Pregnancy is an exciting time in your life and as you prepare for the birth of your baby, it’s important to think about not only how to prepare for labour and birth but also about feeding and caring for your baby.
Breast milk is perfect and uniquely made for growing baby’s needs. Breastfeeding makes a big difference to both your baby’s health and yours – the longer you feed your baby mum’s milk, the longer you and your baby will benefit.
South West Healthcare midwives and nurses will respect your right to choose how to feed your baby, whilst being committed to the protection, promotion and support of breastfeeding. South West Healthcare also have International Board Certified Lactation Consultants (IBCLCs) working in the Infant Feeding Support Service to support your feeding goals.
During your hospital stay, we encourage you and your baby to stay together day and night. By rooming in you will get to learn your babies feeding cues and behaviours. This will enable you to respond to your baby’s needs. It has been shown that staying together helps to establish your milk supply and helps you sleep better when you know your baby is close by.
Breastfeeding on demand means feeding your baby without limits to how often or for how long. Demand feeding has been found to help your milk supply establish faster and also prevent problems such as engorged breasts. It also allows your baby to feed according to their own need.
Your baby needs and will want to feed frequently, until your milk comes and this is considered to be normal. Feeding this frequently helps to bring your milk supply in. There should not be long gaps of over 4 hrs between their feeds in these early days. With frequent feeding milk should come in anywhere between day 3- 6 after birth. You know your baby is feeding well when they:
Day 4: 4-5 wet nappies increasing in frequency and volume. Poo can now be a brighter green and “seedy” in appearance.
Poos and wees – Raising Children Network
Your baby should be back to birth weight by two weeks of age. Normal weight gain is between 20 and 30 grams per day, or between 150 and 210 grams per week.
You know your baby is feeding correctly when:
After some initial short frequent sucks to stimulate milk flow, your baby begins to swallow. Sucking becomes slower, deeper, and more rhythmic with rest periods between each sucking burst. As the feed progresses the sucking bursts become shorter and the rest periods longer. You can hear or see your baby swallowing.
You may develop problems breastfeeding if you:
Your breasts begin to prepare to feed your baby early on in your pregnancy. From week six of pregnancy they may begin to feel fuller, heavier and more sensitive. Not all breast tissue is involved in making milk as much of it is fat and supporting tissue, so the size of your breast doesn’t equal your ability to breastfeed. Later on in your pregnancy, you may notice the nipple and areola (the area around your nipple) becoming darker. Some women also experience leaking of colostrum from the nipple during late pregnancy.
Steps for good attachment:
Some discomfort from the initial stretching of the nipple is normal, but should not last.
If your nipple is squashed or pinched in appearance, it is likely that your baby does not have enough nipple & breast tissue in their mouth, try again for a deeper latch.
Continue to support your breast until your baby is sucking and swallowing in a deep rhythmic pattern.
If you experience pain when your baby starts swallowing, take your baby off the nipple and re-attach.
Good attachment video- Raising Children Network
There are lots of different positions for breastfeeding. You just need to check the following:
Your milk is perfect and uniquely made for your growing baby’s needs. Giving your milk to your baby makes a big difference to both your baby’s health and your health. And every day counts; the longer you feed your baby mum’s milk, the more they benefit. The World Health Organization (WHO) recommends that you exclusively breastfeed up to six months of age, with continued breastfeeding along with the introduction of solid foods up to two years of age or beyond.
Breastfeeding is emotionally and physically rewarding and it can help enhance the bond between you and your baby. It also helps you by keeping your uterus contracted and reducing bleeding. It can help you return to your pre-pregnancy weight.
Breastfeeding can reduce your risk of premenopausal breast cancer, ovarian cancer, diabetes and other illness later in life.
Remember that breastfeeding is a learned skill for you and your baby. It takes plenty of practice and patience.
When trying to breastfeed ask the midwife caring for you for some guidance.
You may be shown many different ways to breastfeed, choose the one most comfortable for you and stick with it – persistence will pay off.
These are known as after birth pains, and though not common with your first baby, they are very common with your second, third, etc.
After birth pains are due to a hormone called oxytocin which stimulates the let down or release of your milk and also causes your uterus to contract.
Ask for a hot pack or pain relief if you require it. The pains should settle in two to three days.
You can also seek support from our Infant Feeding Support Service.
Always offer both breasts at each feed. Start with the opposite breast you started the last feed with.
A nappy change after the first breast will help to wake a sleepy baby for the second breast.
At times your baby may not feel like the second side especially when your milk first comes in. If the breast that baby does not feed from is full and uncomfortable hand express a small amount of breastmilk off and then begin on that breast next time.- Do not pump off as this will increase supply further, your baby should regulate your supply, not a pump.
If the discomfort persists beyond the first minute of the feed, detach your baby by breaking the seal of their mouth with your finger and ask for guidance.
It is important to check your nipple shape as soon as the baby lets go of the breast. If the nipple is a normal shape, then what you are feeling is normal tenderness. This will settle in a day or two.
Your baby has not been well attached if your nipple is an odd shape or in any way discoloured, grazed or cracked.
In their second to third day of life babies do become very frequent feeders. This is normal behaviour to increase the milk supply.
Feed whenever your baby displays hunger signs, and rest when they sleep.
Dummy use should be avoided as a baby showing sucking signs should be fed in order to help establish you r milk supply
In the first few days when your baby isn’t drinking large amounts of milk, they may not burp after a feed. During this time babies are only taking about one teaspoon of colostrum each feed. Give your baby the opportunity to burp by holding them upright with their back straight for a few minutes.
It is not necessary to try to burp them for a long period of time.
Hiccups are common to most newborns, and don’t seem to bother them. They may be relieved by re-offering the breast.
When your milk comes in (anywhere between day 3-6 after birth), your breasts often produce too much milk.
The tight, full feeling starts to settle after 24 hours and feeding your baby often will help.
The use of cold packs on your breasts after feeds may also help these symptoms.
Management of full breasts – The Royal Women’s Hospital
The fullness of your breasts has made the areola (brown area) very firm, so your baby is now trying to latch onto what is more like an inflated balloon.
It can help to express a small amount of milk until this area becomes much softer and easy to shape.
You will probably need to do this for the next day or two until your supply starts to settle.
Keep this in mind if your baby sleeps for longer than usual and your breasts have become overfull again.
Management of full breasts – The Royal Women’s Hospital
Your baby will take plenty of the areola (brown area) into their mouth.
Once attached and sucking there should be no pain.
You will be able to hear your baby swallowing milk regularly.
When your baby releases the breast from their mouth the nipple will be the same shape as when it went in.
Your breast will also feel much softer.
The ‘let down’ is a hormonal response to nipple stimulation (either from your baby or when expressing).
It involves the tiny muscles in your breast contracting and pushing milk down the ducts toward the nipple.
Some women may feel a tingling sensation in their breast, milk leaking from the other breast, thirst or nothing at all. All are perfectly normal.
The only way to really know you have had a let down is the change in your baby’s suck from short shallow sucks to longer drawing sucks and swallowing can be heard.
You will have several let downs in each feed.
Let down reflex – Australian Breastfeeding Association
Every baby has its own feeding pattern.
How often a baby feeds depends on how much milk your breasts can store, and your baby’s size and appetite. It is important to allow the breast and baby to work it out between them. Not limiting their time at the breast will give your breasts the best message about how much milk they need to produce. This is how supply equals demand. This is how milk supply becomes established.
Most babies will breastfeed between six and 12 times over a 24 hour period. The spacing between feeds will also vary greatly. From long breaks, to feeds with very little space between them (cluster feeds).
If you are concerned about the frequency of feeds or length of time it takes to feed your baby, seek guidance from your midwife, Maternal and Child Health Nurse or IBCLC.
There are many reasons why lactating mums wish to express their breast milk and/ or store it.
Sometimes a mother is separated from her baby or finds it difficult to breastfeed. Other reasons may include concerns about breastfeeding in public; as a temporary approach while trying to increase breast milk supply or when planning return to work.
If you express milk, your baby will still be able to have mum’s milk even if somebody else is feeding them. This may be useful if you are away from your baby or returning to work.
It’s best to wait until your baby is a little older before regularly expressing milk for your partner to feed your baby, so you have a chance to get feeding going well first.
It will depend on the reason you need to use a pump as to which type is suitable, so ask for information to compare them.
Be sure to wash equipment after each use with hot soapy water, rinse well and dry on a clean surface.
If your baby is unwell or premature ask for advice about sterilising the equipment.
Expressing breast milk – Royal Women’s Hospital
The aim of lymphatic massage is to encourage drainage of fluid behind blocked ducts to help prevent and resolve inflammatory breast conditions such as mastitis.
Key points:
Technique:
Additional techniques to utilise as advised by your physiotherapist:
Many common problems associated with breastfeeding will resolve themselves in the early weeks after giving birth.
Nipple soreness and damage is often a result of your baby not being attached well to the breast. It is important to seek advice and guidance about correcting the problem so that breastfeeding becomes pain free and comfortable. If your nipples do become sore, express some milk onto the nipple after feeds and allow them to air dry.
Advice can be sourced from an IBCLC in the SWH Infant Feeding Support Service.
This occurs when there is narrowing in the milk duct/s preventing milk from moving through the breast. This can develop into localized breast inflammation, sometimes called ‘blocked ducts’.
Causes
Signs and symptoms
You may experience flu like symptoms such as a high temperature, shivers and joint aches. It is important to get medical advice or help at this stage, as you may need antibiotics. It is important to know that quick and effective treatment of the breast may stop mastitis developing further.
Relieving an inflamed breast
Start treatment as soon as you notice any signs of inflammation in your breast with the following these steps:
If you begin to feel unwell with a high temperature and flu like symptoms, mastitis may be developing and you need to seek medical attention.
Localised breast inflammation – Australian Breastfeeding Association
Infection caused by common bacterial organism staphylococcus aureus (sometimes called a staph infection)
Causes
Signs and symptoms
The breast is red, swollen, hot and painful and the skin will look tight and shiny.
You may well have an elevated temperature, flu like symptoms such as body aches and pains and feel unwell.
Treatment of mastitis
If you are thinking of weaning your baby, it is better to wait until the mastitis is resolved.
Seek support from an IBCLC from the Infant Feeding Support Service and if recommended you can hire a hospital grade breast pump from SWH supplies shop).
Mastitis – Australian Breastfeeding Association
Many mothers have times when they feel their breast milk supply is not enough. It is one of the most common reasons for early weaning. Feel confident that your body can make enough milk for your baby. Remember that supply equals demand, so if you swap breastfeeds with formula, your breasts will make less milk.
If you feel your milk supply is low, you can increase your milk supply by:
If the above measures do not result in your supply being enough for your baby’s needs, seek professional guidance with an IBCLC.
Increasing supply – Australian Breastfeeding Association
Breastfeeding is a learned skill for you and your baby and it is common for women to have difficulty attaching, particularly when breastfeeding for the first time. It takes plenty of practice and patience. Be reassured that this becomes easier with assistance and time, and there are many resources available to help.
Mother-led attachment video – Australian Breastfeeding Association
Most medications are quite safe in breastfeeding mothers.
If you are concerned about the safety of any medicines you are taking while breastfeeding, seek the advice of an IBCLC. You can also speak to a pharmacist who is supportive of breastfeeding.
Medicines in breastfeeding – The Royal Women’s Hospital
Tongue tie or ‘Ankyloglossia’ is when the thin piece of skin under the tongue (the lingual frenulum) is very short and restricts the movement of the tongue.
Tongue ties are present at birth and can range from mild to severe. Approximately 5% of babies are born with a tongue tie.
What are the symptoms?
A tongue tie may not always be obvious and symptoms will depend on severity. Features of tongue tie can include:
It is not always about the appearance of a tongue tie/ oral restriction it is more to do with the function or the effect it is having on your feeding.
If a tongue tie is suspected a thorough examination needs to be completed. Examination and a full feeding assessment can be completed by an IBCLC.
More information
Tongue tie – Raising Children Network
Tongue tie – The Royal Women’s Hospital
Tongue tie – Better Health Channel
There is no safe level of alcohol intake for breastfeeding so avoiding alcohol is the safest option.
Alcohol is passed through to breast milk and may reduce the supply or cause poor feeding and sleep disturbance to your baby. It is recommended that mothers avoid alcohol when breastfeeding.
Alcohol and breastfeeding – Australian Breastfeeding Association
There are some important things to know if you are planning to bottle feed your baby, whether you are using expressed breast milk or formula. You will need bottle feeding equipment including a number of large bottles, rings and caps, and several teats. Which vary in size and shape, generally according to baby’s age. No one is better than the other. Choose bottles that are simple and easy to clean, and try teats with bigger or smaller holes until you find the one that you and your baby are happy with.
New babies immune systems are not yet fully developed to, protect them from infection. That means all bottle feeding equipment needs be properly cleaned and disinfected before and after use until your baby is around 12 months of age.
You will also need access to good quality fresh water, which needs to be boiled before use some type of sterilising equipment to keep everything clean.
Guide to bottle feeding – UNICEF
Bottle feeding – Raising Children Network
Facts about formula – Australian Breastfeeding Association
If you are also breastfeeding, it is suggested to use a “Paced bottle feeding method”.
Paced bottle feeding – Australian Breastfeeding Association