Breastfeeding

Why breastfeed? Sometimes mothers are advised not to breastfeed for health reasons, or they are unable to. But if you can breastfeed there is no doubt that this is best for the health of your baby.

If your baby is born prematurely then it's even more beneficial. There are advantages for you too (see below). Even if you only breastfeed for a few weeks, your baby will benefit, although the longer you can breastfeed for, the greater the benefits.

So, if you are undecided about breastfeeding, why not give it a try? Although you may not find it easy to start with, most difficulties can be overcome with patience and perseverance and, once breastfeeding is established, most mums find they really enjoy it. You may, of course, find you have no problems at all.
 
Successful breastfeeding

Understanding how your breasts produce milk and how to deal with any problems that may arise can help you to breastfeed successfully.

Your milk supply

Your breasts produce milk in response to your baby feeding at your breast. The more your baby feeds, the more milk you produce (provided that your baby is correctly positioned). So, if you let your baby feed whenever he or she wants to feed, youre likely to produce the amount of milk your baby needs. This is known as demand feeding and at first you may find that your baby will want to feed at two-hourly intervals.

Dont be tempted to give your baby a bottle at this stage, as this can reduce the time your baby spends sucking at your breast and therefore reduce the milk supply. Your baby may also get confused between sucking from a bottle teat and sucking from your nipple.

Best for you

The extra fat laid down by your body during pregnancy is used up when breast milk is made. This can help you get your shape back sooner. (But it is important not to diet when breastfeeding.)

Breastfeeding helps your womb to contract and return to its usual size more quickly.

Breastfeeding for three months or more may reduce the risk of developing breast or ovarian cancer later.

Breastfeeding is practical. Theres no cost of preparation and the milk is always available at the right temperature even in the middle of the night.

Different kinds of breast milk

For the first few days after birth your breasts produce a special food called colostrum, which looks like rich creamy milk and is sometimes quite yellow in colour. This contains all the food your baby needs, as well as antibodies which pass your own resistance to certain infections on to your baby.

After about three days your breasts will begin to produce milk, which will be quite thin compared with colostrum. Two different kinds of milk are now produced each time you feed your baby. The fore milk, (which your baby takes first), is thirst-quenching and means your baby gets a drink at the start of every feed. This is followed by the richer hind milk, which is the food part of the feed and contains the calories your baby needs.

The let-down reflex

Your babys sucking causes the let down of your milk. It makes your milk flow down and gather behind your nipple ready for feeding. Sometimes this happens even before your baby starts to feed. Maybe when you hear your baby cry, milk may start to leak from your breasts.

How your baby feeds

Unlike the teat of a bottle, theres no milk in the nipple itself. The breasts are never empty, but the milk has to be let down so that it can gather behind the nipple and areola (the dark area around the nipple). A baby who only sucks on the nipple doesnt get much milk (and may hurt your nipples).

To make the milk flow out, your baby has to be in the right position at your breast. Make sure your babys mouth is wide open and covers most of the brown area around your nipple. Your babys tongue will press the milk out from the milk glands underneath the nipple. When your baby is correctly positioned and the milk begins to flow, you will usually see quick sucks change to deep swallows. Breastfed babies usually pause while they wait for more milk to be delivered rather than sucking non stop.

Finding the right position:-

1. For you
   Make yourself comfortable. Youll need to hold your baby close to your breast without strain and for some time too, so do make sure that your back is well supported all the way down. Try different chairs and different ways of sitting, and perhaps a footstool to raise your legs. Try lying down on your side with your baby up against you. Find whats best for you.
   
   Later, you wont have to think about what position youre in. Youll be able to feed almost however and wherever you want to.
   
2. For your baby
   Take your baby up to your breast rather than trying to bring your breast to your baby. Try using a pillow to raise your baby higher.
   
   Hold your baby close and turned towards you with the head and shoulders directly opposite your breast and the nose opposite your nipple. Your babys back should be in a straight line. Support your baby with a hand across the shoulders, not behind the head. Next, move your babys lips gently against your nipple to get the baby to open his or her mouth. When the mouth is opened wide, draw the baby to your breast quickly. The babys bottom lip should reach your breast first.

Its important for your baby to take in your nipple and as much of the brown skin surrounding the nipple as possible. If your baby is correctly positioned, there will be more of your areola showing above the top lip than below the bottom lip. (This is not always easy to see.)

Your babys chin should now be against your breast with the lower lip turned out. Its the babys lower jaw which does the work of feeding.

If it doesnt feel right, or if it hurts, slide one of your fingers into your babys mouth to gently break the suction and try again. Keep trying until it feels right and you can see your baby taking deep swallows.

Your diet when breastfeeding

Eating well and resting when you can are important in making breast milk. Although your body uses up fat stored during pregnancy, you need extra calories, vitamins and minerals to keep up with the demands of your growing baby.

It is not wise to restrict your diet whilst breastfeeding even if you are very keen to get back into your normal clothes. Your body is working hard to make milk and needs easily available sources of energy (that is, your diet) to do so. Trying to diet will only make you feel more tired. Eating larger quantities at mealtimes and regular snacks will help meet the additional demands of breastfeeding. Rather than snacking on biscuits and cakes, try to eat foods that are more nutritious such as a sandwich or fruit.

Limiting your diet

There should be no need to avoid eating any foods, but if you, your babys father or any previous children have a history of hay fever, asthma, eczema or other allergies, avoid eating peanuts and foods containing peanut products (e.g. peanut butter, unrefined groundnut oils and some snacks). Read food labels carefully and, if you are still in doubt about the contents, you should avoid these products.

Some breastfed babies seem to react to foods that their mother has eaten and may cry more as a result. Foods commonly blamed for this include onions, garlic, citrus fruits and grapes. If you think it might help to cut out these foods, check with your health visitor first. It is important to seek advice before omitting food from your diet, as it is possible to become deficient in certain vitamins and minerals if you dont know which foods to replace them with.

Drinks containing caffeine can unsettle your baby so keep your intake of tea and coffee low. Small amounts of alcohol pass into breast milk, making it smell different to your baby, and may affect his or her feeding, sleeping, or digestion. So it is best to keep well below the daily limits of two to three units for women, and avoid drinking before you feed your baby.

Milk and dairy products are sometimes said to make breastfed babies upset, but dont cut these out of your diet without medical advice, as they provide the calcium you and your baby need.

Some suggested snack foods

Sandwiches or pitta bread filled with salad vegetables, grated cheese, mashed salmon or sardines.
Yoghurts and fromage frais.
Humous and bread or vegetable sticks.
Ready-to-eat apricots, figs or prunes.
Vegetable and bean soups.
Fortified unsweetened breakfast cereals, muesli and other wholegrain cereals with milk.
Milky drinks or unsweetened fruit juices.
Fresh fruit.
Baked beans on toast or baked potato.

Hunger or thirst?

Breast milk is drink and food in one. If the weather is hot, your baby may want to feed more often. Theres no need to give your baby drinks of water, even in a very hot climate.

How often, how long?

Some babies settle into a pattern of feeding quite quickly. Others take longer. In the early weeks, you may find that your babys feeds are sometimes long, sometimes short, sometimes close together, and sometimes further apart. Try to follow what your baby tells you.

Feed when your baby asks to be fed, and for as long as your baby wants.

Once youve put your baby to your breast, let the feed go on until your baby wants to stop. Then, either straight away or after a pause, offer the other breast to see if your baby wants more. If you swap from one breast to the other before your baby is ready, you may only be giving your baby the thinner fore milk from each breast. The hind (milk which comes later) is richer and contains calories that your baby needs.

Allow your baby to decide when he or she has had enough. Both breasts might not always be wanted at each feed. Your baby will show that he or she has finished by either letting go of your breast or falling asleep. Start each feed on alternate breasts so that your breasts are stimulated to make milk equally this should prevent engorgement. You could remind yourself which breast was used last by tying a ribbon or pinning a safety pin to the bra strap on the side you last used. Some mothers can tell simply by feeling to see which breast is more full.

If you feed as often and for as long as your baby wants, youll produce plenty of milk and give your baby what he or she needs. While your baby is very young, this may mean quite lengthy feeds. But if youve got your baby in the right position at your breast, you shouldnt become sore.

At first it may seem that youre doing nothing but feeding. Remember that this stage will not last very long. In time youll find that your milk supply increases and so will the speed with which your baby feeds. Babies have growth spurts at approximately ten days, six weeks and three months.

Your baby may feed more frequently at these times until your milk supply increases to meet the bigger demand.

How much is enough?

Since its impossible to see how much milk your baby is taking from your breast, you may wonder whether your baby is getting enough. If you feed as frequently and for as long as your baby wants, youll find that your baby will stop feeding when he or she is full-up. You can be sure your baby is getting enough milk if he or she:

Has plenty of wet nappies each day and is having nothing but breast milk.

Is growing and generally gaining weight, and it is overall weight gain that is important some babies gain weight steadily, other perfectly healthy babies gain little or no weight one week, then feed more often and make up for it over the next week or two.

Is awake and alert for some of the time.

If you notice that your baby isnt growing in length or generally gaining weight, and is very sleepy or lethargic with no alert times, then he or she may not be getting enough milk. Persistent green stools may also be an indication that your baby is getting too much fore milk and not enough of the high-calorie hind milk. Always make sure that your baby empties one breast completely before offering the other breast. If you are concerned, talk to your midwife or health visitor. Night feeds are important. A small baby can receive as much milk at night as during the day and night feeds encourage the body to make more of the hormone that produces breast milk. When your baby is small its important for night feeds to continue.

If your baby seems unusually sleepy and is slow to start feeding, he or she may be ill, so contact your GP.

Twins

Twins can be breastfed successfully. If you have twins it may help to start feeding each of your twins separately until feeding is well established. Then it may be more convenient to try to encourage them to feed at the same time. Your milk supply will increase to meet this extra demand, but you may need help putting your babies to the breast at the start.

Hints for breastfeeding

• Eat when you feel hungry, and choose healthy snacks.
• Ensure you drink plenty especially in hot weather.
• Eat a wide variety of foods.
• Try not to restrict your diet unless you think a food is upsetting your baby and then talk to your health visitor or doctor before cutting out foods.
• Keep your intake of alcohol low it can unsettle your baby.
• Avoid drinking shortly before a babys feed.
• Avoid drinking too much strong tea or coffee.

As well as your midwife or health visitor, breastfeeding counsellors from organisations such as La Lche League, the National Childbirth Trust, and the Association of Breastfeeding Mothers can provide help and support.

Breastfeeding Questions And Answers

My milk looks thin and is a different colour to bottle milk.

There is a great variation in the colour and consistency of breast milk. Unlike bottled milk, the cream is at the bottom and not the top! The first part of the milk, the fore milk, is thirst-quenching and may look watery and bluish. The second part, the hind milk, is thicker and can vary from creamy white to yellowish. Your baby doesnt mind the colour.

My nipples hurt when he/she feeds. What can I do?

During the first week or two, some breastfeeding mothers feel some discomfort as their baby starts sucking at the beginning of a feed. As soon as the milk begins to flow this discomfort stops. If feeding hurts, your babys position is probably wrong but if you cant get the position right yourself, ask for help.

I've been feeding my baby for two weeks now, but my nipple is cracked and painful. Should I give up?

If your baby is in the right position at your breast, feeding shouldnt hurt.

Check that your baby is fixing properly. Ask for help if you need it. Once your baby is positioned correctly cracks should heal rapidly.

Keep your nipples clean and dry, but avoid soap, which dries the skin too much.

Change breast pads frequently. Avoid pads with plastic backing.

Wear a cotton bra and let the air get to your nipples as much as possible.

Try sleeping topless, with a towel under you if youre leaking milk.

A few drops of milk rubbed into the nipple at the end of a feed may help.

Thrush in your babys mouth can sometimes cause sore nipples. Thrush is an infection that results in small white patches in the babys mouth, which dont wipe away. If you think your baby has thrush, both you and your baby will need medical treatment, so see your GP.

If your nipples remain sore, ask a health visitor or breastfeeding counsellor for advice.

He/she stops and starts and cries and just doesnt seem to settle down.

If your baby is restless at your breast and doesnt seem satisfied by feeds, he or she may be sucking on the nipple alone and not getting enough milk. Check your baby is in the right position and fixed properly to your breast. Ask for help if you need to. Colic may also be a problem.

My breasts are very swollen and hard and painful. Whats wrong?

Your breasts are engorged which means that they are full of either blood or milk. The first type of engorgement can happen during the first few days before you start to produce milk. It is caused by the blood supply to your breasts increasing as your breasts get ready to make milk. Ask your midwife what to do. She might suggest relieving the discomfort by taking paracetamol.

The second type of engorgement is caused by milk and can happen at any time from about the third day after the birth of your baby, when you start to produce milk. This type of engorgement is common in the first few weeks or if your baby has gone a long time between feeds. The answer is to feed your baby. If feeding is difficult for some reason, ask for help. To ease the swelling, try a hot bath or bathe your breasts with some warm water. Smooth out some milk with your fingers, stroking gently downwards towards the nipple. Or try holding a face cloth wrung out in very cold water against your breast. Check your bras not too tight.

I have a hard, painful lump in my breast. What is it?

Its probably milk, which has built up because the ducts are blocked and arent being emptied properly. Check that your bra isnt too tight and that nothing is pressing into your breast as you feed (your bra or arm, for example).

A good feed on the blocked breast will help. As you feed, smooth the milk away from the blockage towards the nipple. If this doesnt work, ask for help. If left untreated, blocked ducts can lead to mastitis (see following).

There is a red, hot, painful patch on my breast and I feel quite unwell. Why?

You may have mastitis. Don't stop feeding, as you need to keep your milk moving. Try different positions to empty different parts of your breast. Try the suggestions for relieving engorged breasts and blocked ducts, get lots of rest, and try not to wear a bra, especially at night. A health visitor or breastfeeding counsellor can offer information, help and support.

You may also need antibiotics to clear the infection. Your doctor can prescribe one that is safe to take while breastfeeding.

Help with breastfeeding

You can get help and advice from:-

A breastfeeding counsellor or support group. Contact your local branch of the National Childbirth Trust, La Lche League or the Association of Breastfeeding Mothers. These organisations can provide you with help and support from other mothers with experience of breastfeeding.

Making breastfeeding work for you

Some mothers are happy to feed anywhere and in front of anyone. Thats fine. Other mothers like being able to breastfeed, but are uncomfortable with the idea of exposing themselves in public. However, it is possible to breastfeed discreetly. You can choose clothes that make it easy, such as a loose top or T-shirt that you can pull upwards.

Practising in front of a mirror before you go out might help you to feel more confident. If you simply find the idea of breastfeeding in front of others awkward and embarrassing, you might prefer to live a very private life for the first few months with your baby. Thats fine too. Dont feel under pressure to socialise if you dont want to. When you do go out, ask if there is another room where you can feed your baby. Many shops and public places now provide mothers rooms. Do what feels best for you.

Expressing milk

If you want to express milk in the first few weeks (perhaps because your baby is in Special Care), ask your midwife about it. Hospitals often keep machines for people who need to express milk and you can be shown how to use one. Alternatively, the Association of Breastfeeding Mothers, La Lche League and the National Childbirth Trust all have breast pumps for hire.

Unless theres a special reason for expressing milk, its usually easier not to try it until youve got breastfeeding well established. After six weeks or so you may want to express milk for someone else to give to your baby.

If youve plenty of milk youll probably find expressing quite easy, particularly if you do it in the morning. However, some mothers do find it quite difficult. Your midwife or health visitor will show you how to express milk either using an electric or hand pump or by hand.

You must express your milk into a sterilised bottle, which you can then cap and keep in the fridge. Dont keep it for longer than 24 hours. You can also freeze breast milk if you want to keep it for a few weeks, but make sure you freeze it as soon as possible after expressing it, and certainly within a couple of hours (there are specially designed breast milk freezer bags). When you want to use it, put it in the fridge until completely defrosted but then treat it as you would bottled milk.

If the father wants to become involved in feeding, he can give your expressed milk to the baby.

Combining breast and bottle:-

1. In the early weeks
   If you want to breastfeed its best to completely avoid giving bottles to your baby in the early weeks. This is especially true if you dont think youre producing enough milk your baby needs to breastfeed frequently to make sure there is enough milk. However, if you are concerned that youre not producing enough milk for your baby, contact your health visitor or a breastfeeding counsellor for help before you decide to give a bottle.
   
   If you do eventually decide to give the occasional bottle, but then would like to go back to full breastfeeding, you can, but you will have to breastfeed your baby often and for longer to increase your milk supply. Feeds will space out again once your milk supply has increased. Of course, weaning your baby off the breast might be the right answer for you, especially if breastfeeding is making you unhappy.
   
2. Once breastfeeding is well established
   Youve more flexibility for combining breast and bottle at this later stage. You can introduce a regular bottle feed of formula milk if, for example, youre returning to work or simply want someone else involved in feeding. If you offer the bottle feed at the same time each day, your own supply will adjust quite quickly and you should be able to keep on breastfeeding at the other feeds. Mothers returning to work, for example, often breastfeed in the morning and evening and their babies have a cup or bottle of formula during the day.
   
3. Changing from breast to bottle
   If youre having difficulty breastfeeding and decide to change to bottle feeding, youre unlikely to experience difficulty getting your baby to take a bottle and youll probably both feel more relaxed when feeding settles down. If you have been breastfeeding exclusively, but now need to get your baby to take a bottle, perhaps because youre returning to work or for some other reason, then you may find it difficult at first.
   
   It might be easier to change over to infant formula using a cup or egg cup. There is no reason why you have to use a bottle. Dont stop breastfeeding suddenly as this can cause your breasts to become hard, swollen and uncomfortable. Give yourself time for the changeover and cut out one feed at a time, starting well before your return to work. Its probably best not to give the first bottle feed at times when your baby is tired and it may help if someone other than you gives the first feeds. Your baby is not then near your breast, smelling and expecting breast milk. Dont panic if you experience difficulties at first. Your baby will get used to the new arrangements in time.