What to expect in the first 12 months of breastfeeding your new baby. An Interview with Katie James, IBCLC

This interview with Katie James, IBCLC and midwife on is a great introduction on what to expect over the first year when you're breastfeeding your baby. I hope you enjoy the video, or you can read the article below.

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The first 6 to 8 weeks

Recapping over last weeks blog, the first 6 to 8 weeks you can expect to breastfeed 8 to 12 times every 24 hours, and it’s a really tough period. At the end of this period, it’s like a light bulb moment. We understand our baby so much more. We understand what’s happening with the baby, their language more, we’ve managed to get into some kind of routine that often our baby has set, and we can plan more of our day. We get back into that point where we can multi-task, "I can cope with having a baby AND going out". 

Before that point it’s a huge shock to the system, and a huge rollercoaster of emotions. It’s really difficult to prepare for being a mother in the 21st century that we live in. The first week with your new baby can be really hard. We no longer live with our parents and sisters and friends, or other mothers to learn from, so it can be a real shock. A lot of new mums say to me “I just thought breastfeeding was going to be natural, I thought it would be easy, and I’m struggling so much”. What happens is, we know that there is a normal period where the nipples will become quite sore. We call it a transient period. It seems to peak around day 3 after birth until around day 5 or 7. This is a really emotional time, often the milk starts to come in around 60 to 80 hours and we can be an emotional wreck. The breasts fill up, we’re leaking milk, they might feel hard, painful, we’ve had no sleep for maybe 4-5 days including labour, and our nipples are feeling really sore. If your baby is not attaching well this is when we can start to have a breakdown. So unfortunately, the biggest reason mums give up in the first month is soreness. So it’s really important to make sure that you keep asking for help. 

You will hear every midwife say it’s like learning to drive a car, and it is. A manual one! There are so many things you have to learn, and no one would hand you the keys to the car and say “go ahead and drive!” and expect you to know what to do! It’s like this for us in the western world with a brand new baby. It takes time. That’s the most important thing to realise. You are going to be exhausted, probably never so much as in the first 6 weeks. You might be worried about whether your baby is getting enough milk. Then when you’re trying to learn new skills, not just breastfeeding, but also handling your baby, settling your baby, looking after your baby, your brain can only absorb so much. Often I’ll say, if I’m teaching midwives or students, “don’t come and be a midwife if you don’t want to have to repeat yourself all the time!”. As a new mum you need information repeated many times until it starts to gel. And that’s often around 6 to 8 weeks, and you just suddenly feel “oh my goodness, I know what to do” and it gets better.

That’s also when your supply starts to settle down, and your breastfeeding is established, and your bond with your baby feels a lot more secure at that point. We’ll often feel quite full until 3 -9 weeks. Some mums might describe that their breasts feel softer, and they worry that their supply has disappeared. It hasn’t! Your body has worked out what it’s doing and it produces the right amount for your baby. You’ll often have settled into your period like you’ve become a mother, and that can really enhance the bond with your baby. Plus the breastfeeding hormones have really laid down the foundations. They’re functioning on normal cylindars, and that prolactin hormone which makes milk is the mothering hormone, and the oxytocin that helps you have a letdown and squeezes the milk out is the love hormone. So you’ve got a double whammy of these protective mothering, bonding hormones. Really powerful and strong.

[related: 10 breastfeeding facts you've never heard before]

After 6 weeks

You can have growth spurts from 3, 6, and 9 weeks and beyond when your baby might feed more than normal for a while, and then suddenly grow! From 6 weeks to 3 months a lot of babies will have lots of morning feeds, then they might go 2-3 hours in the day, then in the evening we have the witching hours, or cluster feeding hours, this is really normal. A lot of parents get worried about colic or wind, but it’s actually really normal. It might start around 3 – 12 weeks, or later, and babies will just be very hungry and tired at the end of the day, and it’s our time of lowest milk supply. So babies will feed and cry, and feed and cry, and go from one side to the other, and be really upset and unsettled for maybe a 3 or 4 hour period. This is really hard work, and then all of a sudden, they’re out like a light. This is often when they’ll have their longest sleep period, from 3 hours or up to 5. Then they’ll wake up 2-3 hourly after that.

From 3 to 6 months

From 3 – 6 months babies are more efficient and quicker when they feed. So the length of feed starts to reduce, but they will take the same amount of milk in a 24 hour period. What we do find, at different stages for each baby around 3, 4, or 5 months is they're starting to learn to crawl, and having more movement. They’re developing better eyesight, and are more aware of their surroundings, they’re learning hugely, their brain is expanding. All of this takes a huge amount of calories and energy, and often at 4 or 5 months they might be bouncing on your knees and strengthening their leg muscles ready to start teaching them to sit up. 

You often have this beautiful pattern from 6 to 8 or 12 or 16 weeks you can rely on them sleeping from midnight to 4am, then it all goes out the window because they’ve been having this gym session all day long and they’re awake and they’re hungry! Often this is when we think if I give them a formula feed at night it’ll help them to sleep all night long, or, I need to give them solids! Unfortunately the research shows that that often doesn't make any difference to help them sleep better, and it’s just a normal stage that they go through.

Going back to work when baby is 3 to 6 months old

This is also sometimes when Mum’s might be going back to work, making it a much more complex and difficult stage. If you are going back to work at this stage, it can be really tricky. It’s best to keep this in mind while you’re still pregnant and talk to your employer about expressing breaks and somewhere you can pump in private, and somewhere you can store your milk. Then, start preparing a few weeks before you go back to work, as our bodies may react differently to the pump than to our baby breastfeeding. Some mums might find initially they find it difficult to drain any good amounts of milk, our body just doesn't respond to a machine the same way as our baby. It can be good to build up a store in the freezer in the weeks beforehand. If you have the ability to have a crèche onsite or a carer that can bring your baby to you in your break, you are entitled to have expressing or feeding breaks and that can be helpful.

That might not work for everyone though. You may be back full or part time and most of us work between 6 to 8 hour days so what we find from about 3 months is you’re probably still nursing 8 to 12 times in 24 hours and so over 6 to 8 hrs at work you’re probably going to need 2, 3 or 4 feeds, depending on what is normal for your baby. The best thing to do is have a feed before you go to work, and when you get home your baby will be very pleased to see you to have another feed and snuggle. Often babies will cluster feed in the evenings to make up for the time you haven’t been there. That’s to do with food, as well as comfort, love and reassurance.

Going through the night can be difficult when you first go back to work, and you may want to have express some milk to help with that. You’ll find that because your system is so used to how you are breastfeeding, it will wake you up at those normal times and you’ll feel full anyway though, so sometimes it’s easier to just roll over and feed baby than to get up and feed baby expressed milk, and still feel full, so then you have to pump anyway.

If you see your supply dwindling, go and see a child health nurse. You may be concerned that you only get a small amount when you express. What we know from the research, is that there is a huge amount of variation of the average daily milk intake by babies. It varies from 470ml per day to 1300ml. That’s because our breastmilk is individually different in fat and protein and carbohydrate, so one woman’s 50mls is very different to another woman’s 50mls. Quantity isn’t everything, it is important, but it’s just something to keep at the back of your mind. If you are finding it very difficult to express milk with a pump, you can check this blog post for more tips for expressing breastmilk.

Each Mother's Experience is Unique

The other thing to keep in mind is that each mothers experience is unique, so have some caution when you’re comparing notes with other mums. Sometimes it can be reassuring, other times it can be quite concerning, but this may just be because of the huge variations between each mother-baby relationship. Go with your instincts because by that stage they are quite well developed. Your gut instinct will tell you if your baby is thriving, and if your baby is smiling and laughing with you and enjoying being with you. You will know. If your baby wakes 3 or 4 times in a night and your friends baby wakes only once, that doesn’t mean anything. It just means we’re different individuals. If we all sat around a table for Christmas lunch we would not all finish at the same time. Some of us would have seconds, we’re all different.

You can spend quite a lot of time researching normal baby sleep, and how you can improve your babies sleep. It’s worthwhile thinking more about how you can help yourself cope instead, whether you can have naps through the day, or call in extra help to have a nap, or get your husband to take your baby for a walk in the morning so you can have an extra hour sleep in.

6 to 9 months and Introducing Solids!

The next stage is 6-9 months when you’re introducing solids and your baby is developing even more. It’s a really interesting, exciting and quite messy period, when you’re introducing solid food. When babies have breastfed up to around 6 months, it could be 5 and a half months, other babies might be closer to 7 months. We just keep trying them. Food doesn’t have to be totally pureed because when they’ve breastfed, they’ve really developed their jaw muscles, so they can have mushy foods, and then go on to have finger food that they can enjoy as well. It will be messy! But that’s part of the fun. What we have to think about, we’re actually ‘introducing’ solids. We’re not replacing anything yet. They might have tasters, they might spit most of it out, they might need 3 to 10 goes for a certain food before they even like it. We don’t want to introduce too many flavours too soon in case they react to it. All of this is experimentation. It’s the change of the oral pleasures and sensations. We are designed to enjoy eating. So they’re going from something that’s been the most wonderful thing in the world, breastfeeding, to new tastes, textures, smell and they will screw their noses up and endure it. But what we will find is that babies are still feeding on the breast as often as they were before. Some mums can be quite worried about it, but that’s quite normal. Other babies might progress a bit sooner, they might have started a bit earlier, so they might be having a couple of tablespoons of food 3 or 4 times a day, and that will start to replace perhaps 1 or 2 breastfeeds. Probably around 9 to 12 months that’s when the food becomes more of a important part of their diet, and that’s when they might start replacing more breastfeeds. But babies will still enjoy their breastfeeds very much and will likely still want to feed through the night. There isn’t any research that says that babies must start sleeping through the night from 6 months. Of course though, some will, but some won’t. That’s all on the scale of normal and is our individual patterns.

It’s probably not worthwhile trying to make your baby eat more solids to help them sleep more. They will eat what they need.

Thank you very much Katie for your wisdom, and thanks for all of our listeners!