Throughout the first two hours after birth, the infant is usually alert and eager to suck. At this time he is most ready for his first nursing.
Colostrum. It is not unusual to hear a first-time mother tell a nurse, "I don't think I have anything yet to feed the baby." Although small in amount, colostrum. is available in the breast in quantities close to the stomach capacity of the newborn. This "liquid gold," which is often yellow but may be clear, resembles blood more than milk in that it contains protective white blood cells capable of attacking harmful bacteria. Colostrum also acts to "seal" the inside of the baby's intestines, preventing the invasion of bacteria, and provides the baby with high levels of antibodies from the mother. Not only does colostrum thus offer protection from sickness, but it is the ideal food for the newborn's first few days of life. It is high in protein and low in sugar and fat, making it easy to digest. Colostrum is also beneficial in stimulating the baby's first bowel movement. The black, tarry stool, called meconium, contains bilirubin, the substance that causes newborn jaundice. Colostrum in frequent doses helps eliminate bilirubin from the body and may lessen the incidence and severity of jaundice.
In the hospital this first nursing may take place in the delivery room, the birthing room, or the recovery area. With minimal assistance from your nurse or partner, the baby will probably latch on eagerly to the breast and suck. He will be more willing if he is unbundled; snuggled within your arm and next to your body, he is unlikely to get too cold (unless perhaps the room is air-conditioned). The purple color of his hands and feet is normal; it is caused by changes in blood circulation that take place at delivery. If you or the nurse is concerned about the cold, place a blanket over the baby after he has begun to nurse.
Many specialists believe that when the first nursing is delayed much beyond the first two hours, the infant may be somewhat reluctant to take the breast thereafter. Nursing without delay also boosts the confidence of the mother, and stimulates the action of hormones that cause the uterus to contract and remain firm after delivery. These contractions may help speed delivery of the placenta and minimize blood loss afterward (breastfeeding alone is insufficient, however, in the case of postpartum hemorrhage, when prompt intervention by the medical staff is essential). During the first few days after birth, some mothers feel these contractions, or "afterpains," while nursing. Mothers who have had other children may be especially uncomfortable with afterpains.
Should you not have the opportunity to nurse right after delivery, or if you can't persuade your baby to take the breast, don't get discouraged. Many mothers have established successful nursing hours or days after giving birth.
Just the breast. When you have finished your first nursing in the hospital, let the nurses know (if you have not done so previously) that you prefer your baby be given no supplementary bottles of water or formula and no pacifiers. Water or formula is unnecessary and may confuse your baby while he is learning to breastfeed.
Newborns do not normally require any fluids other than colostrum (the exception is the baby who has low blood sugar--because her mother is diabetic, her birth weight was low, or she underwent unusual stress during labor or delivery). Supplemental feedings, moreover, can be harmful: they may cause the baby to lose interest in the breast and to nurse less frequently than needed. This is because bottle nipples may (1) lessen the baby's instinctive efforts to open her mouth wide, (2) condition her to wait to suck until she feels the firm bottle nipple in her mouth, and (3) encourage her to push her tongue forward--the opposite of what she needs to do while nursing. The baby who has sucked on bottle nipples may also become frustrated while nursing, since milk does not flow as rapidly from the breast as it does from the bottle.
Time at the breast. Many doctors and nurses tell mothers that to prevent sore nipples they should limit their nursing time during the first several days. Probably nothing else about breastfeeding is as poorly understood as the causes of sore nipples. It may be explained that keeping feedings short will prevent soreness and will help "toughen" the nipples. Actually, sore nipples usually result from improper positioning of the baby on the breast, not from long nursings. Another myth often heard by new mothers is that the breast "empties" in a prescribed number of minutes. Most newborns require 10 to 45 minutes to complete a feeding. As long as your positioning is correct and nursing is comfortable, there is no need to restrict your nursing time. Besides being unnecessary, limiting nursing time may frustrate the baby and lead to increased engorgement when milk production begins.
Positioning at the breast. A baby is correctly positioned at the breast when his gums are on top of the areola, the dark area around the nipples. In this position he will compress the sinuses located beneath the areola to draw out milk. If he instead latches on only to the nipple and starts "chewing," the nipple will probably become sore and cracked, and perhaps even bleed. The baby will also be unable to com press the sinuses beneath the areola and may therefore get too little milk.
Probably the most important skill for you to master, initially, is that of getting the baby on the breast correctly. Some mothers can do this easily, but many need practice. It helps to unwrap the baby first. This will encourage his interest in latching on and make it easier for you to check his position.
The "cradle" or "cuddle" hold, in which the baby's head is held in the crook of the mother's arm, is considered the classic breastfeeding position. I have come to believe that for most new mothers and babies this position is usually not the easiest or most effective for getting a baby well latched on to the breast. In the first few weeks after birth, a baby hasn't developed enough muscular coordination to easily latch on without help; she needs a good deal of direction from her mother. But it is difficult to direct a newborn's head accurately with the inside of one's forearm. Although most mothers sooner or later begin using the cradle hold for most of their daytime nursings, in the early days of breastfeeding the cross-over and football holds are generally more useful.
