Why babies are so unsettled around Day 3 (or 2 or 4…)

When your baby is born, vaginally or by caesarean, they are soon followed by the placenta which has been beside them for around 40 weeks. While it's work is now done, it's absence switches on a major production within your body: it's time to start lactation!

Colostrum has been produced and stored by your breasts since around 16 weeks gestation and it is just what your baby needs during the first days of life outside the womb. Your baby will be recovering from the experience of birth and takes a couple of days to catch up on sleep and gently get used to their new world.

Meanwhile, your body is undergoing a significant change in hormones, as it switches from pregnancy to lactation. Even if you have decided to formula feed from the start, your body will still go through this process.

If you give birth without intervention and have uninterrupted skin-to-skin contact with your baby for at least one hour after birth and your baby attached and breastfed, you can expect changes to begin around 30-40 hours after the placenta is expelled.

You might begin to see signs of your milk “coming in” over the following days however what you will definitely experience is signs of your baby taking it out!

It is normal for babies around the second to fourth days to be fussy, unsettled and feeding constantly around the clock. This is one of the most demanding stages of breastfeeding.

Your baby’s crying signals to your body to respond. It feels urgent and prompts you to quickly bring them back to the breast. Their behaviour and your response are part of the process to establish Your milk supply.

The frequency of milk removal in these first few days is important to establish your milk supply and for your baby to begin gaining weight. It might feel like you are not producing enough milk to satisfy your baby’s hunger but it is this intensive feeding which does the job.

Your baby will be experiencing a lot right now. For the first time, the feel hunger, thirst, warm and cool - and digestion. Some parents worry that the baby is experiencing pain but nearly always they are just experiencing new sensations.

It is expected that babies around Day 2 - 4 will sleep very little and feed almost constantly, with fussiness in between feeds. They might seem to constantly seek the breast, no matter who is holding them. Their behaviour can feel frantic.

Mothers who have had an uncomplicated vaginal delivery will be at a natural low point of their recovery around now. The huge hormonal shift from pregnancy to postpartum can bring on mood swings, commonly referred to as The Baby Blues. This is a physiological response and is different to postnatal depression. Most mothers will have a couple of days when they feel overwhelmed and fatigued. Nature sometimes has bad timing and this is one: overwhelmed baby and mother at the same time. Modern society has added to this stress by discharging them from hospital during this period, rather than a few days later as happened 30 years ago. This is a vulnerable period in your breastfeeding journey. If your birth was complicated, your milk might come in a day or two later - meaning your baby could be fussy and unsettled for a longer time.

If your baby is not yet effectively removing milk from your breast, hand-expressing will be important to establish production. A breast pump is not as effective as hand expressing at this stage of lactation.

The key to establishing your milk supply is removing milk often in this critical time. Even if you or your baby are not yet able to breastfeed, express your breasts as though you have that unsettled baby in your arms.

Physical signs your milk is coming in can include:

• breast fullness, swelling, heaviness, warmth, tingling

• leaking milk

• change in baby’s feeding patterns and behavior at the breast

• your milk will change consistency and colour over a few days, from thick yellow colostrum to thinner white mature milk.

If your baby is removing milk at just the right frequency to match your changing production, you might not feel hard, sore breasts. This is something to celebrate, not worry about. You will see the changes in your baby’s nappy as your baby’s poo gradually becomes more yellow.

Delayed Onset Of Lactation

There are circumstances which can delay the transition to milk production. Some you might know in advance, others are the result of complications or medical events around the birth.

If you are not seeing signs of your milk changing by Day 4, you can be reassured that it will happen, even if circumstances have delayed the process.

These can include:

• First baby - typically around a day later than women who have previous experience breastfeeding

• IV fluids - a drip during labour and/or caesarean birth

• Pain medication during labour

• Complicated or traumatic vaginal birth

• Caesarean delivery

• Large blood loss > 500mls

• Retained placenta

• Maternal diabetes, PCOS, hypothyroidism, pituitary issues

If there is a delay

Your baby might have lost more than the typical 7-10% of their birth weight and your midwives, doctors or nurses may have suggested supplementation with formula. If you have expressed colostrum late in pregnancy, this can be used in addition to what you are expressing and you might be able to avoid formula.

Effective and efficient milk removal is the key: getting the right help is important.

Is it the baby?

Poor attachment, sleepy baby (often due to jaundice) or delaying breastfeeds with dummies or formula can delay milk transitioning to mature milk.

Support milk production by pumping until the baby is effectively removing milk by direct feeding. Consider cup feeding or a Supplemental Nursing System to supplement.

Is it the mother?

Retained placenta and other complications of childbirth should be investigated if your milk is not coming in as expected despite your baby breastfeeding frequently and effectively.

Support milk production by pumping in addition to direct feeding at the breast. Consider cup feeding or a Supplemental Nursing System to supplement.

An IBCLC is will help you develop a plan if you are experiencing a delayed onset of lactation. Ideally, this will be put in place before you leave hospital. However this isn’t always possible.

Feed the baby, support the milk production

Continue offering the breast frequently Practice skin-to-skin contact as much as possible and keep your baby close around the clock so you can respond quickly to feeding cues. Use hands-on pumping with a double breast pump. Focus on frequency, not volume. Allow around 30 minutes after a breastfeed before you pump. This intense triple feeding period is not intended to be a long-term solution - the goal is to identify and resolve the problem as soon as possible.