Breastfeeding

A new mother says the milk hasn't come in on postpartum day 1 — but colostrum is exactly what the newborn needs. Knowing the difference changes your teaching entirely.

Breastfeeding success depends on understanding the three stages of lactation. Colostrum (present at birth through days 2–4) is small in volume but rich in immunoglobulins (especially secretory IgA), protein, and fat-soluble vitamins — it is the ideal first feeding. Transitional milk arrives around days 3–5 (the "milk coming in" phase) with increased volume, causing breast fullness or engorgement. Mature milk follows by approximately 2 weeks postpartum. Newborns should feed 8–12 times per 24 hours, roughly every 2–3 hours. Effective latch is assessed by a wide-open mouth flanged around the areola (not just the nipple), audible swallowing, and rhythmic suck-swallow pattern. Adequate intake is confirmed by output: at least 6 wet diapers and 3–4 stools per day by day 4. The nurse assesses for proper positioning (tummy-to-tummy alignment), monitors for nipple breakdown, and teaches hand expression and breast massage to relieve engorgement. Breast engorgement is managed with warm compresses before feeding and cold compresses after — not by skipping feedings, which worsens it. Contraindications include active herpes lesions on the breast, HIV (in resource-rich countries), active untreated TB (direct breastfeeding — expressed milk may still be given), and certain medications.

Key Distinctions

Don't confuse colostrum with insufficient milk supply — colostrum volumes of 2–10 mL per feeding are normal and adequate for the newborn's marble-sized stomach. Students mix up engorgement management: warm before feeding (promotes let-down), cold after (reduces swelling). A poor latch causes nipple pain and cracking — repositioning fixes this, not stopping breastfeeding.

Clinical Pearl

Count the diapers, not the ounces. Six wet diapers by day 4 tells you what the scale can't — the baby is getting enough.