The checklist of things to learn and know for expectant parents can seem endless, and prioritizing what to know can be difficult. However, carving out time to learn and understand the benefits and realities of breastfeeding, also known as chestfeeding, while the child is still in the womb can help set a newborn and parent up for success.
Sarah Sobik, M.D., M.P.H., IBCLC
, an outpatient breastfeeding medicine specialist at Arkansas Children’s Hospital in Little Rock, consults new and expectant moms about breastfeeding and other pregnancy and newborn topics at the Breastfeeding and Lactation Medicine Clinic
at the ACH Southwest Little Rock Clinic
. She shared her tips regarding breastfeeding education for expectant parents broken down by trimester and the first month of life.
First Trimester (1-12 weeks): Educate Yourself
One of the most important decisions expectant parents make is whether to breastfeed or formula-feed.
The American Academy of Pediatrics recommends that parents exclusively breastfeed (chestfeed) for the first six months of life and then add in complimentary solid foods. The AAP also recommends breastfeeding until two years or beyond, as long as it is desired by both the parent and baby.
There are many benefits of breastfeeding for both a parent and their baby. For babies, mother’s milk matches that child’s nutritional needs. It can reduce the risk of Sudden Infant Death Syndrome (SIDS) and help protect against future diseases like asthma, obesity and diabetes. Breastmilk is easily digested and helps a baby grow.
Human milk helps protect babies against several illnesses, including:
- Gastroenteritis and other GI illnesses
- Ear infections
- Upper respiratory illnesses
The longer a mother breastfeeds, the more protection a baby has. Sobik said if a mother breastfeeds for over six months, it can help protect against leukemia.
Breastfeeding helps a mother recover from delivery and creates a unique bond with their child. It lowers a mother’s risk for several illnesses, including:
- Breast and ovarian cancer
- High blood pressure
- Heart attack
- Heart disease
The shape of a breast or nipple does not dictate whether or not a woman or parent can successfully breastfeed or lactate. While pregnant, a woman should contact her insurance company to get a breast pump, as most provide one. If a mother has Medicaid
or can apply for Arkansas WIC
before her baby is born, it makes the process easier for getting a breast pump after birth. Here is a list of resources
from the Arkansas Department of Health.
A mother should speak with her doctor about breastfeeding if she is worried about certain medications affecting her breastfed infant. Sometimes, if a mother has a history of breast surgery or radiation, Sobik said she’ll discuss the risks with her. One risk is being unable to produce the right amount of milk the baby needs.
For adoptive parents, there are ways to induce lactation so a parent who adopts an infant can breastfeed. An adoptive mother would need to see a breastfeeding medicine specialist several weeks or months before the adoption. Parents who want to breastfeed and have adopted an infant can also use a supplemental nursing system, a device that supplies milk to a child through a tube while they are fed at the breast.
Second (13-26 weeks) and Third (27 weeks to birth) Trimesters: Make Appointments
Mothers who choose to breastfeed should make an appointment for lactation support in the second and third trimesters. A prenatal lactation class can also help prepare parents for the road ahead. Sobik often sees patients for prenatal lactation support and questions regarding breastfeeding in the second trimester.
A pregnant parent typically begins producing colostrum, a thick, nutrient-rich, clear or golden first milk produced in the breasts in the second trimester. It is extremely beneficial to feed newborns because it helps strengthen your newborn’s immune system and is the ideal nutrition for a newborn. A few days after a baby is born, it transitions to full mature human milk.
A woman may produce just a tiny amount of colostrum or none during pregnancy. It does not indicate a woman won’t make enough when her baby is born.
There are no specific guidelines regarding when to begin antenatal hand expression, which means using your hand to gently massage your breast to express colostrum.
Sobik advises her patients who want to breastfeed to begin hand expressing around 36 to 37 weeks. One to two times a day for a few minutes is standard. Hand expressing is recommended over pumping at this stage. Colostrum can be collected in a medicine cup, saved and used at the hospital when the baby is born. Sobik recently published a paper for review regarding research on the subject.
“A lot of women leak colostrum. That doesn’t mean that you should hand express it because what can happen is it can trigger oxytocin, which can lead to contractions and maybe pre-term labor,” Sobik said. “We just don’t know. So it’s not recommended to do it earlier than 36 to 37 weeks.”
First month: Feeding Your Newborn
Breastmilk digests quickly. Therefore, there’s no way to set up a feeding schedule for a breastfed baby, particularly during the first month. The first week of life is the most challenging for new breastfeeding moms. Usually breastfed infants feed anywhere from 1.5-3 hours during the day and 2-4 hours overnight.
“A breastfed baby can feed anywhere from eight to 12, sometimes even 16 times a day in that first week of life,” Sobik said.
A baby’s belly grows the first week of life, which impacts a mother’s milk production:
- First day of birth: A baby’s belly is the size of a cherry seed. Mom only needs to produce 5 to 10 milliliters per feeding.
- Days two and three: A baby’s belly is the size of a peach seed. Mom needs to produce about 15 to 20 milliliters.
- Day four: A baby’s belly is the size of an egg. Mom needs to produce about 30 to 45 milliliters.
Does my baby need a set feeding schedule?
A common myth is that babies need a set feeding schedule. As a child grows, feeding changes each week throughout the first month and beyond.
The guidance is not to let a newborn go more than three hours without feeding as that’s when their blood sugar can drop, Sobik explained. But it’s normal if an infant wants to eat more than every three hours.
This is the guidance up until a baby reaches its birth weight. During the first few days of life, babies lose weight because they pee and poop more than they eat.
“I’ll see a newborn usually when they’re two to three days old. On average, if they’re breastfed, they’re below seven percent of their birth weight. And they have until days 10 to 14 to regain their birth weight, which is biologically normal,” Sobik said. “That’s how long we give them until we start to worry that they’re not getting enough breastmilk.”
After a baby reaches its birth weight, they no longer have to feed every three hours, but whenever the baby is hungry and wants to eat.
A baby will give many hunger cues if they need to eat.
Initial hunger cues: Eyes start to flutter when they’re asleep or coming out of a deep sleep
- Mid-hunger cues: While sleeping, hands begin to move or they smack their lips and start to wake up
- Late hunger cues: Crying
Pumping breast milk
If breastfeeding is going well and a baby is gaining good weight, a breastfeeding parent does not necessarily need to pump during the first four weeks of the baby’s life or until they are transitioning back to work. This helps establish a solid breastfeeding relationship before introducing a bottle. However, Sobik is quick to say that feeding a baby with a bottle, if needed, will not destroy a bonding relationship with breastfeeding.
A bottle is usually introduced at four to six weeks in a breastfed infant. That is when a mother should start pumping.
When a mother transitions back to work, she’ll pump the most, every two to three hours. Lactating parents need to pump for about 20 minutes and use a double-grade electric pump. Pumping both breasts at the same time is best.
“I have a lot of patients come in and say they are pumping one breast at a time. It takes twice as long, and it can decrease milk supply to pump only one breast at a time,” Sobik said. “It can help increase or maintain supply to pump both breasts simultaneously.”
Mothers should pump and provide expressed breastmilk if there are complications with breastfeeding a baby early on. It is hard to build a supply back. They should try to see a lactation consultant early on if they are having issues.
When to see a lactation consultant
Seeing a lactation consultant before birth can help prepare a new parent who wants to breastfeed. However, if there are feeding issues or if a doctor recommends using formula instead of breastmilk, that’s when to make an appointment with a breastfeeding medicine specialist like Sobik or a local lactation consultant.
“I would like to see babies between days four and five of life and then again before day 14 of life to make sure things are going better. That’s when I can make the most impact in the breastfeeding relationship. The longer they wait to seek help, the more work it will take to get back on track,” Sobik said.
When to Choose Formula
Most women can breastfeed, but there are some situations where formula feeding is the only option.
A baby cannot be breastfed and must be formula-fed if they have galactosemia, a genetic disease where an enzyme in breast milk is harmful to the baby. Babies are tested for this during a newborn screening appointment. This is very rare. It will be evident in the first one to two weeks because the baby will become ill. If a mother is receiving chemotherapy, it is not safe to offer the baby breastmilk.
Other considerations as outlined by the Centers for Disease Control and Prevention (CDC)
Mother has HIV and is not on antiretroviral therapy and/or does not have a suppressed viral load during pregnancy, delivery or postpartum.
- Mother is infected with human T-cell lymphotropic virus.
- Mother is using illicit drugs such as opioids, PCP or cocaine. If a mother is stable on methadone or maintenance therapy, breastfeeding should be encouraged.
- Mother has suspected or confirmed Ebola virus.
The leading companies that make formulas are Similac, Gerber and Enfamil. There are standard formulas and ones for babies with gas issues. At this time, WIC
provides Gerber Good Start and Gerber Good Start Soothe. WIC can also provide a specialty formula if a prescription is given by your pediatrician. Sobik said she has rarely recommended soy formula as it is not indicated for most newborns. There is also hydrolyzed or broken-down formula for babies with milk protein allergy. This formula is easier to digest and is recommended for breastfed babies who need additional supplementing.
Formula takes longer for a newborn to digest. Therefore, the newborn can be placed on more of a schedule, feeding about every two to three hours. After the first week of life, as the baby’s stomach has grown, they are typically fed two ounces every two hours and then three ounces every three hours.