you are still having trouble with latch or have nipple damage after the 5th day or you have cracked or bleeding nipples, get hands-on individual help.
  6. Laid-back breastfeeding with mom comfortably supported and baby’s weight on her and not a pillow should be practiced throughout breastfeeding. If mom has a sore neck and shoulders from breastfeeding, it’s a sign that she is not comfortable and is working too hard. Babies take at least 6 weeks past their due date to become automatic breastfeeders and to have more control over their head and neck muscles.

If you have time and resources, please take a comprehensive prenatal breastfeeding class. Prenatal Classes help get the whole family on the same page and reduce stress. Classes are offered in many locales, including Nova Birth Services at (615) 669-6399 and most Maternity Hospitals.