The Hours Before and After Delivery: Advice from a Mother Baby Nurse of 20 Years

Questions are unending when you are preparing for a child. To help bring guidance to our mothers, Nourisher presents a three part series with Kyle Pfahl, a Mother Baby RN, who has over 20 years of experience in delivering babies and caring for mothers. 

Kyle took over Nourisher's Facebook page to answer any and all questions our Nourisher moms might have on the following topics.

Part I: Preparing for the Hospital

Part II: The Hours Before and After Delivery

Part III: Postpartum Care in The Early Days at Home

Read what our mothers asked during Part II and see Kyle’s responses below.

Breast Milk Production in the First and Second Day

Megan: How long does it take for my milk to come in and how do I know when my baby is getting enough? 

Kyle: This is a question that a lot of first time moms have. It generally takes around 3-4 days for mature milk production. Prior to that your baby is still getting fed and receiving the pre-milk - colostrum. Colostrum is full of nutrients and disease fighting antibodies, it is very dense in nutritional value these first few days for your child. We call it “liquid gold.” Although it may not seem like your baby is getting anything, as the flow of colostrum is slow, this is allowing the baby to learn how to coordinate how to suck-breath-swallow. During this time your baby will have less wet diapers.

Don't be worried if you see that weight drop while in the hospital it is normal that babies will loose some weight (5-7%) in the first few days, so a weight lose in the hospital is not an indication that your baby isn't getting enough. Babies tummy's are small, approximately the size of a shooter marble. So they don’t need much volume in the beginning days. It is also important to keep in mind that babies crying doesn’t always mean that they are hungry and not getting enough breast milk. Sometimes they are saying they want to be rocked, or just a little skin to skin time. If it is around your second night with your new baby you may notice that they just can't seem to settle down and get comfortable, this is normal, get prepared. Here is the link to a great article that explains what your baby is going through.
Basically it is an adjustment that your baby is making to his new world; which is quite different. it is bright, cold and all new sounds to mention just a few. So remember to take a deep breath and take this night in stride. Feeding will help, especially cluster feeding, and so will skin to skin, this night will pass and soon you and baby will both be adjusted.

Around 3-4 days post-delivery you should notice your breast getting firmer and fuller. This is a sign that your milk is coming in. Frequent feedings will help your milk supply, to boost your supply further I recommend starting on one to two Milkful Nursing Bars the day your baby is born. As a quick check, your breastfeeding baby is probably getting enough nourishment if: 

• Your breasts feel softer after nursing (because your baby has emptied some of the milk that was making them firm). 
• Your baby seems relaxed and satisfied after a feeding.
• After your baby starts getting mature breast milk, she'll start having a lot more wet & dirty diapers.

Achieving a Good Latch

Kelly: What if the baby has trouble latching?

Kyle: It is very important that your baby has a good latch. A proper latch will ensure a good transfer of breast milk to your baby. To begin with you should be sure your baby is awake and ready to feed. If you baby seems sleepy it is okay to take off her clothes and get her not so comfy so she will become more alert. Then you need to get into a good position and make sure your baby is tummy-to-tummy with you so they are properly aligned. 

Some quick tips: 

• Make sure you bring your baby to you, and do not try to lean into the baby. This will cause you to strain. 
• Remember to keep your baby’s ear, shoulder, and hip in alignment, which will make swallowing easier. 
• The baby’s nose should be opposite the nipple. 
• You might need to hold your breast to help guide the nipple to your baby’s mouth. Grasp the breast on the sides, using either a “C” hold or “U” hold. Make sure to keep fingers far from the nipple so you don’t affect how baby latches on. 
• Aim the nipple toward the baby’s upper lip/nose, not the middle of the mouth. You might need to rub the nipple across the top lip to get your baby to open his/her mouth. 
• The baby’s head should be tilted slightly back. You do not want his chin to his chest. 
• When he opens his mouth wide with the chin dropped and tongue down, he should latch on to the nipple. If he does not open wide, do not try to shove the nipple in and wiggle the mouth open. It is best to move back, tickle the lip again with the nipple and wait for a wide open mouth 
• Try to get as much of the lower portion of the areola (the area around the nipple) in the baby’s mouth. 
• The baby’s chin should indent the lower portion of your breast. 
• Look to see if the baby’s bottom and top lip are flanged out like fish lips. If they are not, you may use your finger to pull the bottom one down and open up the top one more. 

Kelly: How do you know if you have a good latch?

Kyle: Here are some of the signs that you have a good latch:

• Tongue is seen when the bottom lip is pulled down 
• Ears wiggle 
• There is circular movement of the jaw rather than rapid chin movement 
• Cheeks are rounded 
• You do not hear clicking or smacking noises 
• You can hear swallowing 
• Chin is touching your breast 
• When your baby comes off the breast, the nipple is not flattened or misshaped 
• Any discomfort ends quickly after getting the baby latched on 
• Your baby ends the feeding with signs of satiety/satisfaction. These signs include: the baby looks relaxed, “falls” off the breast, has open hands, and/or falls asleep. 

If you are concerned about your baby's latch, or even if you want confirmation that all is well, be sure to see the lactation specialist while you are in the hospital. They are there to help you!

Feeding in the First 24 Hours

Jeanette: I’ve heard the first 24 hours of breastfeeding is mainly just practice and babies are born with reserves to get them through the first sleepy day. Now, I’m hearing that a baby has to eat 8 times that first 24 hours and lactation nurses are quick to teach hand expression, nipple shields, whatever it takes to the point where most mothers become quite frustrated. What is your view, Kyle?

Kyle: Well Jeannette, your question has a lot of different parts. I will begin by addressing the first 24 hours of breastfeeding. It is true that a normal healthy newborn is born with enough energy stores to get them thru the first 24 hours. That doesn’t mean that we don’t repeatedly attempt to latch the baby on. If several attempts remain unsuccessful, it can be beneficial to massage breast and teach the mother hand expression. The colostrum can be collected in a spoon and allow the baby to lick it. This not only will give the baby nutrition, but also stimulate your breasts. It is advisable to attempt a feed every 2-3 hours in the first day, but there is no real medical reason to intervene with formula and forced feedings. We call this practice time. If the baby has not actively latched in the first day we get slightly more aggressive. It would be at this time that I would teach the mom to hand express and spoon-feed her baby every 2-3 hours. If the mom is not comfortable or successful with hand expression then I would introduce the breast pump. She should continue to attempt latching the baby on the breast every feeding, and if unsuccessful she should pump for at least 15 minutes. It would be up to the mom if she wanted to introduce a bottle for her breast milk or continue with spoon-feeding. The nipple shield should be used after the first 24 hours, and only used in certain circumstances. For example, this tool can be helpful if the mom has flat or inverted nipples. Any mom who continues to have problems after 24 hours should seek the advice of a lactation consultant. It is important to remember that although these first few days of feeding might be frustrating, that having all caretakers on the same page will provide a better environment for mother and baby. 

Sarah: How often should the baby feed in the first 24 hours?

Kyle: Technically the first 24 hours are considered practice. The baby is born with enough energy stores for 24 hours. That being said, you should still attempt to feed every two to three hours. The first feed should be during skin to skin right after delivery. If you have a baby that wants to nurse more frequently than that, take advantage. The more the baby breastfeeds the better your milk supply will be. A baby can not breast feed too much. Now if you have a sleepy baby it is necessary to wake the baby up to feed, and that isn't always the easiest task. You can start with taking the babies clothes off and get him a little less comfy, if you still get no real response then try expressing a little colostrum on their lips. Often they just need to get a little taste of what they are missing. You can also wipe their face with a cool cloth. But as I said it is practice, you are getting to know each other and mom is looking for feeding cues, such as licking lips and rooting. Remember to reach out to the hospitals lactation consultant for assistance.

Connecting with Your Baby

Jenny: How important is “skin to skin” right after delivery and in the early days?

Kyle: There are so many wonderful benefits of skin to skin. The sooner you can put your baby on your chest and begin skin to skin the better. It is best if you can continue this “Kangaroo care” for at least the first 1-2 hours immediately following delivery. If for some reason the mom is unable to do skin to skin the dad can step right in. The very first things the baby will feel is security because they are placed directly on your naked skin and can hear your familiar heart beat and can keep warm and secure. Right away this special bonding helps relax the mom and baby and help stabilize the babies breathing, temperature and blood sugar. It has even been shown that an alert active baby who is in close proximity to the mother as in skin to skin is able to find their way to the breast and begin nursing. Babies that are allowed ample time to have skin to skin with their mothers tend to cry less and they experience less pain from procedures such as heel sticks for blood work. Most importantly this time after a baby’s birth provides an opportunity for parents to learn about their baby’s behavior—signs of hunger, signs of fullness, signs of discomfort, and so on. Having the baby in close skin-to-skin contact helps to ensure that the mother will learn her baby’s signals sooner, improving communication and boosting maternal confidence as well as helping babies develop a sense of trust and security. Most hospitals have included skin to skin as routine in the labor and delivery room. I would check with your hospital and doctor to be sure that your wishes of immediate skin to skin are part of your plan.

Feeling At Ease After a Difficult Past Delivery 

Megan: My first delivery had some complications, is there anything I can do to ease my fear that this delivery will be difficult?

Kyle: Megan, I am sorry you had a bad experience with your first delivery. I am sure you were very disappointed it didn’t go as planned. It is hard for me to speculate because I am not sure what complications you endured last time. But I can understand how, if you had a traumatic experience with your first delivery you would be very apprehensive. I feel in your situation it is important that you sit down with your doctor and review what happened. Sometimes when you go over it again and remind yourself exactly why things went unplanned, it might make you less fearful. One bad delivery does not mean you will have another, but it is all dependent upon your circumstances. Like I said, I am not sure what your circumstances were but very often the second delivery goes much smoother. You know more what to expect, in addition to the fact that your OB team is aware of what happened last time. Remember no matter the method or madness of the delivery the goal is a happy and healthy baby! Keep that goal in mind and soon you will have that baby in your arms.

Introducing Pacifiers

Erin: Can I introduce baby to a pacifier while exclusively breastfeeding?

Kyle: Many babies that exclusively breast feed can take a pacifier without any difficulties. There are definitely times when a pacifier comes in handy. It is nice to know you can comfort your baby for a while without having to physically hold or feed them. That being said, a major concern in the early days is that a pacifier can hide the feeding cues that a mom should be looking for the first few days and weeks. But if you have a fussy baby whose needs are met, good feedings, the baby has a dry diaper and is swaddled and you just can’t calm him down you might want to try a pacifier. You can use the pacifier to calm the baby and remove once they are asleep. All babies are unique and some babies can take a pacifier without any problems while other it interferes with suckling at the breast. If you do use a pacifier you can evaluate your feeds and make sure they are comfortable for both you and the baby and use the pacifier as necessary and not all the time which can mask the cues you are looking for.

Allowing Visitors

Imani: Should I limit my visitors?

Kyle: Yes, I would definitely limit my visitors to a certain time. It is your time to bond with your new baby. You may be running on adrenaline and very excited, but you need to rest. With visitors coming in and out unscheduled, it is difficult to both monitor the babies feeding cues and rest. I would continue with restricting visitors once at home too. You have a lifetime to share this bundle of joy - be selfish! 

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