🤱 The First 72 Hours: The Ideal Start to Breastfeeding

When a baby is born, the first few days are the beginning of a new learning process for both mother and baby. Although breastfeeding is a natural process, it is a skill that must be learned initially; Just like learning to walk, it requires patience and practice. The World Health Organization (WHO) and UNICEF emphasize that the steps taken in the first 72 hours after birth are decisive in the continuation of breastfeeding for weeks and months. In this article, the practices recommended by science in this critical window; Starting from the first hour, we cover the value of colostrum (the first thick milk that comes right after birth), proper latch-on, timing of milk arrival, and warning signs to look out for.

🕐 First Hour: Why Is the "Golden Hour" So Important?

The first hour after birth is often referred to as the "golden hour". WHO and UNICEF recommend that every healthy born baby start breastfeeding within the first hour after birth; This is called early initiation. This recommendation is not just tradition, but based on strong evidence: starting breastfeeding two to twenty-three hours after birth, rather than within the first hour, has been shown to increase the risk of neonatal death by about a third.

In the first hour, the baby is usually alert, calm and ready to breastfeed. When this natural preparation window is missed, the baby may fall asleep and it may be more difficult to initiate breastfeeding in the following hours. Therefore, the healthcare team postpones weighing, measuring, or routine procedures as much as possible until the first breastfeeding occurs.

Skin-to-Skin

Skin-to-skin contact (laying the baby's naked body on the mother's bare chest) is the basis of early breastfeeding. Current international guidelines from 2023 state with high confidence that uninterrupted skin-to-skin contact should be routine practice immediately after birth for all babies weighing over 1000 grams, regardless of the mode of delivery (whether normal birth or caesarean section).

This simple app has many proven benefits. A comprehensive review by Cochrane (a trusted organization that compiles independent scientific evidence) found that early skin-to-skin contact supports breastfeeding and increases breastfeeding success. The main benefits of skin-to-skin contact are:

• The baby's body temperature, heartbeat and breathing are more stable
• The baby cries less and is less stressed
• Increased release of oxytocin (the hormone that provides contraction and bonding, also called the "love hormone") in the mother, which contributes to the recovery of the uterus and the flow of milk.
• The baby often turns to the breast on its own, using natural rooting and sucking reflexes

🟡 Colostrum: Baby's First Vaccine

The dark yellow or orange-ish, sticky milk that comes from your breast in the first days after birth is called colostrum (colostrum). Its quantity is small; This is completely normal and even a design. A newborn's stomach is only the size of a marble on the first day, so a small amount of colostrum is just what the baby needs. The worry "My milk is low, my baby is starving" is very common in the first days, but the lack of colostrum is not a deficiency, but a conscious setting of nature.

Although colostrum is small in volume, it is extremely rich in content and is therefore often described as the "baby's first vaccine". The main protective ingredients it contains are:

• Secretory IgA (secretory immunoglobulin A): It is a type of antibody that covers the baby's mucosal surfaces such as the throat, lungs and intestines like a layer and protects them against microbes.
• Lactoferrin: A protective protein that prevents the proliferation of harmful bacteria by binding iron.
• White blood cells (leukocytes) and growth factors: Living cells and substances that support immunity and intestinal development.

Another important function of colostrum is to facilitate the excretion of meconium (the first dark, tarry poop), which is the baby's first stool, by having a mild laxative effect. This helps remove excess bilirubin from the body (a yellow waste substance formed by the breakdown of red blood cells, excess of which causes jaundice), thus reducing the risk of neonatal jaundice.

📅 When Will Milk Arrive? Lactogenesis II

Many new mothers expect the milk to "flow" immediately after birth and become concerned when they see only colostrum in the first days. However, the significant increase in mature milk, that is, the phenomenon commonly called "the coming of milk", is called lactogenesis II (secretory activation) in medicine. Current sources indicate that this transition typically begins in the first 50-72 hours (approximately on day 2-3) after birth, mostly on days 3-4. indicates that it becomes clearer towards the day; Minor delays are common and normal.

During this period, you may feel that your breasts are full, heavy and warm; This is a natural process. Lactogenesis II exceeding 3-4 days is defined as "delayed milk arrival"; This condition can be seen in approximately 20-30% of women and is especially common in primiparous women. The most important factor that ensures timely and abundant milk is breastfeeding frequently and effectively from the first days; because the more the breast is emptied, the more milk the body tends to produce (supply-demand principle).

How Often Should You Breastfeed in the First 72 Hours?

Newborns usually breastfeed 8 to 12 times in 24 hours. This means approximately every 2-3 hours, sometimes even more frequently; including night. Babies can sometimes take several feeds in a row and then sleep longer (cluster feeding). Breastfeeding according to the baby's hunger cues (on-demand breastfeeding) rather than by time is recommended.

It is important to recognize a baby's early signs of hunger because crying is a late sign of hunger and it is more difficult to calm and latch a crying baby. Early signs of hunger:

• Searching for the breast by opening its mouth and turning its head left and right (rooting reflex)
• Bringing hands to the mouth and making sucking movements
• Sticking out your tongue, licking your lips
• Restlessness, fidgeting (stage before crying)

🤱 Correct Latch and Positions

The key to making breastfeeding painless and efficient is correct latch. Latching is the way the baby takes the breast into his mouth. Poor latch is the most common cause of cracked nipples, pain and the baby not getting enough milk. In a good latch, the baby takes not only the nipple into its mouth, but also a significant part of the nipple and the dark ring around it (areola).

Signs of a Good Latch

• Baby's mouth is wide open (like yawning)
• The lower and upper lips are curved outwards (like fish lips), not curved inwards
• According to UNICEF, more of the areola appears above the baby's upper lip than below the lower lip (i.e., the baby has more of the lower part of the areola in his/her mouth).
• The chin touches the breast, the nose is exposed; baby breathes easily
• Swallowing sounds are heard while sucking; Cheeks do not sink in, they look full
• Breastfeeding is painless (there should be no persistent pain except for a slight pulling sensation in the first few seconds)

Common Breastfeeding Positions

There is no single "correct" position; You can choose what is most comfortable for you and your baby. Common positions:

• Cradle hold: The baby's head rests in the elbow bend of your arm on the same side as the breast you are breastfeeding. It is a classic and comfortable position.
• Cross-cradle hold: You support the baby's head with your opposite hand. It is ideal for those who are just learning to breastfeed and for young babies, as it facilitates head control.
• Soccer / armpit hold (football): The baby is under your arm, with his/her body at your side. It is suitable for those who are breastfeeding twins as it does not put pressure on the abdominal area after cesarean section.
• Side-lying: Mother and baby lie on their sides. It is comfortable for night feedings and resting breastfeeding after cesarean section.
• Laid-back (biological feeding): The mother lies back, the baby is placed face down on the chest. Because gravity helps with deep latch, it can reduce nipple sensitivity.

🏥 Baby Friendly Hospital and "Ten Steps"

WHO and UNICEF operate the Baby-Friendly Hospital Initiative (BFHI) to promote health organizations that support breastfeeding. The foundation of this initiative is the "Ten Steps to Successful Breastfeeding"; These steps were last updated in 2018 and are still current. The updated point 4 of the Ten Steps includes ensuring uninterrupted skin-to-skin contact immediately after birth and supporting the mother to begin breastfeeding as soon as possible.

The mother and baby staying in the same room day and night (rooming-in / room sharing) is also an important part of these steps. Having the baby next to you makes it easier for you to recognize hunger cues early and breastfeed frequently on demand. It may be useful to ask in advance whether the institution where you will give birth supports these practices.

✅ Practical Checklist for the First 72 Hours

• If possible, seek skin-to-skin contact as soon as possible after birth and give the first breastfeeding within the first hour.
• Rely on low colostrum; The baby's stomach is small, the quantity is sufficient.
• Breastfeed at least 8-12 times in 24 hours, based on the baby's hunger cues, not the time.
• Check for correct latch each time you feed: mouth wide open, lips turned outward, sucking without pain.
• Stay in the same room as your baby (rooming-in); so you catch early signs of hunger.
• Avoid giving supplementary food, water or pacifiers unless there is a medical necessity (unless recommended by a physician); These may negatively affect the sucking rhythm and milk production in the early period.
• Keep track of baby's wet and dirty diapers (see table below).
• Whenever in doubt, seek help from the breastfeeding consultant / midwife at the hospital.

Is Baby Getting Enough Milk? Diaper Tracking

In the first days, one of the most practical indicators of whether your baby is getting enough milk is the number of wet and dirty diapers. As a general rule in the first few days, the number of diapers increases in proportion to the baby's age in days:

• Day 1: At least 1 wet and 1 dirty diaper
• Day 2: At least 2 wet and 2 dirty diapers
• Day 3: At least 3 wet and 3 dirty diapers
• After days 4–5: at least 5–6 wet diapers per day; stools become yellow and soft, at least 3–4 times daily

It is normal for the baby to lose some of his birth weight during this period (usually a small weight loss is expected in the first days) and the weight begins to gain again after the milk comes. Your physician will monitor your weight; At home, you can observe the number of diapers, the frequency of sucking, and the baby's swallowing sounds while breastfeeding.

🚨 When to Get Help?

While breastfeeding is a natural process, experiencing difficulties is extremely common, and asking for help is a step in the right direction, not a failure. Getting early support allows many problems to be resolved before they escalate. If you have any of the following conditions, contact your doctor, midwife or a breastfeeding consultant (lactation consultant) without delay:

These warning signs may indicate that the baby is not getting enough milk and requires early intervention. Lactation consultants can evaluate latch, correct position, and recommend methods to increase milk production if necessary. Remember: breastfeeding is a team effort, and getting support is in the best interest of both you and your baby.

🌱 Closing: Be Patient and Compassionate

The first 72 hours lay the foundation of your breastfeeding journey; But you don't have to be perfect. Early skin-to-skin contact, starting in the first hour, frequent breastfeeding and learning to latch correctly; These are the strongest initial steps that science points to. It is completely normal to experience ups and downs, feel indecisive and need help during this process.

The World Health Organization and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding (without additional food or water) for the first 6 months and continuing breastfeeding with appropriate complementary foods for 2 years and beyond, as long as the mother and baby desire. But this long journey begins with those first few steps you take. Be patient with yourself, compassionate with your baby, and reach out and ask for support when necessary.

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