I thought I would summarise all my thoughts on breastfeeding on this one page, for easy reference.
Before we have our first baby, breastfeeding looks and sounds so easy! We watch our friends feed their babies, we see pictures of smiling mothers and their fat, happy babies, and we wonder: how easy could it be?
And then we try it out! And we discover that it isn't always as easy at it looks.
Some mothers are blessed with stacks of rich milk, that could feed a whole suburb. Some mothers struggle to even establish a milk supply, let alone continue feeding for months. Most mothers fall somewhere in-between. However, it is a learned skill - both for mum and baby, and tricky for every one to get going, and to keep going.
There is no doubt amongst literature around, that breastfeeding is the healthiest option for our babies. In times past, it was the only option. However, with our busy lifestyles, our desire for our lives to be perfect, our paranoia about the psychological health of our babies, the pressure to go back to work, and the images of skinny mothers around us, it all works against mothers who start off planning to breastfeed.
Breastfeeding, once it is established, is a wonderful experience. It is convenient (no bottles or formula to take with you), and it is a relaxing time with your baby,
For mothers who, despite all efforts, end up bottle feeding, there is a tremendous guilt that can placed on them by other, successfully breastfeeding mothers. It is not helpful for a breastfeeding mother to make a bottle feeding mother feel any more guilty than she already is! Their baby will still grow up to be happy and healthy.
I have breastfed all 6 of my children. It was not always easy, however, and I hope in this section to pass on those tips that I learned, that helped things to go much more smoothly. Of course, I can't cover everything here, and other mums may prefer to do things differently, but this is what I did. My children are all very healthy, and were happily breastfed for (mostly) past a year, with some of them wanting no solids until they were 12 months!
In the information below, I will look at the following topics:
Latching on
The first few days
Jaundice in newborns
Feeding on both sides
The letdown reflex
Sore nipples and mastitis
Frequency of feeds
Spitting up
Looking after mum
Dealing with a drop in milk supply
Weaning
Biting
Feeding while pregnant
Latching on.
My first child refused to latch on at all. She screamed and arched her back every time I tried, for the first 5 days of her life. By day 5, she had not had a single feed! The nurses tried everything they could to make her feed. I was very sore after a difficult delivery, and I still am not sure how I kept sane during that first week! She eventually agreed to breastfeed with the aid of nipple shields, which I used for 10 weeks.
The key here was persistence. I always advise mothers starting out, to persist for 6 weeks, if they have been struggling. For many mothers, that 6 week mark is a turning point, and things start looking up.
For those first few days (well, always, actually, but those first few days are so important to start habits correctly), it is important to sit correctly. This means sitting with your hips back in the chair, and your back straight, and your feet elevated a little, so that your baby doesn't slide off your lap. If you hunch over your baby, it will be uncomfortable, and tricky for baby to stay on correctly.
You will need pillows during the first weeks (especially if you have had a caesar), to keep baby up high enough to feed comfortably. You won't need those pillows forever (unless you are nursing twins), but these first few days and weeks are important, and they are so little.
Always make sure that their chest and head are in line and facing towards your own chest. If their head is twisted, they will struggle to feed. Their mouth needs to be open wide enough to cover most of the areola (the whole nipple area). If they are hungry, they should start sucking with gusto.
Their little noses will look squashed against your breast, but this is the way it is supposed to be. By their noses being squashed, there is a greater amount of air being breathed in. Even with snuffly noses, they seem to be able to breathe quite well in this position. Of course, if they do get a snuffly nose, then you may need to pull them off every now and then for a 'breather'.
Failure to latch on correctly can lead to sore nipples, and a hungry baby, and poor weight gain. If you are really struggling with baby latching on, it is helpful to go and see a Lactation Consultant, who will be able to identify any problems, and help you to correct them. This is also handy to do if your baby is not gaining weight, just to check that your baby is latching on correctly. Sometimes mothers are not aware that there is a problem with the latching on.
The First Few Days.
If they are sleepy during those first few days, and weeks, then stroking their cheek will help them keep going. I always strive to keep them awake while feeding, rather than let them doze off. If they fall asleep, and you try to pull them, off, they can hang on tight and do some damage to your nipples. If they stay and sleep, it will prolong the feeding time, while they snooze and snack, which can be exhausting for mum over a period of time.
During those first few days, feeding will often take around 40 minutes - around 20 minutes a side. Your baby will be tired after a feed, and probably just sleep until hungry again a couple of hours later. After a few days, however, many babies wake up a little, and can start to feed more efficiently. Planning on a 30 minute feed if possible after that first week is helpful - it will allow some time for the baby to be awake after his feed, and you can enjoy time with him for a few minutes before putting him back to bed.
Another thing about that first day or 2 is that sometimes a baby will be especially sleepy, and unable to be woken for a feed for a seemingly long time. Even up to 10 hours. If your baby does this in the first day or 2, then it is usually ok. Perhaps they need that sleep to recover from their delivery. After a day or 2, they will probably be quite happy to be woken for their feeds, or wake themselves.
If they become extra sleepy after 3 or 4 days, then that is different, and worth checking out for jaundice, which can cause sleepiness.
Jaundice in Newborns
It is not very uncommon for some babies to develop jaundice in the first few days after being born. Symptoms include sleepiness, reluctance to feed, and yellow skin. Some babies are more prone to this than others, and sometimes it arises for no apparent reason.
Sunlight and frequent feeds are recommended for a baby with jaundice. This might mean, after that first couple of days, that your sleepy baby will need to be woken quite frequently (every 2 hours) to be fed, so as to help flush out the toxins. Some babies are put under lights in the hospital to help also. This can be quite distressing for mum, but is usually only short lived.
Most babies are fine after a few days of extra feeds and/or lights, so if this happens to you, hang in there, and it will soon pass!
Feeding on Both Sides.
I always recommend feeding on both sides at a feeding. This allows both breasts to be stimulated every feed. This may mean pulling baby off after 20 minutes on the first side (during those first few days ), to allow him to have a turn on the other side, rather than spending 40 minutes on one side, and him not waking again for another 2 hours.
After that first week or 2, baby should feed much more quickly, and you will learn to judge when to pull him off in order to allow him to have some more on the other side. Some babies detach on their own, to be burped and swapped, but others are hangers-on!
Alternating each side that you start a feed on, will allow your breasts to feel fairly even in size. If you always start on the same side (which can happen for short periods if you have especially sore nipples, or mastitis), then you will feel a little 'lopsided'.
The Letdown Reflex.
Sometimes a mother will have an especially strong letdown reflex. This can mean that baby is squirted quite forcibly in the face soon after he starts to feed, and has enormous trouble swallowing. Rather than keep baby on, sputtering and gulping air (which can lead to a tummy ache), it is helpful to pull baby off, once the letdown has occurred, and allow the milk to fall onto a cloth nappy or towel, until the force of the flow subsides. Then put baby back on again, and allow him to finish his feed at a pace he can keep up with. Feeding while lying down is also sometimes recommended for a short time to help with this problem.
Sometimes a mother has a very slow letdown, and it can be frustrating for that hungry baby who wants that good milk right now! It is important for mum to relax, and take deep breaths while she is waiting for a slow letdown. Worrying about it, and fussing with the baby, are only going to prolong the time. Thinking about baby with closed eyes, breathing, and praying are all things that can help get that reflex to kick in.
Before the letdown kicks in, the baby will be sucking very quickly. Once the letdown has occurred, the baby will suck slower, and more rhythmically. You should be able to hear them swallowing regularly.
Sore Nipples and Mastitis.
Sore nipples can be excruciating! They can bleed even to the point of baby drinking, and then throwing up blood. They can be painful enough to make your toes curl up in pain! Yes, I do remember...
While many cases of sore nipples can be due to poor positioning, it does also seem that some mothers are prone to it, regardless of their positioning. The good news is that they do toughen up in time, and that there are some creams available that help ease the pain, and heal the sores. I found Lansinoh (a lanolin cream) helped, but there are others available. Time also helps, so hang in there!
Mastitis is a nasty infection that affects the milk ducts. It often starts with blocked ducts - when the milk gets 'stuck' in the ducts. This can be identified by a 'hot spot' on the breast - redness, and aching. Massaging that spot while feeding is very helpful in draining those ducts, as well as hold or cold packs, and warm showers.
If mastitis sets in, then you might feel 'fluey' - aching joints, fever, breast pain, and sore nipples. Drink lots of extra water! If things don't settle down in 12-24 hours, then it is important to see a doctor for some antibiotics to get rid of the infection.
While breastfeeding can be painful while you have sore nipples or mastitis, it is very important not to stop breastfeeding, but to push on, knowing that it is temporary, and will soon pass.
In extreme cases, some mums need surgery to drain ducts, so it is worth taking seriously!
Frequency of Feeds.
It is important to always feed a hungry baby.
It is not always easy, however, to determine when a baby is actually hungry, and when he is instead tired, unwell, or just needing a cuddle.
I have always chosen to feed my babies on a flexible routine, rather than whenever they cried, or at irregular intervals. In this way, I have been certain that they are being fed, even if they have been sleepy. This has allowed my babies to be relaxed and content, knowing that their mother will feed them, and they don't need to fuss for food. I have mostly (although not always!) needed to wake my babies in order to feed them.
This has meant feeding at around the 3 hourly mark in those first few days (meaning that it is around 3 hours from the time you start a feed, until the time you start another feed). I have chosen to wake my babies to feed them at this time, during the day, rather than let them sleep for long periods. Tiring as it can be, it has been much easier to feed them on this routine, than the unpredictability of waiting until they woke up to wonder if they needed a feed.
If a baby wakes earlier, and is hungry, then they would need to be fed, of course.
However, these first few days are an ideal time to try to feed them as close to that 3 hourly mark as possible. Once they get into that pattern, they will often quickly get used to it, and mums find that their babies will often start to wake for a feed at around the same time.
If a newborn looks to be having good feeds, but is not sleeping well after a feed, then check that they are latching on correctly. It is also worth checking them to make sure they don't have a tummy ache, rather than crying to be fed.
I have found all my babies have an unsettled day around day 3 or 4, where they just haven't slept much all day. During this time, I still try to feed them at regular intervals, and spend much more time cuddling and soothing them than I might otherwise need to. After this bad day, they have always settled down again.
It isn't uncommon for a baby to have unsettled days now and again those first few weeks. I just keep on doing what I need to do, and they usually settle down again in a day or so. They may be a little hungrier than usual because my milk supply hasn't kept up with their growth spurt, or perhaps they have been over-stimulated after a big day out, or lots of extra cuddles with Grandma. Consistency, routine and maybe an extra feed or two seems to settle them down after a day or 2.
I suggest mums consider trying to move their babies onto a 3 1/2 hour routine around the 6-8 week mark if possible, and try to have them on a (approximately) 4 hourly routine around the 10-14 week mark. Some babies will take longer to stretch these times out, and some babies will do it more quickly.
Some mums find that while they have a regular 3 or 4 hourly routine during most of the day, they may need to add an extra feed or 2 closer together at the end of the day because their milk supply drops a little (sometimes referred to as 'cluster feeding'). This is fine. What I suggest, though, is to make sure that most of the feeds are consistent in times.
This would mean avoiding a routine that went 3 hours, 4 hours, 2 1/2 hours, 3 1/2 hours etc. A routine that goes (approximately) 3 hours, 3 hours, 3 hours, 2 1/2 hours, 2 1/2, (or similar) is ok, because for the most part of the day, the feeds are at fairly regular intervals.
Spitting Up.
Some babies regularly 'spit up' after a feed. This can range from a fairly small amount, to a huge gush of milk. If your baby spits up a fairly small amount, then it is nothing to be concerned about.
If your baby regularly produces a large volume of milk, then it is worth checking out.
Some babies can return a large quantity of milk simply because they have eaten too much (like mine!). If your baby is growing well, gaining weight, and is happy after feeds, then they are probably fine.
Some babies, however, return a large amount of milk, and then struggle to gain weight. If this is your baby, then go and talk to your doctor or clinic sister about the options available to help your baby retain his feeds better.
Looking After Mum.
If mum has a struggling milk supply, then she will need to be more patient with stretching feeds, as well as working to keep her milk supply up. This will mean drinking lots of water (a full glass at least every feed), as well as a good calorie intake, and rest.
Some mums feel that this is a time to lose their pregnancy weight, but for many, it will result in lower milk supply. Healthy eating is good, but skimping on calories will mean that your body can't make enough for the 2 of you. Some mums will struggle with supply, while others will have fat, happy babies, but themselves be unwell. Just keep an eye on your eating!
Sometimes, the food that mum eats can cause discomfort to their feeding baby. Foods that are spicy, or high in acid are common culprits for unsettled babies, so that is also an area for breastfeeding mothers to watch out for.
It is so important for breastfeeding mothers (of any age baby) to get adequate rest. A lie down in the afternoon, when baby is asleep, is crucial throughout the whole period of breastfeeding, to help mum to get enough rest. Going to bed at a reasonable hour is also essential. Once baby goes down for the night, so does mum! No pottering around doing housework at midnight, or you will soon be exhausted as you try to keep up.
Some mums love to exercise regularly. This is also fine, within reason. Jogging 5 times a week, and going to the gym 3 times a week is not going to help your milk supply! A walk (or swim) each day, though, is fine.
Dealing With a Drop in Milk Supply.
Sometimes mums go through periods of lower milk supply. How might they know their milk supply isn't keeping up with their baby's needs?
It is useful for a mum to keep a record of things like: the number of wet and dirty nappies, the number and length of feeds, and the weight and height gain of their baby. Visiting the local Baby Clinic every couple of weeks for those first few months is helpful to allow baby to be accurately weighed. If baby is not putting on weight, or growing in height, then that might indicate that your milk supply is not keeping up. If baby suddenly starts waking hungry early for his regular feeds, or in the night (when he was previously sleeping longer), then that may also be an indicator. If baby does not seem satisfied after a feed - perhaps he is fussing - then he may still be hungry. Your baby should start 'filling out' around his body after a few weeks - creases in the arms and legs, and perhaps a double chin. If your baby is looking scrawny, then he may not be getting enough to eat.
If you suspect your milk supply is not doing so well, then there are a few things you can try, to build it up again.
First, check that you are eating well, and drinking lots of water. Check also that you are not rushing around doing too much, and are having a rest in the afternoon. Mums of several children are prone to over-doing things! Over-exercising is also a problem for some mums, and will jeopardise their supply from time to time.
Pumping after feeds is an effective way to increase your supply - just pump for a few minutes after a feed, store in the fridge, and offer to him after the next breastfeed. You can do this up to 3x day, for around 3-5 days to notice a difference.
Other temporary methods of boosting supply include giving a top up feed before bed in the afternoon ('afternoon tea'), or adding another late evening feed, if you aren't already doing one.
Occasionally, it can be helpful to give a top up feed before every sleep, until milk supply is re-established (usually a week or so). In the long term, however, this can sometimes be quite tiring for mum, and a cycle of tiredness and poor supply can be tricky to break, as well as disruptive for baby's sleep.
Sometimes mums find vitamin (or even recommended herbal) supplements helpful to give a flagging milk supply a boost. Sustagen has worked wonders for me!
If your baby is having solids, always give milk first. Otherwise your baby may not be hungry enough to drink enough milk to keep your supply up.
Weaning
Sometimes mums are needing to wean their babies. This might be because they are needing to go to work, or wanting to fall pregnant, illness, family upheaval, or for some other reason. If your baby has been a great feeder up to now, then this can be a little traumatic - for mum, as well as baby!
Many mums, from 9 months onwards, find it easier to go straight to a sippy cup, rather than a bottle. At 9 months, most babies are able to manage a sippy cup quite well. Formula is recommended until around 12 months.
It is usually best to drop the feeds one at a time, to prevent engorgement and mastitis. The midday feed is often the easiest to drop first, followed by the late afternoon feed. The last feed to go can be either the last night feed, or the first feed. Some mums keep one or two feeds for quite some time, and this can often work quite well. This might mean feeding in the morning and/or evening, while giving formula (or cow's milk if over 12 months) throughout the day.
Of course, there is no requirement to wean your baby at 9 months! Feeding past 12 months is recommended by the World Health Organisation, so keep going as long as is convenient for you and your baby.
Biting
A common problem can arise when baby decides to bite. Ouch!
Sometimes they might bite because they are teething, and their gums are sore. Sometimes they are falling asleep and sort of crunch down as they nod off. Sometimes it is because they enjoy the attention they receive from mum!
Whatever the reason, it is certainly NOT fun for mum! What to do?
If they are at the end of a feed, then perhaps simply pulling them off, and changing sides, or finishing up is the simplest way to deal with this.
A stern "No!", while pulling baby off can also shock them into stopping. Often they will cry loudly at being spoken to sternly by mum, and go back to feeding properly.
If that hasn't helped, sometimes a gentle flick on the cheek can make them aware of what they are doing, and help them to forget about biting.
Some mums have been contemplating weaning when baby starts to bite, and this habit just hastens that process! Most babies, especially the younger ones, can be redirected, though, and the biting stage becomes fairly short lived. So hang in there!
Feeding While Pregnant
A common 'wisdom' is that it is not possible to fall pregnant while you are breastfeeding. Many a mother will disprove this theory, though!
While it isn't very common, it is certainly possible for some mums to fall pregnant while still breastfeeding. What to do?
Some mums are able and happy to continue feeding their baby throughout a pregnancy, and beyond. This is no problem if mum is happy.
Some mums, however, are very tired with their pregnancies, and find that trying to maintain a milk supply, as well as a growing baby, as well as their own health and energy, becomes almost impossible.
Other mums become quite sick during a pregnancy, and can't manage feeding a baby, and feeling nauseous, or even vomiting.
If you need to wean baby earlier than expected because of an unexpected pregnancy, then that is fine. Your baby will manage, and you might well feel so much better, and able to cope with a pregnancy as well as a baby.
