Stages for establishing breastfeeding
Lactogenesis phases
It may seem surprising, but from the 5th-6th month of pregnancy, you may already have a small amount of breast milk. This stage is called lactogenesis I. And after delivery, lactogenesis II will arrive, with an abundant production of breast milk, popularly known as “milk coming in.” And finally, there will be galactopoiesis or lactogenesis III, which is the process that maintains the production of milk once breastfeeding is established.
Unlike other mammals, lactogenesis II or milk coming in begins a few days after delivery. These days represent a critical period for breastfeeding, as this is when many of the difficulties with breastfeeding originate.
Regulation of milk synthesis, secretion, and expulsion
Although the maternal hormonal changes that occur postpartum trigger the milk coming in, frequent sucking and emptying of the breast are also important. When we talk about the production and ejection processes, several regulatory systems are at play, all strongly influenced by the baby’s sucking and other stimuli on the nipple.
Prolactin
During pregnancy, in response to increased levels of estrogen and progesterone, the pituitary gland produces prolactin. This stimulates milk production. However, during pregnancy, it remains inactive because progesterone and placental lactogen prevent prolactin from binding to its receptors (competitive binding). After delivery, the levels of these two hormones decrease rapidly, and the action of prolactin is no longer blocked, initiating breast milk secretion.
After delivery, prolactin release occurs in pulses after various stimuli, the most effective being nipple sucking. The maximum peak of plasma prolactin concentration occurs approximately 20-30 minutes after sucking, so its most important effect is to produce breast milk for the next feeding. Hence the saying, “the more sucking, the more production.” This effect is of particular importance when breastfeeding is being established, since after a few weeks there is no relationship between the amount of prolactin and the amount of breast milk produced.
Oxytocin
Oxytocin is released in response to nipple stimulation, by sucking or manipulation; and in response to pleasant physical, visual, auditory, or emotional stimuli, generally related to the baby.
This process occurs continuously during sucking and refills the ducts as they empty. It is important to keep in mind that stress, anxiety, and other sudden unpleasant physical stimuli can block the oxytocin ejection reflex.
Other regulatory factors
The retention of breast milk inside the alveoli increases intra-alveolar pressure, affecting the function of the alveolar cells. It can also compromise vascularization and hinder hormonal arrival, slowing down milk production when the breast is full or there is no effective drainage of the gland.
Your baby cancels these inhibitory effects by adequately emptying your breast. In this way, the production of breast milk adapts to the needs of your baby, from one feeding to another and independently for each breast.
Lactogenesis II: Milk coming in
As we mentioned, the beginning of lactogenesis II or “milk coming in” occurs after the sharp postpartum drop in progesterone and placental lactogen. During this phase, the synthesis of the components of breast milk increases, causing the breasts to increase in size and be warm and painful. There is no relationship between the intensity of the symptoms and the subsequent production of breast milk.
Clinically, the “milk coming in” occurs around the third day postpartum, but up to 25% of mothers perceive the milk coming in after 72 hours. At that time, your baby extracts about 20 cc of breast milk at each feeding.
Factors that favor lactogenesis and breastfeeding:
- Early skin-to-skin contact between mother and child.
- Initiating breastfeeding in the first hour after delivery.
- Frequent breastfeeding.
- Good mouth-to-breast latch.
- Adequate emptying of the breast.
- Early and frequent sucking in the first days.
- Obesity and poorly controlled insulin-dependent diabetes influence the delay in the “milk coming in” that is observed in diabetic and obese mothers.
- Retention of placental remnants, due to the presence of progesterone and placental lactogen, can inhibit lactogenesis II.
- Difficult deliveries and stress are another cause and the one most associated with early abandonment of breastfeeding. In the mother, stress acts by blocking the oxytocic reflex; in the infant, it can alter adaptation to the breast or cause weak sucking.
Galactopoiesis: Or milk stabilization
Once abundant breast milk production has begun, the amount depends on the effectiveness and frequency of breast emptying. In addition to volume, sucking can partially regulate the composition of the milk. Breast milk is continuously produced and stored until the next feeding inside the alveoli and in the duct system. Breastfeeding guide.
Weaning: How to do it?
Like everything in this life, there will eventually be a stage where you end your breastfeeding journey, and understanding how to do it is important. It is well known that the WHO recommendation and clinical guidelines are 6 months exclusively and complementary with food up to two years, and it is even described up to 7 years. There is no reason to stop at a certain age, but obviously this decision will be all yours, and at Happymami, we will accompany you and give you the best solution for the decision you make.
Circumstances that may condition the end of breastfeeding or “weaning”
And, what reasons can motivate weaning? Each case is unique and all are respectable, the most important being: maternal decision, baby’s will, illness of the mother or infant, or work needs. Remember that you have our post about maternity leave and paternity leave. at your disposal.
Types of weaning
In theory, there are 4 types of weaning, depending on the cause.
- Inevitable weaning due to medical or other causes. The reality is that there are few diseases and medications that contraindicate breastfeeding. You can always consult the e-lactancia.org website for any medication to clear up doubts. Breastfeeding problems guide
- Voluntary weaning by the child: You will see how your baby decides not to breastfeed progressively. There are occasions when it may be conditioned by a new pregnancy, which can sometimes alter the taste and amount of breast milk.
- Weaning by maternal decision: The decision to continue breastfeeding or not is legitimate, and you should not accept value judgments for making the decision you consider. Always inform yourself about the pros and cons and you will make the best decision for your case. As a personal note, you cannot change what people think, but you can change how it affects you, and you are doing great.
- Forced weaning due to external causes. Social or family. Unrelated to the mother and child. Remember that the decision to continue offering your breastfeeding is only yours.
- Unintentional weaning. The feedings are gradually spaced out until your baby is weaned.
Feelings that may arise during weaning:
During this weaning stage, many feelings may arise, such as guilt and sadness, and it is completely normal. Lean on your midwife, she will support you in your decision, helping you in your case so that you can handle it better and understand the process. You should know that on the one hand, your baby, if the weaning has been your decision, may show tantrums or inconsolable crying. This is because as a breastfeeding baby, if he is hungry he thinks of his breast that he loves and satisfies him, and obviously he does not understand the case that he cannot use it. And on the contrary, if breastfeeding was causing stress for you and difficulty for your bond between mom and baby, it will be perceived as a relief for both of you.
Guidelines for weaning
To wean there are several options, and if you talk to other moms, each one used a different method and some did well and others did badly, each case is different and you should always adapt these recommendations to your particular case. On the one hand, you should know that, if in your case you are weaning overnight, your doctor may recommend specific medication to cut off the milk. If, on the other hand, you are weaning gradually, the feedings will gradually be spaced out and the production of breast milk will decrease.
How to do a gradual weaning:
There are several strategies that you can choose to carry out a weaning that the AEPED recommends to us:
- Do not offer, do not reject. If he does not ask to breastfeed, do not offer it. If he asks, do not reject it.
- Space out feedings. Distract him in another way (in the park, playing with him, reading a story, lulling him to sleep in your arms…).
- Offer another type of food at the hours when he usually asks for breast. Anticipate his need.
- Manage feedings with the child. Tell him “only at home”, “only 3 minutes”, “only one breast”, “only to sleep”, etc.
- We must talk to him and agree with him on weaning, explaining that “mommy doesn’t want to keep giving boobies”
- If there is pain, periodic extractions must be made to avoid complications such as mastitis. If the weaning is well tolerated, it will not be necessary.
False weanings:
Remember that there are breastfeeding crises and they do not mean that they are a weaning. These breastfeeding strikes are completely normal, in which you will see your baby lose a little interest in breastfeeding, such as if they are sick, due to a scare during the previous breastfeeding or because they have been forced to breastfeed. Why is my baby crying?.
As we have seen, there are several factors that influence the formation and ejection of milk, all of them fundamental for the correct establishment of breastfeeding. Prolactin and oxytocin will be the fundamental hormones in this process, but they need a functioning system as a whole. From Happymami, remember that it can be a difficult process at first, but then it will be very easy. Trust yourself, your baby and the team of healthcare professionals around you, such as your midwife, who will help you achieve your breastfeeding.
Benefits of breastfeeding
Breast milk is unique. It is a living liquid that is specially designed for the human baby and that changes, feeding after feeding, day after day and month after month, to meet the needs of your baby. It also provides active defenses against infection. If you are interested, you can discover more information about the importance of breast milk.
Benefits for your baby
- Protects against respiratory infections, otitis, gastrointestinal and even urinary infections.
- Protects against Sudden Infant Death Syndrome.
- Breastfeeding provides physical contact to babies which helps them feel safer, warmer and comforted.
- Breastfed children have better dental development with fewer orthodontics and cavities problems.
- Enhances intellectual development thanks to the fact that breast milk has specific components that are essential for brain development.
- Breast milk is better digested and has long-term positive effects on the child’s health, reducing the risk of allergies, diabetes, celiac disease, inflammatory bowel disease, obesity, hypertension or high cholesterol levels.
- Seems to have some protection against lymphomas and some other types of cancer.
- Human milk is the food of choice for all children, including premature babies, twins and sick children.
Benefits for mom
- Prevents post-partum hemorrhages, since the baby’s sucking facilitates the uterus to recover its initial size and decreases the possibility of anemia.
- Favors the recovery of pre-pregnancy weight.
- Produces emotional well-being and provides a unique opportunity for mother-child bonding.
- Reduces the risk of breast and ovarian cancer.
- Improves the calcium content of bones when menopause arrives.
Benefits for society and the environment
- It’s free, resulting in savings on artificial formulas.
- By reducing infections and their severity, it lowers medical expenses and work/family issues that these illnesses cause for parents and society. It reduces the use of human and material healthcare resources, and if children get sick, they recover faster.
Breast milk is a natural resource that doesn’t pollute and protects the environment because it doesn’t produce waste, need packaging, or special treatments that require energy expenditure in its production or CO2 emissions.
Are there contraindications for breastfeeding?
There are very few situations in which breastfeeding is contraindicated, but they are minimal. This means that almost all women can feed their babies with their breast milk, if they choose to do so. The contraindications are:
- Mother with HIV infection: in our environment, this is considered a true contraindication.
- Galactosemia: This is a disease that very few babies are born with, which prevents them from digesting lactose in milk, thus contraindicating feeding with breast milk.
How do I prepare my breasts for breastfeeding during pregnancy?
There’s no need to do anything to prepare your breasts for breastfeeding during pregnancy. What is recommended is to be well-informed about the topic. You can attend maternity preparation classes taught by midwives. Seek help, support, advice, and information from professionals who are experts in breastfeeding (nurses, midwives, gynecologists, pediatricians, family doctors…). Ask everything you need to or that worries you. Talk to your partner, share the information, so you can decide together. Talk to other family members to organize a small support network at home and thus be able to dedicate yourself with peace of mind to enjoying breastfeeding and getting to know your baby and you.
The start of breastfeeding after childbirth or C-section
It’s very important to start breastfeeding after birth as soon as possible, regardless of how the baby was born. It’s recommended, whenever the condition of the child and mother allows, that the mother and newborn remain in skin-to-skin contact after delivery, at least for the first two hours, or until the baby first latches.
Your baby has innate abilities that, if we let them, start working after birth. Placed face down on your abdomen, thanks to their senses (especially touch and smell) and their reflexes, they are able to reach your breast on their own. Crawling to it, they will smell it, touch it with their hands and then with their mouth, and finally, they will be able to latch on to the breast spontaneously, with their mouth fully open, covering the nipple and a large part of the areola. Discover more information about the stages of breastfeeding.
Colostrum, a superfood
In this first feeding, they will discover colostrum. It’s the first milk that the mammary gland produces during the last months of pregnancy and the first days after delivery and provides your baby with all the food they need those first days. It’s very dense and yellow, and the mother doesn’t notice full breasts. This liquid is rich in calories, proteins, antibodies, and beta-carotenes, while its fat and lactose content is lower.
Little by little, the milk will become whiter and lighter, and the amount will increase (mature milk) according to your baby’s needs. Clinically, the “milk coming in” occurs around the third day postpartum, but up to 25% of mothers perceive the milk coming in after 72 hours. At that time, your baby extracts around 20 cc of breast milk in each feeding. Keep in mind that if your baby sucks on their hands, it’s not a consequence of hunger; they are reflexes of a normal and healthy child.
Factors that favor the start of breastfeeding and the milk coming in
- Early skin-to-skin contact between mother and child.
- Starting breastfeeding in the first hour after delivery.
- Frequent breastfeeding.
- Good mouth-to-breast latch.
- Adequate emptying of the breast.
- Early and frequent sucking in the first days.
How does your baby react in the first days of breastfeeding?
Generally, newborns have a phase of about two hours, right after birth, in which they are very awake and active. During this period of time, most manage to take their first feeding spontaneously during early skin-to-skin contact. Afterward, they move into a sleep phase (physiological lethargy, of “recovery” from childbirth) that can last between 8 and 12 hours. During this phase, if kept in skin-to-skin contact, the baby will breastfeed again when they need to.
From the first day of life, it’s common for your baby to breastfeed frequently, about 8-12 times a day or more, and for feedings to be irregular and more frequent at night. However, some infants continue to be very sleepy, ask for little, and breastfeed less than they need. In these cases, it’s advisable to place them in skin-to-skin contact, which helps them respond to the mother’s scent and breastfeed spontaneously. Sometimes, it may be necessary to help them wake up by undressing them and dressing them again, giving them a rotating massage on the soles of their feet, or a gentle caress on their back from bottom to top. Here is a link if you need more information about waking or not waking your baby.
Do I give both breasts?
In this first stage, in each feeding, the child must be given both breasts, and it’s necessary for them to completely empty one breast before offering the second so that they obtain the milk from the end of the feeding, which, having a higher fat content, makes the child grow and gain weight. It’s much more important to let the child finish taking the first side before offering the second, even if this means that they reject the second side during that feeding. You shouldn’t limit the time in the feedings. It’s better to allow the child to breastfeed until they show signs of satisfaction, such as letting go on their own or having relaxed arms and hands. If it takes a long time, you should insert your little finger, pressing on the palate, to avoid damaging the nipple. It’s not necessary to wash the breast before or after each feeding, nor should you use soap on the nipples, as it dries them out.
Number of feedings
It’s important to offer the breast on demand, whenever the baby requires it and for as long as they want. That way, we’ll be sure that they receive everything they need; sometimes it will be food, other times warmth, affection, or protection.Each child is different and needs their time to feed, the same happens to us (we don’t all eat at the same speed).
The first few days, they need to breastfeed between 8 and 14 times a day, for two fundamental reasons: the early establishment of breastfeeding and the reduction of the risk of infant hypoglycemia. It’s not advisable to use strict feeding guidelines, as they inhibit natural mother-child interactions, interfere with natural hunger cycles, and cause anxiety in the mother.
The earliest signs of hunger are sucking, head bobbing, sticking out the tongue, bringing hands to the mouth… This is the ideal time to put them to the breast. It’s not good to wait for them to cry to put them to the breast, as crying is a late sign of hunger, and it won’t be easy for them to latch on until they have calmed down. Here is a post about crying and its meaning according to the type.
Breastfeeding techniques
Most breastfeeding problems are due to problems in the breastfeeding technique, either due to an inadequate position, an incorrect latch, or a combination of both.
For a good latch, it’s important that the baby’s entire body is facing the mother and that when opening their mouth, they introduce a large part of the areola, especially on the lower part (where their chin is) so that when actively moving their tongue, they don’t injure your nipple.
The signs that will indicate a good latch are:
- Your baby’s chin touches your breast
- Your baby’s mouth is wide open
- The lower lip is turned outward (everted)
- The cheeks are round or flattened (not sunken) when sucking.
- More areola is visible above the mouth than below.
Positions that will help you with breastfeeding
Regardless of the position you adopt with your baby for feedings, there are some basic tips that you should keep in mind and that will facilitate your baby’s latch. Because there isn’t a single adequate position for breastfeeding, the important thing is that the mother is comfortable, that the latch is adequate, and that the baby is facing and close to the mother’s body.
- As a mom, you should feel comfortable with the position. For this, the use of pillows or cushions can be useful.
- Your baby’s body should be in close contact with yours. When you’re lying down, your baby’s weight will rest on your body. Thus, it will be easier to maintain that close contact that facilitates the activation of your baby’s reflexes.
- Your baby’s head should be facing the breast, well aligned with the body. (Their neck shouldn’t be flexed, nor the head turned). It’s preferable to move the baby than to move the mother’s breast.
- Your baby’s chin should be resting on the breast with the nipple above the upper lip, at the height of the nose. Thus, when your baby activates the search and latch reflex to your breast, the neck will be in slight hyperextension, facilitating coordination, sucking, swallowing, and breathing.
- Remember that it’s preferable to favor spontaneous latching. When your baby’s mouth is wide open, bring them to the breast and allow your baby to latch on. If your baby doesn’t succeed, directed latching may be helpful.
Positions that favor the start of breastfeeding
Below, we mention some positions that can favor the start of a happy and lasting breastfeeding. Discover more information about the breastfeeding positions
- Cradle position:
- As a mom, hold your baby’s neck and head with the same arm and hand as the breast you’re offering
- Reclining position:
- Position yourself on your side so that your breast rests on the mattress
- This position is especially useful for promoting maternal rest when there is pain in the perineum (instrumental delivery, hemorrhoids…)
- Rugby position:
- Hold your baby’s body and head with the forearm and hand of the same breast you’re going to give. This leaves you with a free hand to perform a directed latch if you need it.
- This position is especially useful in C-sections, mothers with very large breasts or morbid obesity, or in simultaneous breastfeeding in twins.
- Biological nurturing position:
- Position yourself semi-reclined (between 15º-65º) and comfortable
- This position is especially useful when there are difficulties with the latch, as it makes it easier for the newborn to activate their instinctive reflexes. You’ll see how your baby bobs their head and moves, looking for the mother’s breast.
How to interrupt the baby’s sucking?
Interrupt the sucking before removing the baby from your breast. Do this by putting a clean finger on the side of your baby’s mouth, between their jaws. Don’t remove it until you notice that they have finished. Or insert your little finger, pressing on the palate, to avoid damaging the nipple.
Do I have to perform any special care of the breast during breastfeeding?
Your breast doesn’t need any special care during pregnancy and breastfeeding. Perform daily hygiene, and that will be enough. Also, use practical underwear with sufficient support, which will make you feel more comfortable.
How do I know if my baby is eating enough?
To know if your baby is feeding well, you can consider:
- Frequency of feedings: Your baby should feed between 8 and 12 times each day.
- Bowel movements: Count the diapers whose contents are the size of the circle formed by touching the tips of your thumb and index finger.
- 1-2 days of life, 1-2 wet diapers, variable meconium
- 2-6 days of life, 5-8 wet diapers, at least 3 greenish bowel movements
- 6 days to 6 weeks, 5-6 wet diapers, at least 3 mustard yellow bowel movements
- More than 6 weeks, 5-6 wet diapers, some babies have fewer bowel movements but greater volume and soft.
- Appearance and general condition: That they have a normal color, the skin is firm, and they are active and alert.
- Weight gain and growth: This section will be assessed by your pediatrician or pediatric nurse
Discover more information to know if your baby is getting enough milk by clicking here
What should I eat while breastfeeding?
A breastfeeding woman doesn’t need special diets. The best nutrition comes from a healthy and varied diet, avoiding additives and pollutants. Only in some cases, due to illness or nutritional problems, may the doctor advise some supplements. Although it’s proven that the aroma of food passes into the milk and can change its smell and taste, there is no food prohibited during breastfeeding. These taste changes that breast milk experiences help the baby become familiar with various flavors, which will allow them to accept complementary feeding more easily. Only in the case of repeatedly observing that after the mother has eaten a certain food, the baby shows some type of discomfort (vomiting, diarrhea, rashes, discomfort, or rejection of milk), may it be necessary to avoid that particular food.Can I take medication while breastfeeding?
If you need to take medication during pregnancy or after delivery, you can consult with a doctor. Remember that most medications can be used during breastfeeding. Not all drugs pass into the milk, and in general, alternatives can be offered in practically all circumstances if the chosen drug carries some type of risk. You can consult the compatibility of medication and breastfeeding on the page www.e-lactancia-org.Conclusion: breastfeeding guide for the first days.
Every case is unique, and you should adapt these recommendations to your own situation. Undoubtedly, the key is that if your free and informed decision is to offer your baby breastfeeding, you can do it. The beginnings can be a little difficult due to the doubts generated by this new stage, but little by little with this breastfeeding guide you will learn and strengthen breastfeeding. Also, do not hesitate to rely on your midwife and breastfeeding groups who will be happy to help you in your case.
