Patient Information Service

Breastfeeding your baby

Women and children’s business unit

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Introduction

In this leaflet you will find information on how to get breastfeeding started and how to avoid common problems.

Breastfeeding is the natural way to feed babies and has numerous and long lasting health benefits. Mum’s milk gives baby all the nutrients he or she needs for the first six months of life. It helps protect your baby from infection and other diseases and as a mum it also reduces your chances of getting some diseases later in life.

Once established, breastfeeding is convenient and for most mothers an enjoyable experience.

Breastmilk is not just a food; it contains many properties which help babies in the following ways:

• It is easily digested

• Breastmilk will give your baby all the nourishment he/she will need for the first six months of life

• Help babies to develop neurologically

• It is thought that breastfed babies respond better to immunisations than formula fed babies

• Exclusive breastfeeding will reduce the chances of your baby developing asthma and eczema.

Formula-fed babies are at a greater risk of:

• Gastro-intestinal infection

• Respiratory Infections

• If baby is born prematurely, increased risk of a life-threatening bowel disorder

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• Urinary tract infections

• Ear infections

• Allergic disease (eczema, asthma and wheezing)

• Insulin-dependent diabetes mellitus

• Sudden infant death syndrome

• Childhood leukaemia

• Juvenile rheumatoid arthritis.

Mums who breastfed are at a lower risk of:

• breast cancer

• ovarian cancer

• osteoporosis.

Colostrum

This is the name given to the breastmilk in the early days. It is a concentrated form of milk which contains all the nutrients and protective factors but with less water content.

In the early days babies have extra water in their tissues which needs to be reduced by their kidneys; therefore a newborn baby’s immature kidneys have the capacity to deal with low volumes of fluid, which is why colostrum is the ideal first milk.

Colostrum gives the baby time to coordinate sucking, swallowing and breathing before he is faced with larger volumes.

Parents should expect their baby to feed at least four times during the first 24 hours following birth, increasingly gradually to at least eight feeds a day by 48 hours of age. The more the baby feeds effectively, the more milk your body will produce.

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Getting started

To initiate breastfeeding, babies need to have closeness with their mother and this is best achieved by skin to skin contact as soon as possible after birth and ideally undisturbed for at least one hour or until after the first feed. If this is interrupted for any clinical reason this should resume as soon as possible. This ongoing contact helps the release of the hormones responsible for establishing and sustaining breastfeeding.

The calming effect of skin to skin contact is therefore good for all babies, enabling them to regulate their heart rate, breathing, temperature and blood glucose levels.

It is important that the baby feeds from the breast at the earliest opportunity, and this can still be achieved if you have a Caesarean section or a forceps delivery. It is important that you have support when your baby begins to breastfeed to ensure he/she is correctly attached. Babies may begin nuzzling the breast and then start suckling quite soon after birth, although if this is not achieved it is important that skin to skin contact continues and staff help you at regular intervals to initiate breastfeeding.

Responsive feeding

Responsive breastfeeding is a term used to describe a mutual relationship between a mother and her baby and is more than providing nutrition alone.

It is always appropriate to offer the breast and breastfed babies cannot be overfed.

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It is important that you respond to your baby’s feeding cues and this will work better if you and your baby can stay together as much as practically possible.

Baby’s feeding cues:

• being restless and wakeful

• making small noises

• movements of his mouth

• smacking his lips

• sucking his fist

• ‘rooting’

• turning his head towards the breast, if being held.

if you notice any of these signs it will be an ideal time to respond to the feeding cues and offer the breast, as he/she is likely to feed more effectively if he/she is relaxed.

Responsive feeding means that you can offer baby a breastfeed as a means of comfort if they are unsettled/unwell or simply want contact and a cuddle. Offering baby a breastfeed if your breasts start to feel full/uncomfortable can help to reduce the risk of breastfeeding complications.

You can also make breastfeeding work for you, for example: if you want to fit in a feed prior to the school run or if you simply want to sit down, have a rest and spend quality time with your baby.

On average breastfed babies feed 11 times a day.

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Before you start breastfeeding your baby

Ensure that you are comfortable and have a drink within easy reach (some mothers feel thirsty when breastfeeding). It is not always necessary to be sitting in a chair; you can also breastfeed in many different positions; ask your midwife or health visitor for further advice and support. It is not necessary to change your baby’s nappy first. Make sure that the position you and your baby are in is comfortable and safe enough for both of you to stay in for as long as the baby wishes to feed.

It is very important to have your baby correctly attached to the breast to ensure that:

• you don’t get sore nipples

• to ensure that your baby is receiving enough breastmilk

• to maintain your milk supply

• to reduce the risk of breastfeeding complications.

How to attach your baby for breastfeeding

1. When you are positioning your baby in preparation for a feed, position him close to you, with his nose level with your nipple, his head in line with his body and so that he is able to tilt his head back (this will enable him to attach and breathe more effectively, swallow and keep his nostrils free from the breast tissue).

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2. His bottom lip and chin should be touching the breast first to enable him to scoop the underneath of the breast first; this ensures that the nipple will be placed far enough back in the baby’s mouth.

3. To know your baby is correctly attached see second picture on page seven and the section ‘Is your baby correctly attached?’

How to guide your baby if he is unable to self-attach

1. If you are going to feed from your right breast, cup the breast with your right hand ensuring that your fingers are away from the areola (this is the darker coloured skin surrounding the base of the nipple) and the nipple. Your thumb should be placed around the edge of the areola and the nipple pointing towards your baby’s nose. The nipple should not be aimed centrally into the baby’s mouth.

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2. You can encourage your baby to open his mouth wide by brushing his top lip with your nipple; with his chin against your breast and with his mouth wide open you will ready with a swift movement to allow your baby to attach effectively. Ensure that his bottom lip has made contact well away from the base of your nipple. Your thumb will need to quickly slide the nipple forward under the roof of his mouth.

3. This sketch shows the position when your baby is attached correctly. Please also see section ‘Is your baby correctly attached?’ on page below.

REMEMBER: If you do not feel as though baby is attached properly or you are experiencing any problems ask your midwife/healthcare worker to advise you.

Is your baby correctly attached?

If your baby is properly attached to the breast you should note the following:

• The baby’s mouth is wide open on the breast

• When the baby’s head is tilted back slightly, the chin will be against your breast and the nostrils will be clear to allow him to breathe easily and swallow

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• Your baby’s cheeks will appear full and rounded

• Feeding is not usually painful although in the early days you may experience a little discomfort.

• Sucking should be quiet, although soft swallowing noises may be heard

• If any of the areola is visible there should be more showing above the baby’s top lip than their bottom lip

• The baby should be feeding with a suck/swallow pattern with pauses

• After day five there should be lots of wet and dirty nappies.

If the baby is not attached properly, insert a finger between the baby’s mouth and your breast to break the suction gently and start again.

When your baby breastfeeds he will not suck continuously but settle into a sucking rhythm, stopping for short periods. Try not to rush your baby, but take time to relax and enjoy the feeding period.

At first your baby tends to suck quickly to quench his thirst, then after a while he will settle into a slower sucking rhythm with pauses. Towards the end of the feed the baby does small shallow sucks in which he will gain breastmilk with a higher fat content, that is why it is important not to rush the feed and allow baby to come off the breast himself.

When your baby has had enough on the first breast, you may want to hold him upright for a while before offering the second breast. Most breastfed babies do not need to be ‘winded’ although some will feel comfortable if ‘winded’.

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Frequent feeding is very important during the early days and weeks to maximise milk production.

Remember: Babies who are over 48 hours old are likely to want to feed at least eight times in 24 hours, with some babies feeding more often. As your baby gets older he will tend to feed less frequently and more quickly.

Your milk supply is determined by your baby, the more he sucks, the more milk you produce. The first two weeks following delivery is an important time to build up your long term breastmilk supply.

Night feeds are very important for your baby and your milk supply, because the hormone responsible for your milk production is secreted in greater quantity at night.

Try and make up time for lost sleep by resting when your baby is asleep during the day. Remember, your baby’s need for night feeds will gradually lessen.

If you have received certain types of pain relieving drugs during your labour your baby may be sleepy for the first two days and may not wake for feeds. It is therefore important to offer the breast even if your baby does not seem interested as this will increase your milk supply and help to get breastfeeding established.

Will formula, teats, dummies or nipple shields affect breastfeeding?

Supplements of formula milk should be avoided unless they have been recommended by your healthcare provider for a medical reason. Giving formula milk to a breastfed baby can: reduce the

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protective effects of breastmilk making baby more susceptible to infections, allergies and other illnesses; reduce the time that baby is at the breast and affect your breastmilk supply; and increase the risk of you getting engorged and painful breasts.

While establishing breastfeeding it is important to avoid giving your baby a bottle or a dummy, as the sucking action is different with these than sucking on the breast and in the early days the baby can easily become confused. The use of dummies can also cause you to miss feeding cues which can then affect the milk supply.

The use of nipple shields is sometimes discouraged as it is thought they interfere with successful breastfeeding. If you decide to use a nipple shield, it is recommended that you seek the support of your midwife or health visitor.

If your baby becomes unwell and a doctor recommends that he receives a supplementary feed, discuss this with your midwife to ensure a healthcare worker cup feeds or tube feeds your baby so that he does not learn to suck on a teat and then later finds it more difficult to suck at the breast.

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How will you know if your baby is getting enough milk?

1. In the first 24 hours your baby should feed four times, increasing to at least eight times a day by 48hrs of age

2. After the first two days, your baby will need to breastfeed at least eight times in 24 hours, breastmilk digests efficiently.

3. Two or three wet nappies per day are normal during the first 48 hours after birth. By day three he should be having three wet nappies in 24 hours and by day five or six there should be six or more heavy wet nappies a day

4. Baby’s first stools are black and tarry and called meconium. When this has passed, usually after the first 24–48 hours, it gradually changes colour and becomes softer. If feeding is going well, babies should be producing at least two yellow stools (may appear ‘seedy’), at least the size of a £2 coin per day by day four. Most babies pass lots of stools and this is a good sign. It is normal for breastfed babies to pass loose stools

5. Your baby is gaining weight

6. After the first few days you hear your baby swallowing during a feed – there should be no ‘clicking’ noise if baby is attached effectively

7. Baby’s skin tone is good

8. The baby’s eyes and mouth are moist

Your breasts and nipples should not be sore. If they are, do ask for help.

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Your baby will be content and satisfied after most feeds and will come off the breast on their own.

If you are concerned about any of these points, speak to your midwife or health visitor.

Hand expression

Hand expression is very important during the first few days as the colostrum which is low in volume may get lost in a breast pump. There are a variety of reasons why every breastfeeding woman needs to be able to hand express:

• The skin contact of hand to breast helps to stimulate the mother’s hormone responses

• To encourage a baby to breastfeed by expressing a few drops of colostrum onto the nipple

• If you and your baby are separated for clinical reasons, hand expressing is a more effective way of obtaining colostrum

• If your breasts become very full and the areola (brown area of your breast) is hard, it can be softened to allow your baby to attach more easily to the breast

• If there are later problems such as engorgement or mastitis, hand expression can help resolve them.

How to hand express

It is important that you are relaxed before you start to help release more of the hormones responsible for milk ‘let down’.

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If you are separated from your baby, it is a good idea to have a picture of him/her in front of you or a blanket/cuddly toy which has been close to baby.

Wash your hands prior to expressing, it is not necessary to wash your breasts.

Massaging the breast first can help to start the milk flow, it should be gentle.

Make a ‘C’ shape with your thumb and fingers and gently squeeze and release about 2cms away from the base of the nipple, this is where the end of the milk ducts are; keep repeating this action until your milk starts to flow, this may take a few minutes. If there is no milk gained, you can try to move your fingers slightly towards the nipple or further away and repeat the process. When the milk stops flowing, rotate your fingers around the breast.

If you are separated from your baby and expressing to gain as much milk as possible, it is important to drain the breasts at each expression; if you are expressing an engorged breast so that baby can attach, you may only need to express enough to soften the breast.

REMEMBER: If no milk is gained through expressing, it does not mean that there is no milk available to baby if he/she is attached effectively to the breast. Warmth applied around your breasts by applying a warm towel/flannel can help the milk to flow more easily. If you need further support or advice, talk with your midwife or healthcare provider.

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Ask a member of staff to show you how to do this, ideally before leaving this hospital. The leaflet ‘Off to the best start’ which has a section on hand expression should have been made available to you during the antenatal period.

Midwives, healthcare assistants, nursery nurses and maternity support workers are trained how to teach women to hand express.

How can your partner/family support you with breastfeeding?

There are many ways in which dads, partners or family members can help, they play an important role in supporting you when you are breastfeeding your baby.

Caring for a newborn baby can be tiring and therefore it is important to catch up with some sleep during the day even if it is 30 minutes here and there; your partner or a family member can support you with this.

Whilst you are breastfeeding you can feel quite sleepy and so other people can help ensure that you are comfortable and safe.

For your own wellbeing it is important that you eat and drink regularly and therefore accept offers of meals from friends/family and make sure that you have a drink and snack when you are breastfeeding (this can be important during the night feeds also).

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Your partner can be involved with ‘skin to skin contact’ to sometimes calm the baby and enjoy this time of bonding with the baby. Nappy changing and bathing can be a time for your partner to interact with baby.

Sore or cracked nipples

The most common reason for sore/cracked nipples is incorrect positioning and attachment of the baby at the breast. Avoid using soaps and other cleansers to wash your nipples as too much washing will remove the natural protective oils from your skin; just rinse them in water during your daily bath or shower.

If you are experiencing sore or cracked nipples, it is important that you seek the advice and support from you midwife or health visitor.

Engorgement

If you feed your baby correctly and frequently during the first few days, your breasts are less likely to become painfully swollen (engorged). You may, however, experience full breasts that feel warm, tender and heavy which is a normal experience in the early days of breastfeeding.

Engorged breasts will be hot and painful and the milk may not flow readily. If this happens, bathe your breasts in warm water or use warm flannels before a feed/expressing to help the milk to flow. It may also be helpful to express a little milk manually whilst having a warm bath, before your baby feeds.

It is important that your baby feeds on demand and is attached correctly at the breast.

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Mastitis

Mastitis refers to inflammation of the breast whether or not you have a bacterial infection.

• Seek professional help if you notice a redness and tenderness in one area of your breast

• The immediate treatment is to drain the affected breast and this is more effectively done by allowing your baby to feed from this side. If you are unable to let your baby breastfeed, you will be required to express as often as needed until you feel more comfortable. Warm water and/or flannels may help alleviate the symptoms and cool compresses afterwards can help. Analgesic medications can also alleviate symptoms

• Do not stop breastfeeding; it may make the mastitis worse.

You may be prescribed antibiotics (your GP will know the medication which is safe for you and your baby).

Remember: With your baby correctly attached at the breast, you tend to experience less breastfeeding problems.

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Breastfeeding helplines

Start4Life 0300 123 1021 or textphone 0300 123 1054

National Breastfeeding helpline 0300 100 0212

NCT helpline 0300 330 0700

La Leche League helpline 0845 120 2918

The Breastfeeding Network (BfN) helplines

BfN supporterline run by mums who have breastfed their own babies 0300 100 0210

BfN supporterline in Bengali and Sylheti 0300 456 2421

Breastfeeding support in Tamil, Telugu and Hindi 0300 330 5469

Drugs in breastmilk helpline 0844 412 4665

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Patient Information Service

www.southend.nhs.uk

For a translated, large print or audio tape versionof this document please contact:

Patient Advice & Liaison Service (PALS)

Southend University Hospital NHS Foundation TrustPrittlewell ChaseWestcliff-on-SeaEssex, SS0 0RY

Telephone: 01702 385333Fax: 01702 508530Email: pals@southend.nhs.uk

If this leaflet does not answer all of your questions,or if you have any other concerns please contact the infantfeeding advisor direct on: 01702 435555 ext 7296.

Written by thebreastfeeding initiative working groupReviewed and revised by Julie Newby,infant feeding advisor November 2015Leaflet due for revision November 2017

Form No. SOU2360 Version 7

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