You and your baby each have a lot to learn, and the way you learn is by practice. You are learning how to position your baby and how to present your breast. Your baby is learning how to correctly grasp your nipple and areola, how to extract milk, how to suck and swallow and breathe without choking, and how to soothe and pacify herself at your breast. Until your milk comes in abundantly on about the third day, your baby may obtain only a couple of teaspoons of milk when she nurses. Instead of waiting an arbitrary number of hours between feedings, plan to offer your breast as often as your baby shows interest (see Infant Signs of Readiness to Feed below) in order to give your baby as much breastfeeding practice as possible. Expect to nurse your baby at least eight, and as many as twelve, times each twenty-four hours during the first month. If your baby doesn't wake or demand to nurse after about three and a half hours have elapsed since the beginning of the last feeding, you should try to arouse her. Ideally, your baby will be with you in your hospital room, but if she must stay in the nursery, request that she be brought to you whenever she stirs.
Infant Signs of Readiness to Feed
Many new parents expect their baby to cry when she is hungry. Few realize that crying is actually a late sign of readiness to feed. If you wait until your baby is crying loudly before you prepare to nurse her, both she and you may experience unnecessary frustration if you are unable to satisfy her need fast enough. Worse yet, some babies become exhausted from crying too long and end up nursing poorly by the time they are brought to the breast. Instead of waiting for your baby to cry, look for earlier, more subtle clues that she is ready to nurse. Babies signal readiness to feed during arousal from sleep, by increased alertness, flexing their extremities, bringing a hand to their mouth, turning their head, or moving their mouth or tongue. One or more of these signs can usually be observed long before the baby cries out loud.
Early Infant Elimination Patterns
The first bowel movement your baby passes, known as meconium, will look tarry black and is present in the baby's intestines during fetal life. Because colostrum is a natural laxative, frequent nursing will help expel the meconium. During the hospital stay, your baby's stools may change to a greenish-black. As the volume of milk your baby drinks increases, his bowel movements will turn yellow-green. By the fourth or fifth day, they should look yellow-gold, with little seedy curds, and the number of movements should increase to four or more each day.
Your baby may urinate only a couple of times a day on the first two days when the volume of colostrum he drinks is low. Once your milk increases in abundance (around the third day), he obtains a greater volume with each feeding, and the number of wet diapers increases to six to eight each day. Begin during your hospital stay to notice your baby's elimination habits. Keeping a record of your baby's feeding times, wet diapers, and bowel movements can be very helpful in monitoring his progress with breastfeeding.
Burping Your Baby
All babies swallow some air during feeding. Although many will burp easily without any special positioning, most parents make a ritual of helping their baby burp after taking the first breast and at the end of the feeding. A few babies need to be burped more often to remain comfortable. Trapped air in the stomach can cause a baby discomfort, making him restless partway into the feeding. Releasing the air may allow a baby to proceed with feeding more comfortably. A bubble of air in the stomach also can make a baby feel full too soon and cause him to stop feeding before he has taken enough milk. Burping the baby after the first breast not only makes room in the stomach for more milk, but the positioning and handling involved in burping can help arouse a sleepy infant to take the second side.
If your baby is sucking well, don't interrupt him to burp. Rather, take advantage of natural pauses for burping and use the time to socialize with your baby as you gently pat and stroke him.
Several good techniques are suitable for burping your baby. My favorite position for burping a newborn is to sit the baby upright on your lap, with your hand cupped under his chin to support his chest and head. Lean him forward slightly while you rub and pat his back. If he doesn't burp after a few minutes, you don't need to persist in your efforts. Another popular position is to support your baby upright over your shoulder (protected with a cloth diaper) and pat his back. Or you can lay your baby across your lap, with his head slightly higher than the rest of his body, and gently rub and pat his back.