Breastfeeding: the first 24 hours
By Sasha Weigel, RN, CLC, CD(DONA)
Congratulations! Your baby is in your arms. What an incredible transformation you’ve just experienced: from one body into two. Now is the time for the two of you two learn, together, how to sustain your baby’s life on the outside. Breastfeeding is something both your body and your baby know how to do. It’s part of the same innate wisdom that knew how to grow and develop your baby when she was on the inside. If you listen carefully, your body and your baby will guide you.
Every time you give birth, you become a new mother, whether this is first baby or your fifth. You are a new duo, and you face the learning curve together. This first 24 hours is all about discovering the nuanced dialogue between your baby and your milk supply. In future weeks, you will hone this dialogue.
- Awake and alert:
For about the first 2 hours following your delivery, you will find that your baby is more active and alert than at any other point in the first 24 hours. Of course not all babies follow this pattern, but most do. You’ll likely discover, that really your energy level peaks within about 2 hours of delivery as well. You may feel energized, overwhelmed, in awe and wonder- or any other range of emotions during this time. But likely your desire to stay awake and take in all this newness will match your baby’s for these first couple of hours before your baby enters her sleepy phase that will last until about 24 hours of life. So these first couple of hours is the optimal time, often dubbed the Golden Hour(s), to begin trying to breastfeed.
- The crawl:
Depending on where you deliver, you may or may not be offered breastfeeding support. You may be taught any number of ways to initiate breastfeeding. If you wish and are able, this is the perfect time to allow your baby to crawl to your breast on her own. It’s a slow process, and it can be hard to sit on your hands and be patient. But, she knows exactly how to get there and will make her way at her own speed (generally takes 30-60 minutes). Here’s a video link of what the breast crawl can look like. If you’re given a limited time with your baby before she’s taken from you for her routine assessment or to the nursery for bathing, you may wish to save the crawling for another time and instead help her to the breast.
- Wait to introduce your baby to family:
During these first few hours while the baby is her most alert, she will likely latch more efficiently and effectively than during any other time during the first 24 hours. So instead of passing her around for family members to meet, which is of course very important, keep her on your chest. Use this time while she’s most awake to try breastfeeding. After the first two hours are over, she’ll likely relax into a long sleep/rest cycle that lasts nearly 24 hours. That time is the perfect time for the cozy arms of family and friends.
- Settling in & stimulating production:
For this first breastfeeding effort, the most important aspects are establishing the bond that is created by breastfeeding and for your breasts to be stimulated. By having your baby on your chest, the warmth of her body, the activity of her hands and arms as they brush your breasts, and her first attempts to suckle, all send the message to your body to begin producing colostrum. Remember it’s a supply and demand system. The more stimulation to a breast, the more colostrum it will produce. This is also the time the baby begins imprinting and taking in her new world through all of her senses. Since her new home is your chest, this early time together can her orient to her new home and help her get settled in.
The least important aspect during this time is nutrition for the baby. The baby has been infused by the placenta with enough nutrients to last nearly 24 hours. * Note: If you have a history of diabetes or gestational diabetes, or if your baby is over approximately 4000g or under 2500g (this varies by different hospital protocol), your baby will likely be under strict surveillance and encouraged to obtain nutrition more quickly. However, if your baby is within what’s considered the Appropriate for Gestational Age (AGA) range, then there’s no rush to feed her and you can await her cues as to when she’s hungry.
- The left breast:
For your first breastfeeding attempts, try the left breast first unless your baby has crawled to your chest and chosen for herself. Babies often prefer the left. The dominant theory is the babies like being closer to the mother’s heart.
- Switching sides:
If she’s successfully latched, don’t worry about switching sides at this point. You can always massage the other breast to begin stimulating it as well. The production of colostrum will even out very quickly.
- Preferred side:
Babies often have a preferred side. It may or may not be the left side. Which side is preferred becomes apparent over the course of the first few weeks, but may start as early as the first day of life.
- No latch?:
It’s fine if your baby has decided to spend her Golden Hours, just after delivery, on your chest but has not yet shown interest in breastfeeding. As mentioned above, she will likely have settled in at this point and begun her deep restorative sleep/rest phase that generally lasts the remainder of the first 24 hours. As long as she’s spent some time at your breasts, providing stimulation from her warmth and movement there, then she is doing everything right, as are you, and there is nothing to worry about. If she were hungry during this time, or eager to try suckling, she’d let you know.
- Sleepy baby:
Depending on where you deliver, who your provider is and who your support people are, you may be encouraged to attempt to breastfeed every few hours following delivery. As discussed, babies tend to be very sleepy during this phase up to about 24 hours of life. They are in recovery mode, just as you are from your birth experience. They have enough nutrients from the placenta to essentially hibernate for this day. Regardless, you may be told that feeding every 2-3 hours is optimal for the baby and for the stimulation to your breasts. If this is the case, try to wake your baby by: unwrapping her if she is swaddled, holding her upright (support the head!), then place her skin-to-skin and manually express a drops of colostrum to put on her lips. Sometimes gently blowing on her face is effective. Because scent is her strongest sense at this stage of development, her proximity to your nipple and the scent of colostrum, may wake her and peak her interest. If not, keep massaging your breast, expressing colostrum and tickling her lips with your nipple and see if this elicits a response. If she is still sleepy after these efforts, you can rest assured that you’ve stimulated your breasts and given it a good try. Let her sleep and try again later.
- Do I have enough?
Yes, you do. You made a baby so you will make colostrum. Colostrum is a thick, concentrated and highly nutritive substance composed of pure fat and protein with very little water content. Only a small amount is needed to sustain the nutrition needs of your infant. Even just a few drops can suffice in the very beginning. If you feel like you’re not making much volume, you’re correct. There simply isn’t a large supply yet. Not to worry, your body just needs to be told how much to make, and it will. As mentioned, it’s a supply and demand system. It’s expected that your breasts will have limited stimulation in the first 24 hours because of the baby’s need to rest during this time. But even having her on your chest while she sleeps is stimulating to your breasts and sends the message to begin making more colostrum. You can also massage your breasts, stand in a warm shower or use warm packs on them for stimulation. Some mothers like to begin using the breast pump during this time to activate their production. None of this necessary, however. As soon as your baby has sufficiently woken up after the 24 hours of rest, there will be plenty of opportunity to get your supply flowing.
- Sleep when your baby sleeps:
Even though there is so much to process and contemplate after delivery, it’s very important that you try to rest. You have your lifetime to relive and discuss your birth experience, but only so long before your baby wakes up and is ready to begin breastfeeding around the clock. You need to take your rest seriously. Sleep and nutrition help increase your colostrum supply. If you don’t feel tired yet it’s because you’re flooded with hormones that make you feel alert and awake. However, your body just went through its greatest physical feat of a lifetime and needs sleep to recover and rejuvenate for the next phase: taking care of and feeding your infant. Part of the design of having a tired baby for the first 24 hours is so that you can rest too.
- Stay hydrated:
The more you drink, the more colostrum, and ultimately milk, you will make. During pregnancy, your body doubles it’s blood volume and amount of fluid on board. Now that you’ve given birth, your body will begin diuresing, or letting go of fluids. This means you’ll be sweating and urinating frequently. You may notice that your hands and feet swell a bit. Again, that’s a product of the movement of fluids in your body, sometimes called a fluid shift. Because you’ll be eliminating so much fluid as a part of this normal process, just make sure you’re taking in more than you are accustomed to. Whether you are thirsty or not, drinking fluid is imperative for the health of your body and your production of colostrum.
- My baby isn’t sleepy:
There are exceptions to every rule, especially when it comes to pregnancy, childbirth and babies. We like to hope that there is a formula behind everything that drives the reproductive process, but as soon as we attempt to point out a pattern, rule or formula, then we as soon notice an outlier. So, after all of the above discussion regarding a sleepy first 24 hours, you may end up having a baby who is alert, active and never settles down into that long rest. She may want to latch from the start and keep on going. If this is the case, your breasts will receive an early message to begin production, and your milk supply may end up coming in sooner as a result (usually day 3-4). Remember to sleep when your baby does choose to sleep, as you may not have had a very substantial break between giving birth and beginning your new task of full-time breastfeeding.
- Feeding cues:
Whether or not your baby had a long rest period following birth or began breastfeeding straightaway, what you are ultimately waiting to observe are your baby’s feeding cues. If she’s hungry, she will begin sticking out her tongue, and making smacking noises with her lips. She may turn her head toward whichever side is touching her, feels warmest or smells like colostrum. If you tickle one of her cheeks, she will move in that direction. Her eyes will be open and she will seem more alert and engaged than usual. Try to get her to the breast right away. If she doesn’t receive the breast soon, she may become agitated from hunger and begin crying. It’s a challenge to latch a crying baby.
I hope these pointers are useful to you as you embark on your breastfeeding journey with your baby. If you ever have questions or could use a little support, please feel free to reach out to Baby Caravan for lactation support. There are also many local resources to help. You can look up Le Leche League chapters here. Cheers!