Baby's can be very sleepy during their first week of life which can make nursing difficult. After all, they did quite a bit of work getting into this world, just like you did. They're recovering, therefore they may refuse to nurse or may fall asleep right after starting. If you took any pain medications during the labor this may add to the sleepiness and their general interest in eating. You'll see how the nurses wrap your little baby tight like a burrito, making them feel nice and secure, which also contributes to their sleepiness - they feel so comfortable and safe it just makes them want to take a cozy little nap! If your baby was born with jaundice, this may also contribute to sleepiness. A sleepy baby still needs to eat or he/she wont thrive and while you may feel bad about having to wake them every three hours (as you should be doing, round the clock with a newborn), its now time to be a momma and feed your little bird (I called my son this all the time, my "baby bird," because he would always open really wide when he got hungry, like "feed me momma!"). Eventually, after he/she is less sleepy, you can start feeding on "demand" rather than having to wake him/her. If you aren't waking the baby up frequently to eat, you will not only interfere with your baby's nutritional needs, but your milk production and supply, and if your baby has jaundice, frequent feedings are necessary to help minimize that.
Tips on waking a sleepy baby:
1. Unwrap your baby from his blanket and strip him down to his diaper.
2. Dim the lights and sit him up on your lap while quietly talking to him. You can burp him at this time, too. Holding a baby upright will usually get them to open their eyes. Once he opens his eyes, make some eye contact with him and talk to him in a lively voice.
3. Stroke the baby's forehead with a cool (not cold) washcloth to help him wake up. Also, try stroking the bottom of his feet or the palms of his hands. You can try to rub his arms, back and shoulders or even move his arms around.
4. If your baby falls asleep soon after latching on, use the side-lying position to encourage longer nursing sessions. You can also try the football hold, but its not quite as effective as the side-lying position.
5. Burp the baby in between breasts.
6. Change his diaper is needed.
7. If your baby will not stay awake, try again in 30 minutes. You may want to try putting a little bit of milk on their mouth, stroking their mouth with your nipple or jiggling your breast a little bit (I know, it sounds weird, but trust me, you'll do whatever you need to, to try and wake him!).
8. Avoid pacifiers, nipple shields, and bottles.
9. Let your physician know if your baby will not get with it after you've tried for 5 - 6 hours.
Bowel Movements of the Breastfed Baby:
As you may know, the first dirty diapers you'll see are filled with meconium - the dark, tarry poop. A few days after birth, after your baby has eaten a few feedings of colostrum, his poop may change to a greenish-brown or brownish-yellow color. Once your milk comes in and the baby is nursing well you'll see a more yellow colored poop. Yellow poop by the 5th day after birth is a good sign that your baby is getting enough milk; if his poop is still dark, he may not be getting enough milk. You will probably see a few BM's a day. They will be soft and appear seedy (or maybe curdled) and have a sweet, cheesy odor (I literally could not each Mac and Cheese the entire time I was exclusively breastfeeding, it grossed me out so much). This is normal and is not diarrhea. Your baby may poop and it will go unnoticed, or you may find that he grunts, fusses, his face turns red...all normal; this is not constipation. A breastfed baby will not encounter constipation problems.
Jaundice:
If your baby has jaundice, you'll notice a yellow color to his skin and eyes. Jaundice will be visible in about 1/3 of babies by the fourth day. It is due to an elevated level of the wast product bilirubin in the blood, caused by the baby's immature liver. Bilirubin is a substance normally produced during the breakdown of red blood cells (these cells will only live a short time before they are destroyed and bilirubin is made). Bilirubin is then processed through the liver and eliminated in the stool. While you're pregnant, your liver processes bilirubin for the baby, but after the baby is born, his liver has to learn how to do the job, which can take a few days. During this time, it may rise in the blood (this normal rise is physiological jaundice). If the levels are really high, your baby may need light therapy (I was a jaundice baby and received light therapy).
Jaundice appears more in babies whose mothers are diabetic, who lose a lot of weight after they are born, in premature babies, and in babies that were brought into the world via induced labor (usually from drugs like pitocin). It is also common in babies who have any bruises from the birthing process or who are sick right after birth. Twins are also susceptible.
There are 3 types of neonatal jaundice:
1. Physiological Jaundice - This is the most common type of jaundice and about 40% of babies develop it. Yellowing may begin on the second or third day and will peak by day five. It will usually be diminished by a week to ten days.
This can be different for premature babies, who have an onset around three or four day and will last around two weeks or more (this is due to their livers being extremely immature).
Mild to moderate jaundice will usually go away on its own and it doesn't hurt the baby. Colostrum is important in breaking down the bilirubin levels, so if a baby isn't eating frequently, a baby may become jaundice. Colostrum will help a baby eliminate meconium and if the baby isn't eating enough, meconium is retained in the bowel and bilirubin cannot be eliminated as needed.
A baby with high jaundice levels will usually have to stay in the hospital a few days for observation and phototherapy treatment. Your baby will wear only a diaper, their eyes will be covered, and they will be given fluids. You may be given a fiber-optic blanket that will wrap around that baby's middle, which will allow the baby to go home. It is rare that a baby's bilirubin levels will increase, but if they do, then it is probably not physiological and will require further treatment to prevent a buildup of the substance in the brain (this is called Kernicterus). Kernicterus, if left untreated, can lead to permanent brain damage or death.
2. Pathological Jaundice - This is a more serious type of jaundice. ABO incompatibility occurs when the mother's blood type is O and the baby's blood type is A,B, or AB. When you're pregnant, maternal antibodies cross the placenta, break down the red blood cells, and cause more bilirubin to be produced in the baby after birth. This type of jaundice may need immediate treatment in the neonatal unit.
3. Breast-Milk Jaundice - this is only suspected when bilirubin levels rises fast late in the first week (around the fifth day) and non-physiological jaundice has been ruled out. It usually lasts four to six weeks, but can go on for eight to ten. If jaundice seems to be ongoing past the first week, this is probably the cause. This is believed to happen due to a substance in the breast milk of some women that interferes with the breakdown of bilirubin. It usually clears on its own, without stopping breastfeeding; in fact, you should continue breastfeeding 8 - 12 times a day. "Since 1994, the American Acdemy of Pediatrics has recommended a different approach: healthy, full-term babies over 72 hours old with bilirubin levels below 20 milligrams per deciliter should be nursed frequently, at least 8 times every 24 hours, and should receive no water supplements."
Difficult Latch-On - Refusal to Nurse and Sucking Issues:
I discussed some latch issues and what you can try here:
http://mommadoulamn.blogspot.com/2011/06/what-you-may-experience-during-your-1st.html
When trying to get a baby to latch on properly or if they are refusing to nurse, keep trying in short, frequent sessions. The process can sometimes become frustrating and upsetting; if you or the baby needs a break, take one. Avoid pacifiers, rubber nipple shields, or bottles (unless of course, 24 hours after birth, your baby hasn't latched on - you should pump milk at least 8 times a day in this case).
If a baby has already begun nursing you may find that suddenly they only want to nurse on one side, or sometimes they don't want to nurse at all. If your baby has been given a pacifier or a bottle he may become "nipple-confused." Babies that become nipple-confused will likely start nursing again if you keep trying for a few hours. Of you can try the above tips.
If your baby hasn't started nursing yet (24 hours after birth) and is having difficulty latching and sucking there may be a problem:
Recessed jaw: a very recessed lower jaw can be seen in a baby's profile. A baby with this issue can only latch on if his chin reaches the breast before his upper lip. If your baby can't do this, then he can't take enough breast tissue into his mouth. Make sure you aren't engorged, tilt the baby's head back just a little as you bring him to your breast (chin touching the breast first). Baby's with a recessed jaw can overcome the issue and learn how to latch correctly with time. Just be patient. In the meantime, while the two of you are learning the proper latch, you should pump.
High Palates: when the roof of the baby's mouth is too high he will have trouble compressing the breast against the palate to express milk. This baby may not be gaining weight very well. If the roof of your baby's mouth is hard to see without looking up from his chest, or if it appears to be deeper than the curve of a teaspoon, your baby's palate may be too high. Try to get your baby to suck on your little finger (nail down) and feel for a loss of suction between your finger and his tongue or your finger and the roof of his mouth aren't firmly touching. Your baby may also be tongue-tied. Use an electric pump after each feeding to up your supply and usually, after a few days he will start to swallow more and gain weight. You'll have to do this for a few weeks or your baby wont be able to get enough milk. Use the football hold.
Tongue-tied: this occurs mostly in males. The tissue that attaches to the underside of the tongue is too short or is connected too close to the tip of the tongue which makes it hard for the baby to extend the tip of the tongue past the bottom lip. He may have a hard time latching on to the bottom of the mother's nipple. You may find that the baby can latch onto one breast, but not the other and you may hear a clicking noise when he sucks. Your nipples may hurt even when the baby is correctly positioned. The tissue (frenulum) should be clipped to release the tongue and it only takes a minute.
Protruding tongue: these babies will have tongues that look longer than normal. The football hold is recommended for babies with this issue. If you get the baby on the breast be sure he is sucking and not coming off the breast easily. You should hear long, drawing sucks, and you should hear him swallowing.
Tongue sucking: some babies suck on their own tongues. If you notice that your baby falls off the breast after a few sucks, their cheeks dimple in when they suck, and/or you hear clicking noises, your baby may be sucking on his tongue. These babies will have little suction and fall off the breast easily. They will only get the milk that drips into their mouth. You can also look in their mouth when they are crying or rooting and see if he is curling his tongue toward the roof of his mouth. When he opens wide and his tongue is down, try to get him to latch on. The cross-over and football holds work the best. Most often, a baby who has lost around a pound after birth will develop this issue. You should pump and bottle feed for 1 - 3 days, get the baby to gain a few ounces and rehydrate, and start over.
Night Waking:
http://mommadoulamn.blogspot.com/2011/06/night-waking.html
Underfeeding & Weight Loss: one of the most common thoughts among mothers is whether or not their baby is getting enough to eat while breastfeeding. Some will offer a bottle after a nursing session, thinking that if they drink that, they must have still been hungry, therefore they aren't making enough milk for their baby. This isn't the case. Most babies will take a few ounces out of a bottle if it is offered, even if they just ate. Others are nursing 8 - 12 times in 24 hours and the mother will think that seems excessive and wonder if the baby is over-hungry. 8 - 12 times a day is normal. Some issues can cause a baby to lose weight, such as a baby who hasn't learned to latch on, a baby who isn't nursing frequently enough, a mother is using a nipple shield, a baby who has bad suction, or a baby who is ill. If a mother takes any laxatives after birth, that can cause the baby to have too many bowel movements and lose too much weight.
Your baby is getting enough milk if:If you and your baby aren't covering all of the above you should have him weighed and examined. After the fifth day after birth, your baby should gain 1 ounce every day. A loss of 10% or more of a baby's birth weight indicates that the baby isn't getting enough to eat.
- You milk came in by the third of fourth day. You may notice your breasts are firm and heavy (engorgement).
- Your baby is nursing 8 - 12 times (every 2 - 3 hours) in a 24-hour period. He/she may sleep a 4 hour stretch at night, but no more.
- Your baby is nursing 10 - 45 minutes at each feeding and seems content (maybe fall asleep) afterward.
- Your baby swallows several times during each feeding. You will hear long, drawing sucks, with a gulp or big swallow. You may notice 5 - 10 sucks and then a pause.
- Your breasts feel softer after each session.
- Your baby is producing around 5 seedy looking diapers everyday and by the fifth day the color is yellow. After the first month it is normal for a baby to go a few days without a dirty diaper.
- Your baby is wetting more diapers by the fifth day. A baby who urinates more than 8 - 10 times a day is getting adequate fluid. Urine should also be clear. Abnormal urine is: yellow, possibly fishy smelling, and/or contains urate cyrstals.
Make sure you:
- Are frequently feeding
- Draining at least one breast at each feeding
- Don't limit time at the breast - don't switch sides after only 5 minutes. Watch your baby, not the clock.
- You know what kind of nipples you have and how to get a baby to latch on it you have flat, dimpled, or inverted nipples.
- Are burping baby between breasts
- You aren't letting your baby go more than 4 hours in the night without a feeding
- Don't sleep on your stomach
- Don't do too much too soon
- Don't have any left over placental fragments in your uterus
- See a lactation consultant
- Get an electric (no other pump will work for this) breast pump and measure out what what you are producing. You can also increase your supply this way. Pump each breast twice, one at a time, for a total pumping time of 20 - 25 minutes. If you are double pumping, pump for 12 - 15 minutes. Feed this to your baby. Exactly two hours later, pump again. Multiply the number of ounces you got at the second pumping by 12. This will give you an estimate of how much milk you are producing over a 24-hour period.
- You will need to then figure out how much milk your baby needs and figure out if you're producing enough.
- After you figure out your milk production, go back to nursing. Be sure you're nursing at least 8 times in 24 hours. Remember, you may need to wake your baby up.
- You should pump after each nursing to stimulate further milk production. Pump each breast, one at a time, for 5 minutes each. Then return to each breast one more time for a few minutes. Use a double-pump for 5 - 10 minutes after each nursing. Feed the baby any milk you collected along with formula. If your baby needs formula, divide the amount of supplement needed daily by the number of feeding the baby is getting each day. If your baby needs 5 extra ounces a day (of formula due to you not being able to produce those ounces on your own) and eats 8 times a day, you will need to give a little over 1/2 ounce at each feeding. You should offer the same amount of breast milk and formula at each feeding.
- Many women have used fenugreek with great success to stimulate their milk production. You can take it in capsule form or make a tea. You can find this in most health-food stores. Taking 2-3 capsules a day should up your supply in 1-3 days. They are also inexpensive - usually under $10 for a large bottle.
- Weigh your baby every few days to make sure he's gaining weight. You will need to re-estimate his intake needs after each weigh-in. Two hours after your last pump, express your milk instead of nursing and re-estimate your production.
- Once your baby is gaining well and you are supplementing with only breast milk you can try to eliminate formula. Off your baby only half of the milk you expressed and freeze the rest. If your baby is continuing to gain weight over the next few days, continue pumping, but don't offer any of the expressed milk. If he is gaining an ounce a day without any supplementing and only breastfeeding, you can stop pumping and have your baby weighed weekly.
(Some information gathered from The Nursing Mother's Companion 4th revised edition by Kathleen Huggins, R.N., M.S.)
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