Breastfeeding

See the Community & Online Resources section of this website for further information and local resources about breastfeeding.

The first milk your breasts will produce is called colostrum.  It is the clear, yellow, sticky fluid your breasts prepare before your breast milk comes in.  It is important because it is loaded with proteins, vitamins, and mineral.  It also provides antibodies that protect your baby from disease and boost the immune system.

While there is only a very small amount of colostrum made by your body, it is all that your baby needs, as his/her stomach is still very small.  Your true milk supply will come in two to four days after giving birth.  Your breasts will feel tight and swollen when this happens.

Your baby will do very well on breast milk alone for up to the first six months of life.  In Canada, we recommend that breastfed babies receive Vitamin D drops as a daily supplement.

There are many people available to help you with breastfeeding.  While you are in hospital after your baby is born, our nurses with extensive training in breastfeeding support will help you to learn breastfeeding techniques and with any difficulties you may have.  After you go home, a public health nurse may visit you to assist with breastfeeding, answer questions and weigh your baby. You can also visit the public health nurses and lactation consultants in their clinic, located in the same building as the maternity clinic.

Each baby is unique, and you and your baby will learn the feeding pattern and schedule that works best for you both. When you first go home with your baby, you should breast feed him/her at least 8-11 times per day.  In general, you should feed on demand and at least every 2.5 to 3.5 hours around the clock.  Initially, you may need to wake your baby to feed.

Always ensure the baby is latched properly on the breast to help prevent sore nipples.  Each feed should last around 20-40 minutes initially.  Once your baby is gaining weight well, there may be some times, especially at night, when babies may naturally space their feeds farther than 3.5 hours apart.  However, your baby should then naturally also make up these missed feeds by cluster feeding or taking additional feeds in the daytime.

How to know if your baby is getting enough milk:

Normal urine output for a newborn is at least 1 wet diaper on day 1 of life, 2 wet diapers on day 2, 3 wet diapers on day 3, etc. and a least 6 wet diapers a day by day 6.  Place a tissue inside the diaper if you cannot tell if it is wet.  Urine should be pale and odorless.

Normal newborn stool should change from dark green to a lighter, more yellow colour on days 3-6 of life. Babies should have at least 2 “loonie-sized” bowel movements in 24 hours.

It is normal for a baby to lose up to 7% of its birth weight within the first week. By 2 weeks of age, your baby should be at its birth weight at minimum. You baby should in general gain approximately 30 grams or 1 ounce per day for the first 2 months.

Mild jaundice (yellowing of the skin) can be normal after the first day of life. However, it can also mean your baby is not getting enough milk, is dehydrated, or is sick. Check with your doctor or public health nurse to be sure your baby’s jaundice is “normal”.

If your baby is lethargic and hard to wake for feedings or does not wake independently for feedings, eats less than 8 times in 24 hours, is jaundiced, is not gaining enough weight, or is not having enough soiled or wet diapers, please follow up with your doctor or public health nurse.

When to follow up with your doctor after leaving the hospital

A public health nurse will call you at home within 24-48 hours of discharge from hospital.  If you are having any difficulties the public health nurse may visit you in your home where they will weigh the baby, help with breastfeeding, and address any other concerns you may have.  You may also arrange to see the public health nurse in their office for breast feeding help and weight checks.  Many other resources for breastfeeding help are available should you need them.

Unless otherwise instructed, your baby should be seen at the maternity clinic within one week of birth for a head to toe exam and weight check, for breastfeeding support, and to help with any other concerns you may have. After this first visit, most babies will have another checkup at two weeks old and one month old at the maternity clinic.  You will have one last visit at the maternity clinic when you are 6 weeks postpartum for a postpartum checkup, pap smear, to discuss birth control, and a number of other topics.  After this your care will be transferred back to your family doctor. If you do not have a family doctor, we will help you find a one.

Additional appointments may be booked as you require during this time.  If you have any urgent concerns about yourself or your baby please call the clinic and we will usually be able to see you the same day at the maternity clinic.

When to call your doctor about your baby

You know your baby better than anyone else.  Trust your own intuition if you think something is wrong.  If your baby develops a fever, is feeding less than usual, or is excessively sleepy, seek medical attention right away.   Babies can become ill very quickly.

Your own health

Follow up with your doctor immediately if you think you have:

• Excessive vaginal bleeding
• Fever or other signs of infection (red, painful, swollen breast or C-section incision, foul smelling vaginal discharge)
• Postpartum depression, feelings of hurting yourself or your baby, or if you feel you cannot cope.

We recommend you read the sections in Baby’s Best Chace on caring for yourself and your new baby.  It contains excellent sections on topics such as breastfeeding, mastitis, infant safety, immunizations, and postpartum depression.

Going Home – Your baby and you

To reduce the risk of SIDS (Sudden Infant Death Syndrome)”
All infants should be placed to sleep on their backs rather than on their sides or tummies.  Commercial devices to keep babies in a certain sleeping position should not be used. Infants should not sleep on sheepskins, pillows, waterbeds, or other soft bedding.  You baby should sleep in its own crib or bassinet, on a standard plastic covered mattress with a thin sheet cover.  Remove pillows, quilts, stuffed animals, and bumper pads from the crib or bassinet. Do not overdress or over bundle your infant.  Consider using an undershirt and sleeper or sleep sack instead of any blankets.  If using thin blanket, tuck it around the mattress, reaching only to the baby’s chest.  Make sure your baby’s head is always uncovered while sleeping. Do not expose your baby to cigarette smoke.

Tummy Time
Babies who lie only on their backs may develop a flat head.  To avoid this:
Change your baby’s head position from day to day in the crib so your baby spends some time facing to the left, some time to the right, and some time up.
While your baby is awake, frequently try to give your baby tummy time.  Many babies do not naturally like lying on their tummies.  Place “face to face” with your baby during tummy time.  Even a few minutes of tummy time, repeated throughout the day helps.  Tummy time also encourages the development of upper body strength, coordination, and head control.

Supplements
Babies who are breastfed should receive Vitamin D drops every day.  Vitamin D may also be recommended for babies receiving formula.
Fluoride supplementation for newborns is not required.  Because there is no fluoride added to the local water supply, it is important to begin using fluoride toothpaste when your baby gets his or her first teeth.  Other supplements for healthy term babies are usually not needed.

Safety
All infants must ride in the back seat of the car inside a Canadian approved rear facing car seat appropriate for their weight.
Infants should never be left alone with pets or small children.
Turn down your hot water heater for tap water to the lowest setting (55-59 degrees Celsius) to help prevent scalds. Even water at this lowest setting may burn your baby in less than 30 seconds.
Necklaces should not be placed around your baby’s neck.  Earrings may fall off and cause choking so should be avoided until age 2.
Baby walkers are now illegal in Canada. They are dangerous and should not be used.
Install safety gates before your infant starts crawling.
Your baby should not be exposed to cigarette smoke.
Check that your smoke alarms and any carbon monoxide detectors in your house work properly.
BC Women’s and Children’s hospital has a “safe Start” program which has resources for parents regarding safety issues and child proofing your home.  (1-888-331-8100 or 604-875-3273)

Post-partum depression

One of the most difficult, yet common complications that arise after pregnancy is post-partum depression.  It seems illogical that a woman who has just experienced the miracle of childbirth and loves her baby to bits, and has a supportive husband and family would get depressed.  Yet this is sometimes the case and often women who suffer from this condition feel guilty about it and may not initially disclose their feelings.  It is important to understand that almost every woman will go through some Post-Partum Blues – where she may feel sad or tearful for no reason.  A significant number of woman will suffer Post-Partum Depression – and a tiny number of women will suffer a post-partum psychosis where they may harbour thoughts of harming their babies.  Please be aware that post-partum psychosis is extremely rare – but still treatable, and that post-partum depression is quite common.

It is not hard to understand why a woman will be tired after she goes through labour and delivery.  She may have been up for days, and working extremely hard physically to push her baby out.  In addition she may have lost a lot of blood, and may have a surgical wound from a Cesarean section or a perineal tear to recover from.  Add to that the stress of breast feeding, tender and cracked nipples, and the anxiety of looking after a newborn and not quite meeting her mother-in-law’s expectations!  It’s a wonder that not more women suffer depression under those circumstances.  So far, we have only mentioned the physical factors that occur to varying degrees with each pregnancy.  In addition, there are hormonal changes that take place, and pre-existing or underlying conditions – such as a prior depressive disorder.

One nutritional theory that may help explain post-partum depression has to do with omega-3 fatty acids.  Since these are so critically important for the development of the baby’s brain and eyes, omega-3 fatty acids are well absorbed in pregnancy and transferred via the placenta.  Post-partum, the placenta is no longer present and there is a drop in omega-3 fatty acids in the mother’s circulation.  Omega-3s are also important for mood and have been used to treat mild to moderate depression outside of pregnancy.  Hence the drop in omega-3 fatty acids can contribute to post-partum depression and the obvious solution is to eat more oily fish and other sources of omega-3s and for more consistent intake, use a fish oil supplement post-partum.  This has benefits for mom, and also for the newborn as it is excreted in the breast milk.

Another supplement that supports mood is Vitamin D – the Sunshine Vitamin – which is often insufficient in the winter months.  We recommend that all newborns get Vitamin D drops (as this vitamin is often low in breast milk) and in addition, mothers would be well-advised to take Vitamin D as well.

Furthermore, exercise has a proven anti-depressant effects and it is important for new moms to find the time to exercise regularly.

Without a doubt, the most important factor in reducing post-partum depression is for the new mother to have a lot of support.  This is mainly from her partner, but also family and friends can be tremendously supportive at this time.  Be aware that a lot of new moms may not ask for help, and that when a new mom may be battling post-partum depression, one of her symptoms is that she does not realize that she needs more help and support.  But it takes a village to raise a child, and when a new baby comes home, it is time to call upon extended family, neighbours and friends to help out.  This support is usually in place for a few weeks, but then dries up.  So although new moms always do their best (it is hard wired into their DNA to look after their babies) they are often with their infants 24 hours a day, 7 days a week.  Hence, one of the most effective strategies early on is to set aside some personal and protected Mom time.  This is a minimum one (but preferably two) four hour block at the same time every week.  This may be a Tuesday afternoon and a Saturday morning, in which the new Mom has child-care arranged and can go out and do whatever she wants to do.  This may include going for a walk and tea with some girl-friends, going to a movie or shopping for her own personal needs.  It should be stressed that this must not be the only time to exercise, as there are many mom and babe exercise options available.  However, this block of time for Mom needs to be established and protected even if it means calling in favours from in-laws or hiring a baby sitter.  Moms are worth it!

There are also many mom and babe support and socializing groups available.  Check at community centers and online – and if one is not offered in your area – consider starting one.

These strategies are definitely helpful in reducing the incidence and severity of post-partum depression – but they may not be sufficient.  Be aware that despite a mom’s best efforts, medications may still be required – and these are perfectly safe to use when breast-feeding.

Speak to your maternity doctor or family doctor for more help – and see the Reference section for Post-Partum support.