Breastfeeding Expectations During the First 24 Hours

Breastfeeding in the first 24 hours of my newborn's life was one of the greatest joys of my life. It was also very difficult. Much more difficult than I had anticipated.

As I looked down at the newest member of my family that I had waited so long to meet, I was overwhelmed with gratitude. After a few minutes of gazing at her tiny form, my mind turned to overwhelm. How was I going to feed this baby? Take care of her? How am I qualified to do this?

As her tiny body snuggled against mine, all of those overwhelming thoughts started to melt away. 

Although the beginning few hours and days of her life were a blur, I still remember those first minutes more than 10 years later. Even though I didn't completely understand it at the time, the first few hours are so important for establishing a healthy breastfeeding relationship.

In this article, we will look at what makes this time so important. 

Expectations the First Few Hours

The first few hours of a newborn's life are a whirlwind of activities. After labor and delivery, your baby will go straight to your chest for skin to skin time during the golden hour. Your newborn should feed within the first hour of life and then undergo medical interventions such as their first exam, eye ointment, Vitamin K injection as well as weight and other measurements. 

After this initial alert time of about an hour or two, a newborn will often go into a long period of deep sleep. If you think about how difficult labor felt for you, imagine how much more your baby has been through. Whether your baby was born prematurely or full term, they will generally be pretty sleepy for the first 24 hours after birth.  

Engaging in skin-to-skin contact is highly beneficial for both mother and baby during this time. It helps regulate the baby's body temperature, promotes the release of hormones that aid in breastfeeding, and facilitates bonding. After the initial recovery period, skin to skin contact with your newborn will continue to encourage the baby to engage in more frequent feeding. Additionally, with the baby on your chest you will be able to recognize their early feeding cues more easily.

Despite your baby's sleepiness, it is imperative during the first 24 hours of life that you attempt to latch and feed your baby every few hours. Breastfed babies require frequent feedings during the first day to maintain their metabolic processes.This process is also important for establishing your milk supply as a breastfeeding mother. 

Early Breastfeeding Establishes Supply 

While breastfeeding is entirely under the control of hormones for the first 9 or so days postpartum, feeding your newborn often in the first few days of life will help you to establish your milk supply. Early and frequent feeding during this time will increase prolactin receptors at the level of the breast. More prolactin receptors cause the breast to make more milk in the following weeks of breastfeeding. 

Another piece of successfully establishing your milk supply is to feed your new baby on demand. This means at least 8-12 times in a 24 hour period. In the early sleepy hours of life, this may also mean gently waking your baby for a feeding if they are not waking on their own. Newborns should feed as often as possible in the early hours of life. In addition, you do not need to limit their time at the breast as long as they are feeding effectively. 

Another important step is to pay attention to your new baby's hunger cues. Early feeding cues include behaviors such as rooting, sucking on their fist, or making sucking noises. By responding to these cues and offering your breast, you help establish a healthy breastfeeding routine.

Breastfeeding at night is also extremely important for establishing and maintaining milk supply. Nighttime feedings stimulate the release of hormones that aid in milk production. Prolactin levels are highest in the early morning hours. Your milk supply will be highest during this time of day. 

Remember, establishing your milk supply will take time and patience. With frequent breastfeeding and responsive feeding, you are providing your baby with the nourishment they need and promoting a healthy breastfeeding relationship. Seek support from lactation consultants or healthcare professionals if you have any concerns or difficulties along the way.

Common Early Breastfeeding Problems 

Several problems are common to breastfeeding mothers in the first 24 hours postpartum: 

• Sore nipples: some amount of discomfort can be normal, but pain that is not going away or is accompanied by nipple damage likely means that your baby is having trouble latching correctly.  
• Recovery from a cesarean section (c-section) may present additional challenges. The recovery process and incision site can make finding a comfortable breastfeeding position difficult. 
• Medications given during labor, especially pain relievers, can also have an impact on the baby's alertness and feeding patterns. 

Tips for Surviving and Thriving in the First 24 Hours

Here are some helpful tips and strategies for the first 24 hours of breastfeeding:

1. Breastfeed within the first hour: Initiate breastfeeding as soon as possible after delivery. This early skin-to-skin contact will stimulate the baby's natural feeding reflexes.

2. Be persistent in offering the breast: Even if your baby is not showing immediate interest or latching well, keep offering the breast frequently. Both you and the baby need to practice in order to get into a good feeding rhythm. 

3. Skin-to-skin contact: Keep your baby in skin-to-skin contact with you as much as possible. This promotes bonding, helps regulate the baby's body temperature and blood sugar levels, and encourages their desire to breastfeed.

4. Avoid pacifiers and bottles: In the first 24 hours, it's important to establish breastfeeding before introducing pacifiers or bottles. 

5. Frequent feedings: Newborn babies have small stomachs. They will need to eat frequently as colostrum volume is generally 5-10 ml (or 1-2 teaspoons) every few hours. (The amount of each feeding differs from baby to baby and mom to mom.)

Offer the breast whenever your baby shows hunger cues, such as rooting or sucking on their hands. Crying is a late sign of hunger. Recognizing early hunger cues helps stimulate your milk supply. It also ensures your baby gets the required nourishment.

6. Consult a lactation professional: It is always a good idea to seek the opinion of a professional who can evaluate your baby's latch and offer support. 

Remember the first 24 hours of breastfeeding are challenging. However, with patience, persistence, and support, you can establish a successful breastfeeding routine for you and your baby.

Do I Put My Baby on a Feeding Schedule?

Some mothers worry that if they don't start a schedule right away, their babies will never adhere to a routine. Thankfully, that is not true. 

During the first few weeks of your baby's life, it is not necessary to follow a strict newborn feeding schedule. Newborns have small stomachs and require frequent feedings to meet their nutritional needs and promote healthy growth. Instead of adhering to a set schedule, it's important to pay attention to your baby's hunger cues and feed them on demand.

The frequency and duration of breastfeeding can vary greatly from one baby to another. Some babies may want to feed every hour, while others may go longer between feedings. It is perfectly normal for breastfeeding patterns to vary throughout the day and night. If you try to impose a rigid feeding schedule you can interfere with your baby's natural feeding instincts. This can hinder the establishment of a successful breastfeeding relationship.

The first several weeks of breastfeeding are a full time job. 

The Pain of Breastfeeding 

While breastfeeding is a natural and beautiful way to nourish your baby, it is important to acknowledge that some women experience pain in the early hours of breastfeeding.  Many mothers have some tenderness or sensitivity in the first 24 hours. Pain that does not go away after the feeding or that is accompanied by nipple damage is not normal.  

If you are experiencing this kind of pain during breastfeeding, it is likely due to an improper latch. A correct latch is essential for your baby to effectively extract milk as well as for you to feel comfortable. Look to see if you are getting a deep latch by observing how much breast tissue is in your baby's mouth at each feeding. Your baby needs to latch with a wide open mouth, flanged lips and grasp a majority of the areola and not just the end of the nipple. 

A second cause of pain associated with breastfeeding is uterine cramping. This is a normal occurrence for most breastfeeding mothers in the first hours and few days postpartum. Oxytocin is the hormone that is responsible for causing milk letdown. Additionally, it is the hormone that is responsible for uterine contractions. This is the reason why breastfeeding mothers are less likely to have a postpartum hemorrhage. Thankfully, this phenomenon only lasts the first couple of days at most. It is also a great sign that your baby is extracting milk well. 

How Do I Know My Baby is Getting Enough Milk? 

One of the common concerns for new breastfeeding mothers is whether their baby is getting enough breast milk. While it is not possible to measure the exact amount of milk your baby is consuming through direct breastfeeding, there are ways that you can track their input.  

• Wet Diapers: One of the first signs to observe is the number of wet diapers your baby has in a 24-hour period. In the first few days, your baby should have at least one wet diaper per day of life (e.g., one wet diaper on day one, two wet diapers on day two, and so on). By the fourth day, your baby should have around six wet diapers or more per day.
• Gaining Weight: Weight gain is another important indication. Most newborns lose a small amount of weight in the first few days after birth, but their weight should start to stabilize towards the end of the first week of life. Then, they should regain their birth weight by two weeks of life. Generally, a newborn should gain around 5-7 ounces per week after the first two weeks of life.
• Happy and Settled Baby: Another sign of adequate intake is that your baby seems satisfied after a feeding. Your baby will latch, have audible sucks and swallows and feed for several minutes at a time. Often, they will nurse from both breasts or maybe just one in the early days. Your baby should be relaxed after a feeding. 

Do your best to avoid using a breast pump or supplement with infant formula too soon. If your goal is to establish breastfeeding, be vigilant to your baby's signs of hunger and offer your breast as often as they want to eat in the early weeks of age. 

Additionally, ask for help sooner rather than later. Skilled breastfeeding specialists can save you from heading down the wrong path in your breastfeeding journey. 

Enjoy Every Moment

These first few moments of your newborn's life go by so quickly. In addition to keeping up with feeding sessions, enjoy the early days of breastfeeding. 

If you are looking for a way to communicate your breastfeeding desires to hospital staff, be sure to download My Breastfeeding Plan. It is a customizable plan that will assist you in making your breastfeeding desires known. 

© 127 Pediatrics; November 2023

This article is for informational purposes only and should not be construed as medical advice.

Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls only pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.