Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families. You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana. You can also connect with Cindy and Jana on Twitter, Facebook and Pinterest.
Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn. A month later, we received a phone message from Noella: “You aren’t going to believe it. Nathan is now breastfeeding! I just decided to try it one day and it worked!”
Why babies may not latch at birth
Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:
- Baby may be recovering from a difficult birth.
- Baby may have a tongue tie.
- Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
- The shape of mom’s nipples may make it difficult to grasp the breast.
- Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.
If baby will not latch in the first 24 hours after birth:
- Keep your baby skin to skin as much as possible.
- “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
- Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
- Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
- Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.
If baby continues to not latch after 24 hours:
- Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
- Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
- In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
- Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
- You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
- Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
- Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
- Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
- A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
- Search out a mother-to-mother support group such a La Leche League.
In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.