The First Hour: Skin-to-Skin and the First Feed

The first hour after birth, often called the “golden hour,” is a unique window of opportunity for establishing breastfeeding. During this time, your baby is typically in a quiet, alert state and has strong instincts to find the breast and begin nursing. Taking advantage of this special time can significantly enhance your breastfeeding success.

The Importance of Immediate Skin-to-Skin Contact

Placing your baby directly on your bare chest immediately after birth, skin-to-skin, provides numerous benefits for both of you. For your baby, skin-to-skin contact helps regulate body temperature, heart rate, and breathing. It reduces stress hormones and crying while promoting bonding. For you, skin-to-skin stimulates the release of oxytocin, the hormone responsible for milk letdown and maternal bonding.

During skin-to-skin contact, you may notice your baby beginning to root, turning their head and making sucking motions. Given time and opportunity, many babies will actually crawl toward the breast and self-attach. This instinctive behavior, known as the “breast crawl,” demonstrates the powerful innate feeding reflexes present at birth.

Even if you’ve had a cesarean delivery, skin-to-skin contact and early breastfeeding are still possible in most cases. Communicate your wishes to your healthcare team beforehand so they can facilitate this important bonding time. If immediate skin-to-skin isn’t possible due to medical circumstances, initiate it as soon as you and your baby are stable.

The First Breastfeeding Attempt

Your first breastfeeding attempt may feel awkward or uncertain, and that’s completely normal. Your baby doesn’t need large volumes of milk immediately after birth; their tiny stomach is only about the size of a cherry. What your body produces in these first days is colostrum, a thick, yellowish substance packed with antibodies, immune factors, and essential nutrients.

Colostrum is produced in small quantities, but this is exactly what your baby needs. It coats your baby’s digestive tract, providing protection against infections and helping establish healthy gut bacteria. The concentrated nature of colostrum means that even small feedings provide significant benefits.

During this first feeding, focus on positioning and patience rather than perfection. Allow your baby to lead when possible, supporting their instincts while gently guiding them toward the breast. If your baby doesn’t latch immediately, don’t worry. Continue skin-to-skin contact and try again when your baby shows signs of readiness.

Mastering the Art of Positioning

Proper positioning is fundamental to successful breastfeeding. Good positioning ensures that your baby can latch effectively, helps prevent nipple pain and damage, and makes feedings comfortable for both of you. There are several positions to choose from, and what works best may vary based on your body, your baby, and your circumstances.

The Cradle Hold

The cradle hold is perhaps the most commonly pictured breastfeeding position. Your baby lies across your body, facing you, with their head resting in the crook of your elbow on the same side as the breast you’re using. Your forearm supports their back, and your hand supports their bottom or thigh.

To achieve a good cradle hold, ensure your baby’s ear, shoulder, and hip are aligned in a straight line. Their body should be turned toward you, belly-to-belly, rather than lying on their back with their head turned toward the breast. Support your breast with your opposite hand if needed, using a C-hold (fingers underneath, thumb on top) to guide the nipple toward your baby’s mouth.

The cradle hold works well once breastfeeding is established, but it can be challenging for newborns because the mother has less control over the baby’s head. Many lactation consultants recommend starting with other positions during the first weeks.

The Cross-Cradle Hold

The cross-cradle hold is similar to the cradle hold but provides more control over your baby’s head, making it ideal for the early learning period. In this position, you support your baby with the arm opposite the breast you’re using. Your hand cups the back of their head and neck, with your fingers behind their ears and your thumb near their ear on the other side.

This position allows you to guide your baby’s head precisely as they latch, making it easier to achieve a deep, effective latch. Once your baby is latched and feeding well, you can gently transition to a cradle hold if you prefer, or continue in the cross-cradle position throughout the feeding.

When using the cross-cradle hold, be careful not to press on the back of your baby’s head, which can cause them to push away from the breast. Instead, support at the base of the head and neck, allowing your baby freedom to tip their head back slightly as they latch.

The Football Hold (Clutch Hold)

The football hold positions your baby at your side, with their body tucked under your arm like a football. Your baby’s legs extend behind you, and you support their head with your hand while their body rests on your forearm and a pillow.

This position is particularly helpful for mothers who have had cesarean deliveries, as it keeps the baby’s weight off the incision site. It’s also beneficial for mothers with large breasts, mothers nursing twins, or babies who have difficulty latching in other positions. The football hold provides excellent visibility of your baby’s mouth and latch.

A nursing pillow placed at your side can make the football hold more comfortable by supporting your arm and bringing your baby to the proper height. Ensure your baby’s body is facing upward slightly, with their nose level with your nipple before latching.

The Side-Lying Position

Side-lying nursing allows you to breastfeed while resting on your side, with your baby facing you at breast level. This position is wonderful for nighttime feeds and can help exhausted mothers get more rest while still nourishing their babies.

To use this position, lie on your side with pillows supporting your head and back. Place your baby on their side facing you, with their nose level with your nipple. You can tuck your lower arm under your head or around your baby. Use your upper hand to support your breast and guide your baby to latch.

While side-lying nursing can be a lifesaver for tired mothers, it’s important to practice safe sleep guidelines. If you fall asleep while nursing, ensure your baby is on a safe sleep surface away from pillows and blankets. Many mothers find it helpful to nurse side-lying then move their baby to a safe sleeping space when the feeding is complete.

The Laid-Back Position (Biological Nurturing)

The laid-back position, also called biological nurturing, harnesses your baby’s natural feeding instincts. In this position, you recline at a comfortable angle (not flat on your back) with your baby lying tummy-down on your chest. Gravity helps keep your baby in contact with your body, and they can use their reflexes to find and attach to the breast.

This relaxed position can be especially helpful in the early days when both you and your baby are learning. It takes pressure off you to “get it right” and allows your baby’s instincts to guide the process. Many mothers find that laid-back nursing reduces nipple pain and helps babies who are struggling to latch in other positions.

The pediatric specialists at myPediaClinic often recommend trying laid-back nursing for mothers experiencing latching difficulties. The position allows for hands-free nursing once your baby is latched, freeing you to rest or gently support your baby as needed.

Achieving the Perfect Latch

A proper latch is crucial for effective milk transfer, comfortable nursing, and preventing nipple damage. Understanding the components of a good latch and knowing how to achieve it can save you from many common breastfeeding problems.

Signs of a Good Latch

When your baby is latched correctly, you’ll notice several key signs. Their mouth should be opened wide, with lips flanged outward like a fish rather than tucked under. You should see more of the areola visible above your baby’s top lip than below their bottom lip, indicating an asymmetric latch that allows deep attachment.

Your baby’s chin should be pressed into your breast, with their nose free or just lightly touching the breast. Their cheeks should appear rounded rather than dimpled or sucked in. You should hear rhythmic sucking and swallowing sounds, particularly after your milk comes in.

From your perspective, breastfeeding with a good latch should not be painful. You may feel a strong tugging sensation, and the initial latch may be briefly uncomfortable, but sharp pain or pain that continues throughout the feeding indicates that something needs adjustment.

Steps to Achieve a Deep Latch

Achieving a deep latch requires patience and practice. Begin by positioning your baby so their nose is level with your nipple. Wait for your baby to open their mouth wide, like a yawn. You can encourage this by tickling their lips with your nipple or expressing a few drops of colostrum.

When your baby opens wide, quickly bring them to the breast (not the breast to them), aiming your nipple toward the roof of their mouth. Your baby should take in not just the nipple but a significant portion of the areola as well. The nipple should reach far back in your baby’s mouth, beyond the hard palate to where the soft palate begins.

If the latch feels painful or looks shallow, break the suction by inserting your clean finger into the corner of your baby’s mouth, gently remove them from the breast, and try again. It’s better to relatch several times to get it right than to endure a painful feeding that can damage your nipples.

Common Latch Problems and Solutions

Shallow latching, where the baby takes only the nipple into their mouth, is one of the most common problems. This causes pain for the mother and ineffective milk transfer for the baby. To correct a shallow latch, ensure your baby opens very wide before latching and bring them quickly to the breast. Laid-back positioning often helps babies latch more deeply.

Babies who clamp down or bite may be reacting to a fast letdown or may have tension in their jaw from birth. Releasing the jaw tension through gentle massage or consulting with a practitioner who specializes in infant bodywork may help. If the clamping seems related to milk flow, try laid-back nursing or removing your baby from the breast momentarily when the flow is strongest.

Some babies have anatomical factors that affect latching, such as tongue-tie or lip-tie. These conditions restrict the movement of the tongue or lip, making it difficult to latch effectively. If you suspect your baby has a tongue-tie or lip-tie, seek evaluation from a qualified healthcare provider who can assess and, if necessary, perform a simple release procedure.

Understanding Your Milk Supply: Days 1-14

Your milk supply undergoes significant changes during the first two weeks as your body transitions from producing colostrum to mature milk. Understanding this process helps you know what to expect and reduces anxiety about whether you’re producing enough.

Days 1-2: Colostrum Production

During the first one to two days after birth, your breasts produce colostrum, often called “liquid gold” for its concentrated immune properties. Colostrum is thick and yellowish, produced in small quantities measured in teaspoons rather than ounces. This is perfectly matched to your newborn’s tiny stomach and immature kidneys.

Your baby may want to nurse very frequently during these first days, sometimes seeming to want the breast almost constantly. This frequent nursing is normal and important; it stimulates your breasts to begin producing milk and helps your baby learn to breastfeed. It also helps your baby pass meconium, the dark, tarry first stools, more quickly.

Days 2-5: Milk Coming In

Between days two and five, you’ll notice your milk “coming in.” Your breasts will feel fuller, firmer, and possibly warm as they begin producing larger volumes of transitional milk. Transitional milk is thinner than colostrum and may appear white, yellowish, or even bluish. It gradually transitions to mature milk over the next week or two.

When your milk comes in, your breasts may become engorged, feeling uncomfortably full, hard, or even painful. Engorgement occurs because your body doesn’t yet know exactly how much milk your baby needs, so it tends to overproduce initially. Frequent nursing, gentle hand expression, and cold compresses between feedings can help relieve engorgement.

If engorgement makes it difficult for your baby to latch because the breast is too firm, try expressing a small amount of milk by hand before attempting to latch. This softens the areola and makes it easier for your baby to get a deep latch. Reverse pressure softening, where you gently press around the nipple to push fluid back, can also help.

Days 5-14: Establishing Your Supply

By the end of the first week, your body begins to regulate milk production based on supply and demand. The more frequently and effectively your baby nurses, the more milk your body produces. This feedback system means that frequent nursing during these early weeks helps establish a robust milk supply.

During the second week, you may notice your breasts feeling less full between feedings. This doesn’t mean your supply is decreasing; rather, it indicates that your body is becoming more efficient at producing milk on demand rather than constantly stockpiling it. Your baby’s feeding patterns may also start to become more predictable, though significant variation is still normal.

It’s important to let your baby nurse on demand during these first two weeks rather than trying to impose a schedule. Babies know when they’re hungry, and responding to their cues ensures adequate nutrition and helps establish your milk supply. Most newborns nurse 8-12 times per day, though some may want to nurse even more frequently.

Recognizing and Responding to Feeding Cues

Learning to recognize your baby’s hunger and fullness cues allows you to feed responsively, ensuring your baby receives adequate nutrition while supporting healthy eating patterns from the start. Babies communicate through behavior long before they can use words, and reading these signals becomes easier with practice.

Early Hunger Cues

Early hunger cues are subtle and easy to miss if you’re not watching for them. These include stirring from sleep, stretching, and bringing hands toward the mouth. Your baby may open and close their mouth, make sucking motions or sounds, and turn their head from side to side as if searching for the breast (rooting).

Responding to these early cues makes breastfeeding easier because your baby is calm and alert, ready to feed. They have the patience to latch properly and the energy to nurse effectively. Watching for these cues is especially important during the first two weeks when you’re still learning your baby’s unique communication style.

Active Hunger Cues

If early cues are missed, babies progress to more obvious hunger signals. These include increased physical movement and restlessness, putting fingers or fists in the mouth, rooting more urgently against whatever is near their face, and fussing or making short, irregular sounds.

At this stage, your baby is still calm enough to nurse effectively, but you’ll want to begin feeding soon before they become more upset. If you’re out and about, these cues are your signal to find a place to nurse or to prepare a bottle if you’re supplementing.

Late Hunger Cues

Crying is actually a late hunger cue. By the time your baby is crying from hunger, they may be too upset to latch well. They may arch their back, turn away from the breast, or have difficulty coordinating the suck-swallow-breathe pattern needed for effective nursing.

If your baby reaches this point, take a few moments to calm them before attempting to nurse. Hold them skin-to-skin, speak soothingly, rock gently, or let them suck on a clean finger briefly. Once they’re calmer, you can try latching again. Learning to recognize earlier hunger cues will help you avoid this situation in the future.

Signs Your Baby Is Getting Enough Milk

One of the most common concerns during the first two weeks is whether your baby is getting enough milk. Since you can’t see how much breast milk your baby is drinking, you’ll need to rely on output and weight gain as indicators. The pediatricians at myPediaClinic monitor these carefully during early well-baby visits.

Diaper output is a reliable indicator of intake. In the first two days, expect at least one wet diaper and one bowel movement per day. By days three to four, you should see at least three wet diapers and three bowel movements daily. By one week, your baby should have at least six wet diapers and three to four yellow, seedy bowel movements per day.

Weight gain is tracked at pediatric visits. It’s normal for newborns to lose up to 7-10% of their birth weight in the first few days. They should regain their birth weight by about two weeks of age and then gain approximately 5-7 ounces per week. If your baby isn’t meeting these milestones, your healthcare provider can assess whether supplementation or other interventions are needed.

Common Challenges in the First Two Weeks

Almost every breastfeeding mother encounters challenges during the first two weeks. Knowing what to expect and how to address common problems can help you persevere through difficult moments and achieve your breastfeeding goals.

Sore Nipples

Some nipple tenderness is common in the first week as your nipples adjust to frequent nursing. However, significant pain, cracked nipples, or bleeding indicate a problem that needs attention. The most common cause of nipple pain is a shallow latch, so working on latching technique is the first step.

To help heal sore nipples, express a few drops of breast milk after feedings and allow it to air dry on your nipples. Breast milk has antimicrobial properties that promote healing. Medical-grade lanolin or a hydrogel pad may also provide relief. Avoid using soap on your nipples, as this can dry them out and worsen irritation.

If nipple pain persists despite good latch, consider whether your baby might have a tongue-tie or other anatomical issue. Infection, including thrush (yeast) or bacterial infection, can also cause nipple pain. If you see white patches in your baby’s mouth or experience burning nipple pain, seek evaluation for thrush.

Engorgement

Engorgement typically occurs when your milk comes in, usually between days two and five. Your breasts may become swollen, hard, warm, and painful. Severe engorgement can make it difficult for your baby to latch because the breast is too firm, creating a frustrating cycle.

The best remedy for engorgement is frequent nursing, at least every two to three hours, and ensuring your baby effectively drains the breast. If your baby can’t latch, hand express or pump just enough milk to soften the breast, making latching possible. Cold compresses between feedings can help reduce swelling, while warm compresses or a warm shower before feeding can help milk flow.

Untreated engorgement can lead to plugged ducts or mastitis, so it’s important to address it promptly. If engorgement persists for more than 48 hours or you develop fever, red streaks, or flu-like symptoms, contact your healthcare provider immediately.

Cluster Feeding

Cluster feeding occurs when your baby wants to nurse very frequently for several hours, often in the evening. During cluster feeding, your baby may seem never satisfied, wanting to return to the breast repeatedly with only short breaks. This is normal behavior, particularly during the first two weeks and during growth spurts.

Cluster feeding serves several purposes. It helps establish your milk supply by stimulating frequent production. It provides comfort and closeness for your baby during the challenging evening hours. And it may help your baby take in extra calories before a longer sleep stretch at night.

While cluster feeding can be exhausting, it’s temporary. Prepare by staying hydrated, having snacks and entertainment within reach, and accepting help with other responsibilities during these intense feeding periods. Remember that your baby’s frequent nursing is not a sign of low milk supply; it’s a normal developmental pattern.

Sleepy Baby

Newborns are notoriously sleepy, and some babies need encouragement to wake and nurse frequently enough. Sleepiness is especially common in the first few days, in babies who are slightly jaundiced, or after difficult births. While it might seem convenient to have a baby who sleeps for long stretches, infrequent nursing can lead to poor weight gain and low milk supply.

To encourage a sleepy baby to nurse, try skin-to-skin contact, undressing your baby to their diaper, changing their diaper before feeding, or gently stimulating them by stroking their feet or back. Switch breasts when sucking slows, as the change in position can help wake them. Compressing your breast during nursing can increase milk flow and keep your baby actively feeding.

If your baby consistently sleeps for more than three hours between feedings in the first two weeks, or if they’re very difficult to rouse, contact your pediatrician. Excessive sleepiness can sometimes indicate that a baby isn’t getting enough milk or has other health concerns that need attention.

Low Milk Supply Concerns

Many mothers worry about having enough milk, but true low milk supply is relatively uncommon. Often, perceived low supply is actually a misinterpretation of normal infant behavior or unrealistic expectations about feeding frequency. Babies who want to nurse frequently, fuss at the breast, or don’t sleep for long stretches may be behaving normally, not signaling inadequate milk.

True signs that may indicate low milk supply include inadequate diaper output, poor weight gain (less than expected or weight loss beyond the normal initial drop), a baby who is persistently lethargic or difficult to rouse, and infrequent or absent signs of swallowing during nursing.

If you’re concerned about your milk supply, the most important step is to nurse frequently and effectively. Offering the breast at least 8-12 times per day, ensuring a good latch, allowing your baby to finish one breast before offering the other, and adding pumping sessions after feedings can all help increase production. Staying hydrated, eating adequately, and resting as much as possible also support milk production.

Building a Breastfeeding Support System

Breastfeeding success is significantly influenced by the support you receive during the first two weeks. Building a network of knowledgeable, encouraging support people can help you navigate challenges and feel confident in your breastfeeding journey.

Partner and Family Support

Your partner and close family members play crucial roles in supporting breastfeeding. While they can’t breastfeed for you, they can handle household tasks, bring you food and water while you nurse, burp and soothe the baby between feedings, and provide emotional encouragement when things are difficult.

It’s helpful to discuss breastfeeding goals and expectations with your partner before the baby arrives. Educate them about what to expect in the first two weeks, including frequent feeding, cluster feeding, and the normal challenges of early breastfeeding. When your support people understand the process, they’re better equipped to help and less likely to suggest unnecessary supplements or formula.

Professional Lactation Support

Lactation consultants are healthcare professionals specially trained in breastfeeding support. They can evaluate your baby’s latch, assess your milk supply, identify issues like tongue-tie, and provide personalized guidance for your specific situation. Many hospitals have lactation consultants available during your postpartum stay, and outpatient consultations are available for ongoing support.

The myPediaClinic team includes specialists who can provide lactation support as part of your baby’s pediatric care. If you’re experiencing breastfeeding difficulties, scheduling an early appointment allows us to assess both you and your baby and develop a plan for success.

Peer Support and Resources

Connecting with other breastfeeding mothers can provide invaluable support and reassurance. Support groups, whether in-person or online, allow you to share experiences, ask questions, and receive encouragement from mothers who have faced similar challenges. La Leche League and other organizations offer free support groups in many communities.

Reliable educational resources can also help you understand breastfeeding and troubleshoot problems. Look for evidence-based information from reputable sources such as pediatric hospitals, professional lactation organizations, and established parenting health websites. Be cautious of advice from well-meaning friends or internet sources that may not be accurate.

When to Seek Help

While many breastfeeding challenges can be resolved with basic adjustments, some situations require professional intervention. Knowing when to seek help ensures that problems are addressed before they become more serious.

Signs You Need Immediate Support

Contact your healthcare provider or a lactation consultant promptly if you experience any of the following: your baby hasn’t had the expected number of wet or dirty diapers, your baby hasn’t regained birth weight by two weeks, your baby is excessively sleepy and difficult to wake for feedings, you have severe nipple pain or damage that isn’t improving, you have signs of infection such as fever, red streaks on the breast, or flu-like symptoms, or your baby is refusing to breastfeed.

Early intervention for these issues can prevent more serious problems. Don’t hesitate to reach out for help; supporting new breastfeeding families is exactly what lactation professionals are trained to do.

Red Flags in Your Baby

Some signs in your baby warrant immediate medical attention. These include jaundice (yellowing of the skin and eyes) that appears within the first 24 hours or seems severe, fewer wet diapers than expected, no bowel movements after day four, or green, watery, or bloody stools. Lethargy, weak cry, or difficulty staying awake even during feedings are also concerning.

Additionally, watch for signs of dehydration such as dry mouth, sunken fontanelle (soft spot), decreased tears, or dark, concentrated urine. If you observe any of these signs, contact your pediatrician immediately or seek emergency care.

Red Flags in the Mother

Mothers should also watch for signs that require medical attention. Breast symptoms such as a hard, red, tender area on the breast accompanied by fever may indicate mastitis and require antibiotics. Extreme engorgement that doesn’t improve with nursing and comfort measures may need medical management.

Beyond breast issues, watch for signs of postpartum depression or anxiety, which can sometimes interfere with breastfeeding. Overwhelming sadness, excessive worry, difficulty bonding with your baby, or thoughts of harming yourself or your baby require immediate professional support.

Week-by-Week Guide: What to Expect

Understanding the typical progression of breastfeeding during the first two weeks can help you anticipate what’s coming and recognize whether your experience falls within normal expectations.

Days 1-3: The Learning Phase

The first three days are about learning and colostrum. Your baby is learning to latch, and you’re learning to position them. Feedings may be frequent but short, and your baby may be sleepy. You’re producing small amounts of colostrum, which is exactly what your baby needs. Expect your baby to nurse 8-12 times or more in 24 hours. Watch for at least one wet and one dirty diaper per day.

This is the time to focus on skin-to-skin contact, getting help with positioning and latch, and resting as much as possible. Don’t worry about schedules or timing; simply feed your baby whenever they show hunger cues.

Days 4-7: Milk Coming In

Your milk should come in during this period, and you’ll notice significant changes. Your breasts will feel fuller and perhaps uncomfortable. Your baby may feed for longer sessions as they learn to handle the faster flow. Expect weight loss to stop and slight weight gain to begin. Diaper output should increase to at least six wet diapers and three to four yellow, seedy stools per day.

Engorgement is common during this phase. Manage it with frequent nursing, gentle hand expression if needed, and cold compresses between feedings. Your baby’s latch may improve as they get more practice and become more alert.

Days 8-14: Establishing Patterns

The second week is about building on what you’ve learned. Your milk supply is becoming established based on your baby’s demand. Feedings may become somewhat more predictable, though significant variation is still normal. Your baby should be gaining weight steadily, approximately one ounce per day or 5-7 ounces per week. Nipple soreness should be improving, and engorgement should have resolved.

By the end of two weeks, your baby should have regained their birth weight. If not, consult with your pediatrician to evaluate whether interventions are needed. Most breastfeeding problems can be resolved with proper support, allowing you to continue providing the best nutrition for your baby.