Breastfeeding Your Baby. FAQ.
Breastfeeding your baby
why breast is best
Can I get breastfeeding advice before the birth and will I get help in hospital?
If you are planning to breastfeed, ask about specific breastfeeding support or sessions available in your area prior to the birth (see opposite), as having additional information beforehand is extremely useful and will help you in the first few weeks when you are trying to get breastfeeding established
You should get breastfeeding support while in hospital, both in the delivery suite and on the wards; this may come from a variety of sources, not just from the midwife Many maternity units have
Benefits of breastfeeding
Giving your baby the healthiest start in life
There are several unique advantages to breastfeeding, the main one being that breast milk arrives on demand as the perfect food for your baby. Other benefits of breast milk
include the following:
• Breast milk protects babies from infection.
• It reduces the risk of some diseases.
• Breastfeeding is thought to increase a child’s IQ later in life.
* It can reduce the risk of allergies. It has also been reported that babies who are formula-fed are more likely to have breathing problems such as asthma, and gastric problems
such as colic. Constipation is also more common among formula-fed babies, and hence there are more hospital admissions from bottlefed babies.
* There are greater benefits for the mother if she breastfeeds, such as increased weight loss.
maternity support workers who offer support with breastfeeding. Other units encourage local voluntary breastfeeding support workers to come into hospital to offer women guidance
while they are staying in hospital and then afterwards at home. Some babies will breastfeed well without problems, while others take a little while to learn, so ask for help and
assistance as and when you need it. There are a few tips to remember to help you make a good start: * Skin-to-skin contact at birth is recommended to encourage milk production.
* Good positioning and attachment at the breast is very important Hold your baby close to you and facing your breast, with her head, shoulders, and body in a straight line (see
p.225-229), and make sure that her nose or her top lip is opposite your nipple, so she is able to latch on easily
* Ensure your baby can reach the breast easily, without having to stretch or twist
* Always move your baby towards the breast rather than your breast towards the baby
* Feed your baby on demand, allowing her to feed as often as needed for as long as she wishes * Avoid supplements of water or formula milk unless there is a medical reason for
this that has been fully explained to you.
* Avoid giving your baby bottles or dummies while you are establishing feeding as this can create nipple confusion” as nipples and teats require different sucking techniques.
* Try to relax and enjoy your baby’s feeds
Should I put my baby to the breast as soon as she is handed to me after the birth?
Holding your baby close to you as soon as possible after the birth is recommended, partly to encourage breastfeeding and skin-to-skin contact.
Thinking ahead being practically and emotionally prepared
It’s wise to think about how to prepare for breastfeeding before the birth. * Address your perceptions about breastfeeding and those of your partner and family, and deal with
negative stories This is because some of the problems associated with breastfeeding include embarrassment and a lack of confidence in your ability to produce enough milk.
* Purchase nursing bras and try to attend your antenatal classes, where breastfeeding will be discussed. The National Childbirth Trust (NCT) and La Leche League (LLL) also run
classes on breastfeeding (see p 3 10).
that your baby is close to the breast. Your baby may root for the nipple and some babies will latch on instinctively, while others may just sniff and lick the nipple. Don’t be
worried if your baby does not latch on straight away as babies are born with enough nutrients to last several hours before getting hungry.
What is colostrum?
Colostrum, commonly called the first milk or premilk, is a watery, white/yellow substance produced by the breasts for the first few days. Most women do not notice it until after
the birth, although it starts being produced from as early as 20 weeks in pregnancy and may leak during pregnancy. Although colostrum is not abundant, it has a high
concentration of nutrients. It is high in protein and vitamin K and it also contains antibodies and white blood cells to protect your baby against infection. Colostrum helps
your baby to excrete waste products and lines the stomach with a protective layer that helps fight against foreign substances, such as bacteria, in the body. It is also thought
that colostrum helps to prevent allergies
Help! My breasts are like huge beach balls. Will they stay like this if I carry on breastfeeding?
Between three and six days after birth, your breasts prepare to increase their milk production and may be tender, throbbing, lumpy, and uncomfortably full This is due to the
blood and lymphatic flow to the breasts increasing and a larger volume of milk being produced This is normal, but if milk isn’t effectively removed at each feed, breasts can
become swollen, or engorged. This should be a temporary condition, as long as your baby latches on well and feeds on demand for as long as she needs. Some mothers find it
helpful to massage the breast during feeds to encourage milk flow Wearing a supportive feeding bra and alternating hot and cold flannels can relieve the discomfort
When will my milk come in?
After the birth, your body produces the hormone prolactin, which tells your brain to produce milk, and most women start to produce breast milk between days three and six Which
day your milk comes in may also depend on the type of birth you had, as some studies suggest that milk production is delayed if you have a Caesarean. A delay can also occur if a
woman is on medication, such as insulin, to control blood sugar levels. Also, although this is a natural process, certain factors can affect when, and how much, milk is
produced, such as a woman’s thoughts on breastfeeding and how relaxed she feels, and if a mother is undergoing any stress or anxiety.
There are so many different formula feeds around nowadays - is breast really still the best?
It’s true that there are many types of formula milk, with each one striving to be as close to breast milk as possible. However, there are some nutrients and bacteria-fighting
cells present in breast milk that cannot be artificially produced. Breast milk contains everything a baby needs for at least the first three months As well as promoting the
benefits of their own brand, all formula brands also acknowledge that breastfeeding is the best option.
Establishing breastfeeding
Each mother has a different experience when starting to breastfeed Both you and your baby
will be learning and practising together, which can seem quite strange for something that is supposed to be so natural. Some babies will simply attach themselves onto the nipple
(”latch on”) straight away, while others will take longer and may need help from a midwife Sometimes, the type of labour and birth that you experienced can affect how quickly
you establish breastfeeding.
a store of water and fat in her body to provide nourishment until milk is available She will. however, have a strong urge to suckle.
How should I position myself for feeds? For subsequent feeds, it is worth taking the time to check that you are in a comfortable position (see below, right). It might help if
someone holds your baby while you make yourself comfortable -perhaps with cushions behind your back, or a cushion to lie your baby on.
How should I start the first feed? Many babies begin to breastfeed if left ‘’skin-to-skin”, lying directly on you near your breasts, for about 45 minutes Your baby can smell
your milk and will naturally start to make mouthing movements and turn her head to your nipple At first, your baby will need only a small amount of food because she has
Latching on
How should I position my baby? The key to successful breastfeeding is ensuring that your baby is in the right position and has a good ”latch”. Move your baby so that her nose
is opposite your nipple and “tummy to mummy” (your baby’s tummy is lying across your tummy) in a straight line and held close to you (see below). Wait until she opens her mouth
Structure of breasts really wide (this ensures that her tongue is in the right
position) and then move her mouth onto the breast.
How do I know if my baby has latched on properly? It is important to make sure that the whole of the nipple and areola are in your baby’s mouth. This enables your baby to get a
good sucking action and prevents your nipples from getting sore or cracked. The baby’s bottom lip should be curled back, and sucking will be long and deep (rather than little
chomping movements). You may also notice that her ears move
as she sucks. When your baby has latched on correctly, I fatty tissue
you shouldn’t feel any pain (or, possibly, only a slight
During pregnancy pain when she first starts to suck). If it still hurts after she
has begun sucking, she is not latched on correctly and
you should ease her off the breast and start again after adjusting her position
How do I take my baby off the breast? Do this by sliding your finger gently inside your baby’s mouth - this will break the seal it forms around your breast
I’m expecting twins - can I still breastfeed?
Lots of women successfully breastfeed with twins, although it may take extra planning, as life is easier if both babies adopt the same routine and are fed together. Most women
think that they won’t produce enough milk to satisfy twins; however, milk production works on on a supply and demand basis, so the more your babies suckle, the more milk you
produce You can either fully breastfeed with both babies latching on. or express milk (see p 234-235) and alternate when each baby latches on Expressed milk may be cup-fed to
minimize the risk of a baby taking to a teat and possibly preferring this to the nipple The Twins and Multiple Births Association has plenty of advice on caring for twins (see
p.310).
I’ve heard that it’s harder to breastfeed straight after a Caesarean - is this true?
Women who undergo a Caesarean are likely to be
in more pain than those who have had a vaginal birth, and studies have also shown that postoperative pain
can affect breastfeeding. Also, following major surgery, it’s not easy to move around for a day or so These factors make feeding more challenging initially. However, most
hospitals provide good post-delivery pain relief, which helps women to breastfeed Adopting feeding positions that don’t
put pressure on your stitches also helps (see below). Even if breastfeeding does not happen in the first 24 hours, it is important to allow skin-to-skin contact between you and
your baby as soon as possible.
Will I need a special bra?
It is important that your breast is free during feeding With a normal bra, you would have to remove a garment, so yes, it is advisable to purchase at least two nursing bras.
Nowadays there are lots of attractive bras available. The bra should have a zip or drop-cup fastening to allow one cup at a time to be undone. Ask a trained assistant to measure
you, as a poorly fitted bra can contribute to problems such as mastitis (see p.233) It’s best to wait until 36 weeks before choosing a bra as your breasts continue to grow, The
average increase is around two cup sizes.
Breastfeeding after a Caesarean
Breastfeeding after a Caesarean section can be more challenging than following a vaginal birth as your baby may be sleepy from the effects of the drugs and you will be feeling
uncomfortable from the stitches. If your baby is asleep most of the time, do encourage her to wake for a feed every couple of hours Finding a comfortable position to feed is
important for the let-down reflex.You may find lying on your side facing your baby easier and this is a recommended position after a Caesarean In the days following the
operation, when you are more mobile, you can try feeding sitting up with your baby lying on a pillow to alleviate pressure on your wound.
Breastfeeding is such a struggle. What are we doing wrong?
Although breastfeeding is supposed to be a natural process, for some mothers and babies it can be a challenge. There are a few basic guidelines to help you relax your baby and
get her to latch on properly (see p.228). First, try not to force the nipple into your baby’s mouth. Instead, wait for your baby to lean towards the nipple. For this to happen,
your baby must be turned towards you with her head, shoulders, and body in a straight line (see p,229). Your baby’s lower lip should be below your nipple. To soothe your baby,
you can try stroking her lip with your nipple, or squeeze a few drops of milk onto her lips If your baby wants to feed, she will open her mouth to receive the nipple If so. draw
her closer so that she can latch on across the nipple and around the areola (the darker skin around the nipple) Once she is in the right position, you shouldn’t be able to see
any of your nipple, just a small area of the areola. It should also feel comfortable. Although you shouldn’t force the nipple on your baby you can move her towards the breast so
that her mouth touches the nipple and is encouraged to open wide. Avoid bending forwards, as this can give you backache and may encourage a poor feeding technique.
There are key signs that your baby is properly latched on. These are that the bottom lip is curled back, the chin touches the breast, the mouth is wide open, your areola shows
more above her top lip than under her bottom lip, and the sucking pattern changes to long deep sucks.
How often should I breastfeed my baby?
This is commonly asked by mothers as they feel that the baby should have a routine or pattern. However, it is best not to schedule feeding times and force your baby into a
pattern of, say, every 3-4 hours All babies, but particularly breastfed ones, should be fed on demand. All babies are different and you will soon become familiar with your
baby’s signs of hunger. For example, your baby may ”root”, or search, for the nipple, may not settle, and may make crying or
Troubleshooting
Sore, cracked nipples area common complaint among breastfeeding women and a source of great distress, often leading women to abandon breastfeeding altogether. Knowing what steps
you can take to prevent this happening, or how to alleviate any discomfort, will help to make breastfeeding a more relaxing experience. * Make sure your baby latches on properly
and is removed from the breast gently (see p 228). If your breasts are engorged, expressing some milk first helps your baby to latch on more easily
* Keep your nipples dry between feeds Let the air get to your nipples and use breast pads to soak up leaks of breast milk.
* Relieve sore nipples with a chilled cabbage leaf. You can use a nipple cream if necessary, although most midwives suggest avoiding these if possible.
whimpering sounds. A baby can only hold about 1-2 ounces of milk in their stomach, so some babies may be hungry after an hour, while others may hold out a bit longer. If your
baby dirties a nappy just after a
feed, it is likely that she will become hungry again sooner, usually within an hour of the feed It is also important to allow your baby to feed for as long as possible on each
breast before changing side, to
ensure that she gets the full benefits of the milk
What can I do to help my baby get enough milk?
There are steps you can take to ensure successful breastfeeding and that your baby gets enough milk. * Hold your baby close to you as soon as possible after the birth She will
start to ”root” for your nipple when she is ready to feed.
* Feed your baby as often as she demands in the first few hours and days after the birth This will enable your body to synchronize with your baby’s needs. Feeding on demand in
this way also helps your milk to come in around days 3-5.
* Check that your baby is latched on correctly (see p.228). When your baby is in the correct position, you will both feel comfortable and relaxed. If the baby is not latched on
correctly, it may become painful for you, and you are more likely to stop breastfeeding earlier.
* Allow your baby to feed on one side as long as possible This is because the consistency of breast milk changes during the feed The first part, or foremilk, is lower in fat
compared to the hindmilk The longer she feeds, the more milk you will produce. * Avoid giving your baby a bottle and/or a dummy until feeding is established as this may lead to
nipple confusion. In some cases, a baby may find it hard to latch on, or reject the nipple in favour of a teat. If this continues, your milk production will fall significantly *
Some women believe they should not exercise as it may affect milk production, but this is not the case Studies have revealed that even high-intensity exercise does not affect
breast milk production.
How will I be able to tell that my baby has had enough milk?
Although you can’t measure the exact amount of milk your baby gets, the breasts work on a supply and demand basis, so your body responds to your baby’s sucks and the amount of
milk she takes and produces more according to her needs. Usually, babies feed for at least 10 minutes each feed in the first few days after the birth and you may need to offer
both breasts before she is satisfied. You can tell that your baby is feeding well as her lower jaw will move steadily while she is on the breast. When she is full, she will fall
asleep or release the nipple and be contentedly awake. You should not break the feed, even to change breasts. Your breasts may feel softer and less tense after a feed. Another
sign that your baby has enough milk is the amount of wet and dirty nappies she produces (Breastfed babies tend to have runnier poo than bottlefed ones, see p 242) If you think
that your baby is not satisfied, ask your midwife or health visitor for advice and support before using formula milk.
I get wet patches on my clothes and find breastfeeding so messy. Do you have any advice?
Your breasts leak when they are full and overflow, or when the let-down reflex kicks in, for instance when another baby in the room cries or when you feed from the other breast.
To avoid this, try expressing to stop your breasts becoming too full. Breast pads can help there are disposable and washable ones available. If one breast leaks when your baby
feeds on the other, put a plastic, washable breast shell inside your bra before you start to feed. If the shell
is sterilized, you can save the milk that it collects and freeze it This can be given to your baby at a later date or donated to a milk bank at your local hospital, if you have
one. When you’re out, carry a change of clothes, bra, and breast pads. If you feel a let-down, cross your arms and hug yourself, pressing gently against your breasts, which may
stop the flow. You will probably leak most in the first few weeks of breastfeeding, while you are establishing the right supply for your baby Many women find that the problem
disappears after the first six weeks
Do I have to watch what I eat and drink if I’m breastfeeding?
Yes. Generally, it is important to remember that your baby receives all the nutrition she needs through your breast milk, so having a well-balanced diet is really important (see
p.50). However, there are certain foods and drinks that will affect your baby’s digestion. For example, if you eat lots of fruits, such as grapes and oranges, it can cause loose
stools or diarrhoea in your baby You are advised to avoid high amounts of salt as this can cause your baby to become dehydrated It is also advisable to avoid alcohol Not only
can it make your baby quite sleepy, but there have been studies linking this to cot death
Can all women breastfeed? My mum says she wasn’t able to.
The majority of women are able to breastfeed. You may find that the system of maternity care hindered your mother’s breastfeeding, as there was a time when mothers were told to
feed only every four hours. Learning as much as -you can about breastfeeding in advance makes you more likely to succeed. A common myth is that breast size affects the ability
to feed, but this is not the case. Breast surgery may affect breastfeeding, but even after the most invasive surgery, it is possible that a portion of the original glands and
ducts remain intact. Hopefully you will feel confident enough to give breastfeeding a try.
I want to go back to work six weeks after the birth. Is it worth starting to breastfeed?
Yes, most certainly. Even if you only breastfed for the first week, your baby would benefit from the colostrum. So continuing breastfeeding up to six weeks is good It is
estimated that around 40 per cent of women stop breastfeeding at around six weeks, which may also coincide with the fact that they are no longer receiving visits from a midwife
or health visitor and therefore have a lack of support. Once back at work, you can express your milk, either at work, depending on the facilities, or in the mornings and
evenings at home
What are the benefits of expressing milk?
Expressing breast milk (squeezing milk out of your breasts, see left) enables your baby to receive all the benefits of breastfeeding if you are unable to be with your baby for
every feed. Mothers express their milk for many reasons Some like to give their baby breast milk from a bottle if they are going out when a feed would normally take place, while
others who are going back to work express several feeds’ worth so they can continue to breastfeed their baby, Mothers of premature babies being cared for in a special care baby
unit might express all their baby’s feeds
When can I start expressing?
You can start expressing as soon as is practical after your baby is born. Also, studies have shown that expressing as soon as possible can greatly increase long-term milk
production. For mothers who breastfeed and are returning to work, expressing should start at least a week before so that the baby can get used to receiving the milk from a
bottle or cup. Once you start expressing, if possible, you should express around every three hours, including once in the night when prolactin levels are highest, aiming to
express 6-8 times in a 24-hour period. As breast milk is made on a supply and demand basis, the better your baby feeds, or the more often you express, the more milk you will
make for your baby. An Australian study found that women who express milk are more likely to continue breastfeeding for up to six months.
Expressing breast milk
Providing additional milk supplies
You can express breast milk as soon as you feel ready after the birth, although some women prefer to wait until breastfeeding is established, at around four weeks. Expressing
milk means your partner can start to help with feeds and you may be able to get out for periods.
How is it done? Most women use a pump to express their milk There are many different types available, ranging from manual to electric ones. The other way to express your milk is
manually. To do this, support your breast with one hand, making a c-shape towards the back of your breast and gently squeeze in a downward motion, moving towards the nipple;
stop, and then repeat until you have enough milk You will soon learn where the
best place is to put your finger and thumb. Sometimes it is difficult to get a”let-down reflex” when you are expressing – try thinking of your baby and you should soon be making lots of milk.
How should breast milk be stored? It is important that you put the expressed breast milk into a sterile bottle liner or a sterile bottle. This can then be stored in the fridge
for 24 hours, or in the freezer for up to three months Label each bottle or container with your name (if your baby will be with others at a nursery), and the date and time you
expressed it. To defrost the milk, warm it gently in a bowl of hot water – don’t use your microwave Do not keep milk in the fridge door, as the temperature fluctuates.