Timing of breastfeeding
Breastfeeding pattern; Nursing frequency
Expect Your Breasts to Become Engorged
If your breasts become engorged:
- Your breasts will feel swollen and painful 2 to 3 days after you give birth.
- You will need to nurse your baby often to relieve the pain.
- Pump your breasts if you miss a feeding, or if a feeding does not relieve the pain.
- Talk to your health care provider if your breasts do not feel better after 1 day.
It's normal during the first week after a baby is born for a mother's breast to become heavy, and tender, and full as the milk is coming in. And even before that as the blood flow is expanding and the lymph flow is expanding to allow the milk to come in. But sometimes that progresses to something we call engorgement. I'm Dr. Alan Greene and I want to talk briefly about engorgement. What causes it, how you can prevent it, and what to do if engorgement does happen. We call it engorgement if the pain becomes really severe because the milk is so full in the breasts that it squeezes shut some of the blood and lymph vessels. So causes swelling in the tissues. It's not just too much milk. It's real swelling of the breasts. And it can be quite painful and make nursing kind of difficult. Probably the best way to prevent engorgement is frequent, early feeding. If you feed as often as the baby wants to, and at least every 2 to 3 hours when the baby is awake during the day, and no longer than 4 or 5 hours one stretch at night during that first week will often prevent engorgement. Engorgement is less common, too, if you don't do supplemental feedings. But even if you do everything perfectly, some women will still become engorged. It's not a guarantee. If you do and don't do anything, the engorgement will likely last for 7 to 10 days. But if you take steps to treat the engorgement, usually it will be gone within maybe 24 to 48 hours, at least the worst part of it. So what does treating engorgement mean? It's a couple of very simple steps. The first one is really to try to empty the breasts completely. Again, going back to frequent feeding and to encourage the baby to nurse to finish the first breast first. Don't try to switch breasts in between, but start and let them empty as much as they can. And then only after they come off it their timing, try the other breast. Then start with the opposite one next time. Then you can do a lot with cool and warm compresses. Doing a cool compress in between nursing can help reduce the swelling and reduce the tenderness. And then a warm compress you want to switch to in the 10 to 15 minutes before nursing to help encourage let down and help the breast drain more fully. You can actually get compresses that are made for this purpose that you can warm or you can cool. And they can fit inside a nursing bra. Another thing that can be very helpful are cabbage leaves. There have been a few studies suggesting this and a lot of personal experience people have had just taking a cabbage leaf out of the refrigerator and wearing it as a compress. There seems to something in there that does help. Whatever you do, you may also want some pain relief, something like acetaminophen. And if that's necessary don't hesitate if that's something that's going to keep you nursing because breast milk is the very best thing for kids.
Expect Your Baby to Nurse Often
During the first month:
- Most babies breastfeed every 1 and 1/2 to 2 and 1/2 hours, day and night.
- Babies digest breast milk more quickly than formula. Breastfeeding babies need to eat often.
During growth spurts:
- Your baby will have a growth spurt at around 2 weeks, and then at 2, 4, and 6 months.
- Your baby will want to nurse a lot. This frequent nursing will increase your milk supply and allow for normal growth. Your baby may nurse every 30 to 60 minutes, and stay at the breast for longer periods of time.
- Frequent nursing for growth spurts is temporary. After a few days, your milk supply will increase to provide enough milk at each feeding. Then your baby will eat less often and for shorter periods of time.
You Will Make Enough Milk for Your Baby
Some mothers stop nursing during the first few days or weeks because they are afraid that they are not making enough milk. It may seem like your baby is always hungry. You do not know how much milk your baby is drinking, so you worry.
Know that your baby will nurse a lot when there is an increased need for breast milk. This is a natural way for baby and mother to work together to make sure there is enough milk.
Resist supplementing your baby's diet with formula feedings for the first 4 to 6 weeks.
- Your body will respond to your baby and make enough milk.
- When you supplement with formula and nurse less, your body does not know to increase your milk supply.
You know that your baby is eating enough if your baby:
- Nurses every 2 to 3 hours
- Has 6 to 8 really wet diapers each day
- Is gaining weight (about 1 pound or 450 grams each month)
- Is making swallowing noises while nursing
The frequency of feeding decreases with age as your baby eats more at each feeding. Do not get discouraged. You will eventually be able to do more than sleep and nurse.
Nursing at Night
You may find that keeping your baby in the same room with you, or in a room close by, helps you rest better. You can use a baby monitor so you can hear your baby cry.
- Some mothers like their babies to sleep next to them in a bassinet. They can nurse in bed and return the baby to the bassinet.
- Other mothers prefer their baby to sleep in a separate bedroom. They nurse in a chair and return the baby to the crib.
The American Academy of Pediatrics recommends that you not sleep with your baby.
- Return the baby to the crib or bassinet when breastfeeding is done.
- Do not bring your baby into bed if you are very tired or taking medicine that makes you really sleepy.
Expect your baby to nurse a lot at night when you go back to work.
Breastfeeding at night is ok for your baby's teeth.
- If your baby is drinking sugary drinks and breastfeeding, your baby may have problems with tooth decay. Do not give your baby sugary drinks, especially close to sleep time.
- Formula feeding at night can cause tooth decay.
The 6 O'clock Syndrome
Your baby may be fussy and nurse a lot in the late afternoon and evening. You and your baby are more tired by this time of day. Resist giving your baby a bottle of formula. This will decrease your milk supply at this time of day.
Your Baby's Stools
Your baby's bowel movements (stools) during the first 2 days will be black and tar-like (sticky and soft).
Breastfeed often during the first 2 days to flush this sticky stool out of your baby's bowels.
The stools then become yellow-colored and pasty or seedy with small flecks of digested breast milk in it. This is normal for a breastfed baby and is not diarrhea.
During the first month, your baby may have a bowel movement after each breastfeeding. Do not worry if your baby has a bowel movement after every feeding or every 3 days, as long as the pattern is regular and your baby is gaining weight.
References
Newton ER. Lactation and breastfeeding. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 25.
Rosen-Carole C, Stuebe AM. Practical management of the nursing "dyad". In: Lawrence RA, Lawrence RM, eds. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia, PA: Elsevier; 2022:chap 7.
Version Info
Last reviewed on: 11/10/2022
Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
