The First Week

By Krista Gray, IBCLC. Last updated February 23, 2013.

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You’ve planned and prepared for you new little blessing and the time has finally come – your baby is here!  What should you expect during the first week after birth?

Following Delivery

6959630279_bd936a1d85_bWhether your labor and delivery was completely natural, an emergency cesarean section, or something in between, it is important to hold your baby in skin-to-skin contact immediately (or as close thereto as possible) following birth.  Delay all non-essential checks of baby that cannot be done while baby is in skin-to-skin with mother until after the first breastfeed. (With a cesarean delivery the mother will need help holding baby.)

Babies instinctively know what to do.  When labor is unmedicated, babies can be placed on their mother’s stomachs and will actually crawl up, find the breast, and spontaneously breastfeed on their own.  It is called “the breast crawl” and it quite powerful to watch!  However, even if you choose to lay your baby directly on your stomach and breast and help him attach, the important thing is bonding together, skin-to-skin, without interruption until after the first breastfeed.

The first 24 hours

During the first 24 hours, hold your baby in skin-to-skin contact as often as possible.  This helps to establish a mother’s milk supply and encourage a baby to nurse on demand.  You cannot spoil your baby and you cannot nurse your baby too often.  Nurse on demand – at least 10-12 times in a 24 hour period.  Rooming-in with your baby while in the hospital will help facilitate frequent nursing.

If your baby is sleepy (which is especially common if there were any pain medications during labor or baby is preterm) then it is important to wake your baby to feed him.  There should not be longer than one 4-hour stretch of sleep in 24 hours; otherwise your baby should nurse at least every 2-3 hours.

Breastfeeding should never hurt, even in the beginning, so if you are experiencing pain seek out help.  If you are in a hospital setting, ask to see the lactation consultant.  If you are in a birthing center or at home, talk with your midwife about what could be causing the pain.  The majority of the time the pain is caused because of an issue with positioning and attachment.  The earlier you are able to sort the problem the less likelihood your nipples will be damaged or your baby will learn a poor latch.

During the first 24 hours, your baby should have at least one dirty diaper and one or more wet diapers.  A newborn baby’s stomach is very small.  Thick, rich, colostrum is all he needs for the first few days until a mother’s milk comes in.

The First Week

Practices begun in the first 24 hours should continue during the first week.  Keep your baby nearby while he is sleeping so you are aware of when he wakes and his early feeding cues.  Spend as much time in skin-to-skin contact as possible.  Consider co-sleeping in the same room or even bed sharing.

After birth, a baby shouldn’t lose more than 7% of his birth weight.  However, a more accurate weight assessment is 24 hours following birth rather than immediately afterwards. 1

What if I experience engorgement?

Sometime between days 2-5 a mother’s milk will come in.  Nursing often will help her from becoming engorged.  Other ways to help with engorgement in the early days include draining one side fully then offering the other side.  At the next feed, begin by offering the side that was offered last in the previous feed.  Breast compressions during nursing are also helpful.  If a mother’s breasts are still very full and painful she can hand express to stop the pain.  Most importantly, do not give supplements!  Engorgement and oversupply can quickly change to a low milk supply for your baby once supplements are introduced.

How do I know if my baby is getting enough milk?

This always seems to be a concern for breastfeeding moms – though it should not cause worry.  There are several ways to ensure your baby is receiving enough milk.

  1. What goes in must come out.  Make sure you baby has enough wet and dirty diapers.
  2. Weight gain.  Though it is normal to lose 7% (sometimes up to 10% of birth weight) a baby should have gained his birth weight back by 2 weeks old.  (The only exception may be if there was a breastfeeding issue that has been corrected and weight gain is now occurring, but may take a little beyond 2 weeks because it was not identified initially.)  Once a baby reaches his birth weight, it is typical to gain 30-40 grams per day.  Over time you will be able to chart your baby’s growth.  Make sure to use the World Health Organization Growth Charts because they are the only ones based on breastfeeding as the norm. (These should be used for both breast and bottle-fed babies.)  Your child should follow his growth curve.  If he was born in the 2nd percentile, for example, this is all he needs to follow.  This is his normal.  There are big babies and there are small babies. . . all that is important is that your baby follows his percentile.
  3. Observation of breastfeeds.  Is he content following nursing. . . at least for a few minutes?  Do you notice an active suck-swallow cycle?  These are important signs your baby is feeding well.

If you have any concerns, seek qualified lactation support immediately!  A minor problem could have a detrimental impact to long-term breastfeeding if left alone.

Show 1 footnote

  1. Noel-Weiss, J. et al (2011) An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. International Breastfeeding Journal 6:9