Breastfeeding

You may have been thinking a lot about your baby, what it may look like, what you may call baby and how you may feed your baby. You may already have a ‘name’ for your bump to help you relate to them more easily.

Have you noticed how your baby moves more at certain times of day? Does baby respond to your voice or to loud noises around it? Take time out to focus on this, talk to your bump, stroke it and include partners and other siblings in this too. This starts the development of a really strong and loving bond between you both and aids the transition to motherhood and being responsive to baby when born. Your baby will also recognise these actions and so you are starting to build those important connections in baby’s brain.

Useful information: Building a Happy Baby (unicef.org.uk)

Once baby is born, there are many ways to develop this relationship further. This includes gazing into baby’s eyes, responding to their ‘babbling’, mirroring their facial expressions as well as smiling and talking to baby.

Holding and cuddling baby is important too. Babies cannot be ‘spoilt’, and responding early to their needs helps babies to feel secure and calm. There is a mounting body of research that tells us that these interactions between baby and their family are important for baby’s mental, emotional and social development.

Also, you and your baby will love it too, and go on to enjoy a closer bond.

During pregnancy your body starts to prepare for breastfeeding - you may notice changes in your breasts. This may make you think more about feeding so gather as much information as you can.

 

The values of breastfeeding and breastmilk

Choosing to breastfeed offers more than just nutrition to your baby - there are health, development and growth benefits for both baby and yourself.

Take a look at some of the information below:

• Benefits of breastfeeding - NHS (www.nhs.uk)

 

Human milk, tailor-made for tiny humans

"Human Milk, Tailor-Made For Tiny Humans" advert from Human Milk on Vimeo.

 

Take a look at some of the information below:

• Reasons to be proud (NCT)
• The benefits of breastfeeding - Baby Friendly Initiative (unicef.org.uk)

Many pregnant women are encouraged to express their colostrum milk late in pregnancy before baby is born. Reasons for this could be:

• Women with Gestational Diabetes Mellitus (GDM) or pre-existing diabetes
• Twin/triplet pregnancy
• Planned C-section births
• Induction of labour
• Thyroid disease
• Cleft lip or palate
• Downs syndrome or congenital disease
• Mothers with breast abnormalities/surgery
• Expected period of time when you may be separated from your baby
• Because you want to!

Having a small amount of milk available will help you feel confident in getting breastfeeding off to a good start. But don’t worry if this is not right for you or if you try and don’t have much success - this does not mean breastfeeding won’t work for you!

Speak to your midwifery team about this and ask for a collecting kit to get you started.

Download our Antenatal Hand Expressing leaflet here.

Skin-to-skin contact after the birth is a great way to say hello to your baby and start your breastfeeding journey. It will:

• Soothe and calm both you and your baby after the birth
• Keep baby warm and regulate heart rate and breathing, so easing the transition to life outside the womb
• Stimulate digestion and an interest in feeding, allowing baby to use all its natural instincts to crawl and seek out the breast
• Enable colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection
• Stimulate the release of hormones to support breastfeeding and mothering.

Take a look at some of the information below:

• Skin-to-skin contact - Baby Friendly Initiative (unicef.org.uk)

Keeping baby close to you day and night will help you to recognise baby's early feeding cues as you will hear and see them. They will also hear you and gain comfort from that. Being close to your baby also promotes higher levels of hormones that promote milk production and so aids breastfeeding.

Learning your baby’s feeding cues can take a little while but will help you know when your baby is hungry or needs some comfort. These are some of the common signs:

• Beginning to wake up or move about in their sleeping place
• Sucking fists or fingers
• Making smacking noises with lips
• Making small murmuring noises
• Turning head and opening mouth – referred to as rooting.

You may think that baby will cry to let you know they are hungry, but this is a late feeding cue and recognising earlier cues can be much easier than waiting until they are upset. It also means baby will feed a little more frequently and so get all the milk they need.

In the early days babies will feed little and often. At birth their tummy is only the size of a cherry! By day 3 think walnut and by 1 week it's about the size of an apricot, so you can see baby doesn’t need huge volumes. Nature is very clever and milk production matches baby's tummy size perfectly in those early days!

Babies will feed on average 8-12 times including overnight as a minimum. Feeds won't always be equally spaced, but every baby is different. Night-time feeds are especially important as the hormone that produces milk is highest at night.

A feed may last 5-40 minutes, and baby may want both breasts, which is quite normal. They may also want to come to the breast for comfort, and you may want to offer the breast if you feel full or just want to sit down for a cuddle. Responsive breastfeeding helps to ensure your milk production is maximised and baby gets all the milk they need. It also promotes the close and loving bond between you and your baby.

Useful information: Responsive Feeding Infosheet (unicef.org.uk)

As babies grow and develop, they may become more efficient, and feeds become quicker or more spaced.

Your baby may want to feed more frequently at certain times of day – this is known as cluster feeding. Early evening is a common time for this to happen but can be at any time of day. Cluster feeding helps to increase and regulate your milk supply to meet your baby's needs and is a normal part of feeding behaviour.

Watching your baby feed will give you many clues to how feeding is going.

Initially you will see some rapid sucks then baby will settle into a nice deep rhythmic suck / swallow pattern with some pauses. Towards the end of the feed the pauses will be longer and the sucking shallower, more like fluttering – this is an important part of feeding so let you baby complete this process. They should let go of the breast themselves when finished.

Watch this video to see really good drinking at the breast:

You will also see the following things that reassure you baby is getting enough milk:

• An increase in number of wet nappies – 1-2 wet nappies in first day or two, 3 or more by day three then from day 5-6 onwards you should see 6 or more wet nappies per 24 hours. Urine should be pale in colour.
• Having at least 2 poos a day – this will change from the black stick meconium to a green then yellow stool becoming looser. By day 6-7 onwards they should have a minimum2 a day, at least the size of a £2 coin yellow and watery, ‘seedy’ appearance. In the first 4-6 weeks less than 2 poo’s in 24 hours may be an indication to seek help.
• Once baby approaches 4-6 weeks of age they may slow down how often they poo and will develop their own pattern – it is common for breastfed babies to go 10 days without a poo, this is not constipation and doesn’t need any intervention if baby is well in themselves.
• Baby is content at the breast and settled after feeds
• Baby is gaining weight – babies commonly lose weight in the first 5 days but should then start to gain weight consistently.

This checklist will help you identify if things are going well – it is also in your Red Child Health book so take a look at it: UNICEF UK mothers breastfeeding checklist

Breastmilk is all your baby needs for the first 6 months. They do not need any additional water even in warm weather.

It is recommended that all breast-fed babies are given a daily vitamin D supplement from birth even if you are taking a vitamin D supplement as a breastfeeding mum. (This is because we do not get enough natural sunlight in the UK). Vitamin supplements for both you and your baby are available from your local Children’s Centres in Nottinghamshire.

Are you eligible for Healthy Start vouchers and free vitamin supplements? Check it out here: Get help to buy food and milk (Healthy Start).

Positioning

This is how you hold your baby to breastfeed and it is really important to find what works for you. There are different positions that you can try – you may stick to one or try a few different ones.

You may find that reclining back slightly with baby laying on your tummy is comfortable and this allows baby to search for the breast and use his own clever skills to latch on.

Check out this video to see natural breastfeeding positions:

You can try feeding lying on your side or sat in a chair, supported in an upright position. This will make it easier to hold your baby so their neck, shoulders and back are supported and they can reach your breast easily.

Whatever position you use, there are some important principles to remember - the word CHINS may help you to remember:

• Close – baby needs to close to you to breastfeed.
• Head free – baby needs to be able to tilt their head back to feed, as we do when we drink
• In line – babies head and body need to be in a line. Baby should not have to twist their head to face the breast.
• Nose to nipple – line baby up with their nose opposite your nipple so you know they’re in the right place. They will then put their head back to latch on.
• Sustainable – make sure you and baby are comfortable and can stay in that position for the duration of the feed.

 

Attachment

This is how baby latches onto the breast. Hold your baby close and allow them to tilt their head backwards so that their top lip brushes against the nipple. As they open their mouth wide with their head tilted backwards the chin should reach the breast first – you may need to move baby swiftly in towards the breast as they gape to allow the nipple to be drawn well back in baby’s mouth.

This leaflet shows the sequence really clearly: Breastfeeding leaflet (unicef.org.uk)

Other useful resources include:

• Positioning and attachment video - Baby Friendly Initiativ (unicef.org.uk)
• Breastfeeding | Feeding Your Baby | Start for Life (www.nhs.uk)

Signs that baby is latched well include:

• Chin pushed into the breast as they take a mouthful of breast tissue, giving full and rounded cheeks
• Mouth open wide and rhythmic sucking and swallowing seen
• There is no pain for you when you feed – the first few sucks may feel really strong but should quickly ease
• If you can see any of the dark skin, or areola around your nipple, there should be more above baby’s top lip than below lower lip
• Baby finishes the feed and lets go of the breast themselves.

Once breastfeeding is established you may choose to express breastmilk occasionally, if you need to go out or return to work. You may choose to express by hand or to use a pump.

 

Hand Expressing

Many women find this easy and convenient and in the early days can help obtain small amounts of colostrum to tempt baby to feed. It can also help if your breasts feel full or engorged, to soften them and allow baby to latch more effectively.

 

Using a breast pump

Some women choose to us either a hand pump or electric breast pump. There are many available on the market to buy. If you are receiving support from The Healthy Family Team and they recommend expressing it may be possible to loan a breast pump from them.

 

Storing breastmilk

Once you have expressed your milk you will want to be able to store it safely. For more information view The Breastfeeding Network - Expressing and storing breastmilk leaflet.

Sometime breastfeeding is not as straight forward as you may hope and you may need additional support. See here for the support available in Nottinghamshire. Many problems are linked with positioning and attachment not being quite right. These include sore or cracked nipples, slow weight gain in baby, frequent feeds and windy unsettled babies.

 

Painful feeding

Check positioning and attachment (see above) first and get support immediately, it may be that baby isn’t latching as well as he could.

The Breastfeeding Network have a really good resource to help you decide what the problem may be:

• If Breastfeeding Hurts - The Breastfeeding Network
• Overcoming Breastfeeding Problems: Sore nipples - Baby Friendly Initiative (unicef.org.uk)

 

Overfull or engorged breasts

This is where the breasts feel full, hard and painful. Many women feel this in the early days as milk supply adjusts and transitions from colostrum to more plentiful ‘mature’ milk. It can also happen if baby doesn’t feed as often as needed or isn’t latched effectively so breasts don’t drain as well.

Responsive breastfeeding will reduce the risk of engorgement – this leaflet explains responsive feeding: Responsive Feeding Infosheet (unicef.org.uk). Getting support to ensure baby is latching well is also really important.

Overcoming Breastfeeding Problems: Engorgement - Baby Friendly Initiative (unicef.org.uk)

 

Not enough milk

Lots of women worry that they don’t have enough milk but this is rarely the case. For signs that baby is getting enough milk see here (link back to How I know my baby is getting enough milk above). Feeding responsively and ensuring baby is latched well at the breast will also ensure a good milk supply.

Over time, the amount of breastmilk a mother makes will reduce if:

• Baby is not latched onto the breast effectively
• Formula or other fluids or solids are introduced
• Baby is fed to a schedule – so that feeds are restricted in number or length
• Baby is fed using a nipple shield
• Baby is given a dummy

Overcoming Breastfeeding Problems: Low milk supply - Baby Friendly Initiative (unicef.org.uk)

 

Block ducts and Mastitis 

If a baby is not latching effectively or doesn’t feed often enough you may develop a blocked duct or mastitis. Symptoms of a blocked duct include a small tender lump on the breast which may lead to a hot red patch which is tender to the touch. You may also feel unwell with flu-like symptoms.

This leaflet explains more and also outlines self-help remedies and when to seek medical help.

If you think you have blocked ducts and/or mastitis it is very important to:

• Seek support to ensure baby is latching well
• Continue breastfeeding - this is the best way to ease a painful full breast and speed up your recovery. Stopping breastfeeding suddenly can make the problem much worse
• The latest evidence recommends not excessively emptying the breasts by prolonged feeds or expressing between feeds. Gentle hand expression is recommended
• Seek medical advice if you feel unwell with flu-like symptoms which don’t improve with feeding, as you may need to be prescribed with antibiotics

 

Thrush and breastfeeding

Other causes of breast and nipple pain are often misdiagnosed as thrush in breastfeeding women but it is actually uncommon especially in the early weeks. Seeking help and support with positioning and attachment (link to above)  should always be the first step to be taken towards pain free feeding.

This leaflet gives further information about thrush and breastfeeding.

 

Tongue tie

A restricted frenulum (the skin under the tongue) or ‘tongue-tie’ does not always cause problems with breastfeeding. With effective support to ensure baby latches well many women can successfully breastfeed without any intervention. If you feel there may be an issue seek support.

For more information:

• Tongue-Tie - Baby Friendly Initiative (unicef.org.uk)
• Home - Association of Tongue-tie Practitioners

You may need to breastfeed your baby whilst out and about and the law supports you with this, making it illegal for any business to stop you breastfeeding or ask you to leave. However, you still need to feel comfortable feeding your baby so these tips may help:

• Practice in front of a mirror at home – you may think everyone can see your breasts but you’ll be amazed how little shows!
• Try to get settled before baby gets too hungry – have a café or venue in mind and plan your journey around this
• Go out just to breastfeed the first time – don’t have a long list of other things you must achieve
• Chose a seat in an area where you will feel comfortable – don’t chose a window seat if you feel nervous feeding. Consider turning your back to the main café or positioning your chair differently.  Make yourself comfortable and try to relax
• Consider other areas you could feed in such as changing / fitting rooms, in the car or dropping into your local Children’s Centre or library
• NEVER FEEL LIKE YOU NEED TO SIT IN A TOILET TO FEED YOUR BABY
• Think about your clothing and what may help you feel comfortable – shirts and cardigans over a vest top work well, as do tops that are stretchy or have zips / buttons. Clothes specially designed for breastfeeding are useful but not essential
• Find a place that has joined our Nottinghamshire Breastfeeding Welcome scheme - they will display a sticker and certificate to show this.

Visit our Infant feeding support in Nottinghamshtire page to view our accredited venues.

Useful information:

• Breastfeeding in public - NHS (www.nhs.uk)

Going back to work or study doesn’t mean breastfeeding has to stop. With a little planning and organisation breastfeeding can continue without problems.

Continuing breastfeeding enables you to keep that close and loving relationship with your baby as well as protecting both yours and your baby’s health and development. Your baby may be going to nursery so continued breastfeeding will offer protection from new infections they may be exposed to as they explore new environments and mix with more children.

Continuing to breastfeed also provides your baby with comfort and security, to help them feel settled now they’re spending more time away from you – and you too!

If you are returning to work and still breastfeeding, you need to inform your employer in writing in advance and discuss with them so that you can make an appropriate plan. You may want to consider your hours, days of work and where / when you will be able to express if needed. You’ll also want to think about your childcare, so you feel happy with this.

For information read the above 'expressing milk and storing breastmilk'.

Further information:

• Protecting pregnant workers and new mothers - HSE
• Breastfeeding at study or work - Baby Friendly Initiative (unicef.org.uk)

We always think about all the professional support that is available, but there is a lot of invaluable support closer to home.

 

Partners

Your support is crucial in the early days. Mum and baby are working so hard to get feeding established and she needs to feel supported and that she is not alone in this. There may be times when she is very tired, tearful and even threatening to stop breastfeeding – sometimes she may just need to vent how she feels then carry on breastfeeding as before!

You don’t have to feed your baby to bond with them, there are many other things that you can do.

• Be positive, patient, give moral support and never suggest mum gives up
• Find out about local breastfeeding support groups and go together
• Be there at important times like midwife visits and the 10-day check up with your health visitor
• Change nappies, change nappies and change more nappies!
• Make snacks and meals to help with fatigue and hunger – or enrol family help if you’re not a whizz in the kitchen!
• Give your baby their night-time bath
• Skin-to-skin contact is great for you to bond with baby too

Watch this lovely video of a dad interacting with baby for tips on things to do with baby:

 

Grandparents

Your support is equally invaluable and emotional support is just as important as practical support. Try to remain positive and reassuring, even if things have changed and you did things differently when you had your children. Other things that you can do include:

• Understand why breastfeeding is important, even if you bottle-fed your children
• Spend time with any older grandchildren and make sure they feel special
• Offer to watch baby when mum needs a rest during the day – but be aware she may not want you to take baby far from her
• Provide reassurance that mum is making the right decisions for her family
• Encourage her to get additional support if she is struggling
• Help out around the house
• Make drinks, snacks and meals

 

Friends

If you’re a good friend of someone who has recently had a baby you can be a great support, making her laugh and giving the opportunity for her to get things off her chest.

You can help keep her grounded in what's happening in your friendship group so that she doesn’t become isolated. As time passes you can start to plan some baby friendly treats or get-togethers with your friends. But remember to keep it short and sweet initially, as she may tire easily.

 

Your Healthy Family team

Within the Healthy Family Team (HFT) there are staff who have had training to help support women with initiating and maintaining breastfeeding. You may have had the opportunity to meet one of the team antenatally, but if not, you will receive a visit from the Health Visitor around day 10-14. There are Healthy Child Assistants within the team whose role is to offer breastfeeding support to mums in the early weeks.

Click here to find out more about the Healthy Family Team.

If you encounter problems that do not resolve readily they may arrange for you to see one of the Specialist Infant Feeding Leads for further support.

 

Specialist infant feeding leads

In Nottinghamshire there are 3 Specialist Infant feeding leads who are all International Board Certified Lactation Consultants (IBCLC) and can support you with more complex feeding issues. They are:

• Theresa Drozdwoska - Specialist Infant Feeding Lead for Broxtowe, Gedling and Rushcliffe
• Alison Jee - Specialist Infant Feeding Lead for Newark and Sherwood and Bassetlaw
• Joanne Glossop - Specialist Infant Feeding Lead for Mansfield and Ashfield

All 3 Leads run breastfeeding clinics across the county and referral is via your Healthy Family Team – contact the Advice line on 0300 123 5436.

 

BABES Breastfeeding groups

Currently run in most Children’s Centres across the county – see: Children's Centre Service | Nottinghamshire County Council or scan QR code below:

At a BABES session you can meet other mums, share ideas and tips and make new friends. The groups are run by the Children’s Centre Service staff and also facilitated by our Breastfeeding Peer Support volunteers. These are our amazing mums who have breastfed themselves then undertaken a training course and now support our groups. They’re there to listen to you, reassure you when breastfeeding is going well or signpost you to other resources when it isn't. 

 

Notts Happy Baby Corner 

Sometimes you may just want to access some information or support at a time that suits you. We have our own Facebook page with lots of useful information regularly being added. Why not follow us?

See our NottsHappyBabyCorner page here  or scan the QR code below:

 

National breastfeeding helplines

There are national helplines that can help you on your breastfeeding journey, so take a look.

National Breastfeeding Helpline: 0300 100 0212 – available 7 days a week, 9.30am to 9.30pm. Support is also available in Welsh and Polish via the National Breastfeeding Helpline – call 0300 100 0212 and press 1 for Welsh and 2 for Polish.

Rydyn ni’n cefnogi mamau trwy’r gyfrwng y Gymraeg – ffoniwch 0300 100 0212 ac wedyn gwasgwch opsiwn 1.

W naszej ofercie nowy serwis z informacjami dotyczącymi karmienia piersią i emocjonalnym wsparciem mam w języku polskim. Zadzwoń pod numer 0300 100 0212 po czym wybierz 2.

See Breastfeeding Helplines - The Breastfeeding Network for further information.

It is recommended that all breastfeeding mothers and babies take a vitamin D supplement. Breastfed babies should have a daily supplement of 8.5 to 10mcg. Breastfeeding mothers should take 10mcg per day.

If you're under 18, or on benefits, you may be entitled to free Healthy Start vitamin drops and food vouchers. These vitamins can be obtained from your local Children’s Centre, and if you are not eligible for free vitamins you can purchase them for a very small charge.

Find out more about the vitamins your baby needs.