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 Mastitis, blocked ducts, and engorgement

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 Mastitis, blocked ducts, and engorgement

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La leche league - info source on what to do if you have any of these issues - self help and advice

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Mastitis (breast inflammation), includes a wide range of symptoms, from a small, tender area (often called a blocked duct), through to severe infection.

If your breasts are inflamed or swollen, it's important to act quickly to relieve discomfort and stop it getting worse. You may also need to deal with any underlying causes.

LLL Leaders are here to help.

What do all these words mean? A quick guide

What are the signs of mastitis?

How can I prevent mastitis in the future?

Mastitis just means 'breast inflammation'. Recent research is changing how mastitis is viewed and treated. It's now understood as a wide spectrum, from a small, tender area - often called a blocked duct - to a severe infection.

Milk blisters/blebs look like tiny white or yellow dots on the tip of the nipple. They can cause no trouble, or they might be very painful (often described as 'stinging' pain). Sometimes they form in one or more 'milk pores', blocking milk from coming out of part of the breast. They are part of the mastitis spectrum of related conditions and the self-treatment measures suggested for mastitis may help. Milk blisters that don't block milk coming out, and don't hurt, can be safely left alone. They eventually disappear.

Engorgement is when the whole breast becomes swollen with extra fluid. It's common 2-5 days after birth, when milk production is increasing very fast. The mastitis self-treatment measures described below are helpful for engorged breasts, too. Treat engorgement promptly to avoid developing mastitis.

A breast abscess is a collection of pus (infection) within the breast. It is usually a complication of mastitis that was not adequately treated. An abscess needs urgent medical treatment: drainage and antibiotics.

One or more areas that are tender (sometimes called a blocked duct).

Your breast might feel warmer, harder, or lumpier than usual.

There may be a patch of skin on your breast that has changed colour (dark skin might look darker than usual, on light skin you might see a red patch).

You might have a fever and feel like you have the flu. Your body may respond to inflammation with an increase in temperature - it doesn't necessarily mean you have an infection. See below, "Do I need medical help?"

Could it be a breast abscess?

Most (though not all) people with an abscess feel very ill. If you have one or more lumps in your breast that don't get smaller as milk is removed, and don't respond to the treatments for mastitis suggested in this article, contact your GP or NHS 111. An abscess needs urgent medical treatment. It's usually possible - and may be preferable - to continue breastfeeding while an abscess is treated, if you want to. LLL Leaders can support you through it.

When breasts are too full of milk, or the breast is injured, your body may react with inflammation - a response to a threat. Blood flow to the area increases, and fluids and immune cells rush in to repair damage and fight off bacteria. As pressure within the breast increases, it feels tender or painful, and it may become difficult for the milk to flow easily.

Common causes of mastitis

Issues with positioning and attachment: Your baby is not removing milk efficiently.

Scheduling or limiting feeds: If breasts aren't relieved as often as they need to be, this can result in mastitis (and decreased milk production). The amount of milk breasts can hold - and how long they can comfortably hold it for - varies hugely between individuals, and changes over time.

Oversupply: Having a lot more milk than you need. Sometimes it's caused by 'overpumping'. Sometimes it just happens - this is more likely with second or subsequent babies. Your baby may get upset, gag, and splutter when your milk releases. They are probably growing very fast. Your breast/s may feel uncomfortably full a lot of the time. If you're struggling with oversupply, LLL Leaders can help.

Suddenly removing less milk than usual: For example, because your baby is ill, sleeping longer, or you are away from your baby.

Weaning: If you reduce the amount you breastfeed faster than your breasts can manage.

Breast injury, e.g. from a too-tight bra, bag or sling strap, breast pump, or seatbelt. Or even sleeping on your stomach.

Bacterial infection in the breast, possibly through an open nipple wound.

Less common causes of mastitis

Previous breast surgery, such as implants

Being under a lot more stress than usual, or extremely exhausted

Being anaemic or having other health conditions that make your immune system work less well

Gut health. Some experts think that imbalances in the 'microbiome' (the bacteria that live in your body) may make some people more likely to get mastitis. The breast has its own microbiome which is affected by many factors, including your diet, antibiotic use, and whether your baby feeds direct at the breast. It's a developing field of research.

Factors that may make mastitis more likely:

Causes of engorgement

your baby is unwell and feeding less than usual, or less than your breasts need

your baby starts sleeping for a longer stretch at night

you are away from your baby and don't express as often as your breasts need.

In the first few days after birth, you may have more engorgement if you were given extra fluids during labour and birth. But engorgement can happen at any stage of breastfeeding if there's more milk than your breast/s can comfortably hold. For example, if:

Take standard doses of an over-the-counter non-steroidal anti-inflammatory medication such as ibuprofen, if you can usually take it. Paracetamol may also be helpful if you're in pain, but ibuprofen is more useful for mastitis, because it also reduces inflammation. Both are safe to take while breastfeeding.

Experiment with cold or cool compresses on the affected area/s between feeds, to see what helps you feel most comfortable. Some cultures and communities advise new mothers to avoid cold in the early week after birth, and to use heat instead - if this is the case for you, see "things to avoid", below.

Remove milk as often as you need to, to keep the breast as comfortable as you can. Feed your baby whenever they want to be fed or continue expressing whenever you would usually express. Offer a feed or express some milk if your breast feels very full and uncomfortable.

Rest as much as you can. Inflammation is tiring for your whole body. Those who have had mastitis often say that they got it when they were under extra stress, or busier than usual - it may be a sign that you need to slow down. Rest is an important part of healing. Taking time off work, or having a partner or support person help you care for your baby can be useful for a few days.

Experiment with different feeding positions. This may help you be more comfortable and help to drain different areas of the breast.

Some experts recommend taking probiotics, or the food supplement lecithin. Check with your healthcare provider, a breastfeeding supporter, or LLL websites for current information.

Contact an LLL Leader or your local LLL group for more information and support.

Start treatment at the first signs of breast swelling or inflammation. It's often possible to deal with it at home without medical help.

Things to avoid

Rough massage of your breasts. This can increase inflammation - and really hurts! If you want to massage while feeding or expressing, use gentle touch, as if you were stroking a cat.

Applying a lot of heat, e.g. hot showers or compresses. Heat can increase inflammation. If a little warmth helps the milk to flow when you're feeding or expressing, or helps you feel more comfortable between feeds, use it for as short a time as possible. Don't direct a hot shower straight at your breast.

Trying to force milk out of the breast won't fix the inflammation and may make it worse.Electric toothbrushes, combs or other devices.

Trying to remove a lot more milk than usual. This can increase the amount of milk you're producing, increasing pressure in the breast. If you need to express more milk than your baby wants, aim to express just enough to be comfortable - not every available drop.

Some of the treatments that used to be recommended for mastitis don't help, and may even make things worse:

My breasts feel full but I can't get milk out - help!

Babies sometimes refuse to feed on a breast that has mastitis. The milk is safe for your baby but may taste different from usual. Your baby may also be objecting to a slower flow of milk - some people notice a temporary supply dip during mastitis. It usually goes back to normal when the breast has recovered. You will need to express milk from the affected breast until your baby is willing to feed on it again.

See Nursing Strikes for ideas to encourage your baby to feed.

Treat the inflammation by taking ibuprofen and perhaps applying a cold compress about 20-30 minutes before you feed or express.

If your baby is struggling to attach because the whole breast is engorged (full and tight), try expressing a little milk before offering the breast to your baby. Or try 'reverse pressure softening': press firmly around the nipple with fingertips or finger lengths for about one minute before feeding. This moves swelling away from the nipple.

Try gentle 'lymphatic drainage' massage (towards your armpit). See Further Reading.

What if your baby will feed, or you're trying to express, but little or no milk is coming out?

Don't panic! Engorgement or mastitis can act like a traffic jam in the breast . These tips can help you get the milk moving again:

Your symptoms are the same after 24 hours, or getting worse

You start to feel ill - shivery, shaky, like you have flu

You have a fever

A patch on your breast has changed colour and is getting larger, or you see streaks on your breast

You see signs of infection, such as a wound that looks crusty or oozes yellow, or your nipple is a different shape, size, or colour from normal.

If you're feeling okay in yourself (you don't have a fever or feel ill), you can try treating yourself at home for 24 hours. If by that time your symptoms are improving, you can continue for another 24 hours.

Get breastfeeding help if you need it. A breastfeeding supporter can help you get your baby deeply and comfortably attached at the breast.

Keep your milk flowing. Avoid too much milk building up in your breasts: feed or express as much as your baby wants, and offer extra feeds or express some milk if your breasts become uncomfortable at other times. If you have a lot more milk than you need, a breastfeeding supporter can help.

Check your breast comfort. Make sure nothing is pressing on the breast (see above, "Why does it happen?")

Watch out for early signs of mastitis and start self-help measures right away.

Contact NHS 111 or your GP straight away if:

You may need antibiotics. The NHS guideline on mastitis says that you should usually be given a 10-14 day course (if you have a shorter course, the mastitis is more likely to come back). If you need antibiotics, it's important to keep up with the self-help treatments above, as well as taking the medication. Let your doctor know if you're still not feeling any better by the third day after starting antibiotics.

Mastitis can be horrible, and make you question whether you can carry on breastfeeding. It's important not to suddenly stop removing milk while you've got mastitis, as this can lead to complications. You need plenty of practical and emotional support, and good medical care if necessary, until you're feeling better.

Written by Jayne Joyce and Justice Reilly

Last updated June 2024

My Baby Won't Breastfeed When a Mother is Unwell
Mastitis
La Leche League International article on mastitis: https://llli.org/breastfeeding-info/mastitis/

References

Baeza, C. et al. 2022. Re: "Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022" by Mitchell et al. Breastfeed Med 2022 17(11):970-971.

Douglas P. Re-thinking benign inflammation of the lactating breast: A mechanobiological model. Women's Health. 2022;18. doi:10.1177/17455065221075907

Mitchell, K.B. et al.; Academy of Breastfeeding Medicine. 2022. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 17(5):360- 376. Erratum in: Breastfeed Med 2022 17(11):977-978.
Engorgement
NICE Mastitis and Breast Abscess (Clinical Knowledge Summary)
Blebs
Last revised in December 2023 Wilson, E. et al. 2020. Incidence of and risk factors for lactational mastitis: a systematic review. 36(4):673-686.

Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD006946. DOI: 10.1002/14651858.CD006946.pub4.

Douglas P. Re-thinking lactation-related nipple pain and damage. Womens Health (Lond). 2022 Jan-Dec;18:17455057221087865.
Over-the-counter medication
Mitchell KB, Johnson HM. Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs. J Mammary Gland Biol Neoplasia. 2020;25(2):79-83.

O'Hara, M. A. Bleb histology reveals inflammatory infiltrate that regresses with topical steroids: A case series. Breastfeeding Medicine. 2012

NHS Specialist Pharmacy Service - UK Drugs In Lactation Advisory Service

Using paracetamol during breastfeeding , published November 2023

Using NSAIDS during breastfeeding , published February 2024

Other websites

Academy of Breastfeeding Medicine Clinical Protocol #36:The Mastitis Spectrum, 2022. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Books The Womanly Art Of Breastfeeding . LLLI, London: Pinter & Martin, 2010

Breastfeeding Answers Made Simple . Mohrbacher, N. Amarillo, TX: Hale Publishing, 2010.

This information is available to buy as a printed booklet from our .

Copyright LLLGB 2024

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Mastitis, blocked ducts, and engorgement - La Leche League GB

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Avoiding and treating mastitis and breast infections

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Why call the support line?

When it comes to feeding - we know how physically and emotionally challenging it can be. It can take time to feel confident about feeding your baby. If you need information, support or just someone to talk to, give one of our trained breastfeeding counsellors a call on 0300 330 0700* (option 1). The line is open every day from 8am to midnight, including bank holidays.

Please do call with any questions or worries you have. Watch the video below to see one of our lovely breastfeeding counsellors, Fran, answer the five most common questions we get calls about, including ' Am I doing this right?' and 'How long should I feed for?'

Who will you speak to?

By calling 0300 330 0700 (option 1), you'll speak to one of our amazing breastfeeding counsellors. They've had extensive training and will use their person-centred counselling skills to support you. This includes listening to you without judging or criticising and offering relevant information and suggestions - whether you're breastfeeding, formula feeding or a bit of both.

NCT breastfeeding counsellors can also provide new mums with face-to-face support. You can find them at breastfeeding support groups, such as Baby Cafes, and the breastfeeding session if you attend an NCT antenatal course.

Our Infant Feeding Line is free to all parents and available to anyone who would like support with feeding their baby. If you would like to make a donation, please click here. You can also tell us about your experiences of support from an NCT breastfeeding counsellor.

What do parents say about our feeding line?

This is what mums who called the infant feeding line have said about the support and information they received.
"She was open and listened in a relaxed environment. She helped me understand that what was right for one woman and their baby was not necessarily right for another." "Approachable, kind and friendly. Gave common sense advice and increased my confidence as a new mum. What a brilliant woman doing an essential job. Can't believe I found such a wonderful, free, non-judgemental service." "She was decisive and clear in the way she spoke. She is obviously hugely knowledgeable and was able to reassure me and give me practical hands-on advice. She spent a good amount of time with me explaining and making sure I was confident and happy before moving on." "The breastfeeding counsellor was so helpful. Her kind, caring manner really helped me not to worry. She is a true gem and I can't thank her enough."
Call us if you have any questions about feeding: 0300 330 0700 (option 1)

The line is open everyday from 8am to midnight, including bank holidays.
* A call to an 0300 number costs the same as a call to a normal home or business landline. If your phone includes free calls to landlines, calls to 0300 numbers will be part of this.
Further information

You'll find lots more information and support about feeding your baby our website here.

For sources of breastfeeding support, visit this page.

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Support with breastfeeding or bottle feeding: our infant feeding line | Baby & toddler, Feeding articles & support | NCT

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When it comes to feeding - we know how physically and emotionally challenging it can be. It can take time to feel confident about feeding your baby. If you need information, support or just someone to talk to, give one of our trained breastfeeding counsellors a call on 0300 330 0700 * (option 1).

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Essential listening for new parents to be

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This episode is all about getting breastfeeding off to a good start. Frances, Karen and Megan chat about the things parents need to know, including the baby’s f

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Brilliant resource to answer the questions you want to know? If i eat this will it make my baby gassy, affect my supply etc !

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By Kelly Bonyata, IBCLC

Is there a list of foods that I should avoid while breastfeeding?

There are NO foods that a mother should avoid simply because she is breastfeeding. It is generally recommended that you eat whatever you like, whenever you like, in the amounts that you like and continue to do this unless you notice an obvious reaction in your baby to a particular food. There is no such thing as a "LIST OF FOODS THAT BREASTFEEDING MOTHERS SHOULD NOT EAT" because most nursing moms can eat anything they want, and because the babies who are sensitive to certain foods are each unique - what bothers one may not bother another. If you have a family history of allergies and think your baby might be allergic, you might want to avoid certain foods, but again, this would be different for every child.

More information:
How does mom's diet affect her milk?
Can nursing mothers eat strong-flavored or spicy foods?

Yes, in general. There are many cultures who regularly eat spicy foods and strong-flavored foods, and there is no evidence that a greater percentage of these babies are fussy, gassy, or have other problems with the foods their moms eat. We do know that some strong flavors, like garlic, can pass into the milk but it does not seem to cause problems. In fact, one study showed that babies nursed better after mom ate garlic.

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How will eating "gassy foods" affect baby?

It is common for nursing moms to be warned away from eating the so-called "gassy foods" such as broccoli, cauliflower, cabbage, beans, etc. However, gassy foods have no more potential to affect your baby than other foods.

Eating certain foods may cause gas in mom due to the normal breakdown of some of the undigested carbohydrates (sugar, starches, soluble fiber) by bacteria in the large intestine (see Gas in the digestive tract).

However, breastmilk is made from what passes into mom's blood, not what is in her stomach or digestive track. Neither the gas nor the undigested carbohydrates (whose breakdown can cause gas in mom) pass into mom's blood, so it is impossible for these things to pass into your milk to make your baby gassy.

This is not saying that your baby will not have a sensitivity to a certain food, but a food's potential to affect baby really has nothing to do with whether it makes mom gassy.

See also My baby is gassy. Is this caused by something in my diet? @

Can acidic foods that mom eats be "too acid" for baby?

Will too many sweets or increasing/decreasing fat in my diet affect breastmilk?

No. Breastmilk is not affected by the amount of sugar that mom eats.

In addition, the fat and calorie content of mom's milk is not affected by her diet. However, the kinds of fats in the milk can be changed (to a certain extent) via diet.

See also:

What affects the amount of fat or calories in mom's milk? @

Is my exclusively breastfed baby gaining too much weight? @

How might I increase baby's weight gain? @

Can I drink soda (diet or regular)?

Soda generally contains carbonation (the part that makes it fizzy), caffeine and/or artificial sweeteners. See below for more information.

Can I drink coffee or soda that contains caffeine?

Can I eat/drink foods containing artificial sweeteners?

Nutrasweet (aspartame)

According to Hale ( Medications and Mothers' Milk, 2012), Nutrasweet (aspartame) levels in mother's milk are too low to produce significant side effects in infants who do not have PKU (phenylketonuria). It IS contraindicated in babies with proven PKU. Hale lists aspartame in Lactation Risk Category L1 (safest), but L5 (contraindicated) if baby has PKU.

Splenda (sucralose)

According to Hale ( Medications and Mothers' Milk, 2012), there has been little research on sucralose in breastfeeding women. Per Hale, it is poorly absorbed from the GI tract and is excreted unchanged in the urine. The United States FDA considers sucralose to be safe for use in breastfeeding women. Hale listed sucralose in Lactation Risk Category L2 (safer).

A 2015 study ( Non-nutritive sweeteners in breast milk: Perspective on potential implications of recent findings) indicates that non-nutritive sweeteners (NNS) are passed through to breastmilk, and concludes that "because the effects of prolonged infant exposure to sucralose, ace-K, and saccharin on their current and future health are not well understood, we encourage caution in concluding that NNS are appropriate for consumption by lactating mothers."

Sorbitol

Sorbitol is a sugar alcohol found naturally in some fruits and vegetables and is used as a sweetener in foods and medications. It's not listed in Hale, but is unlikely to be a problem breastfeeding-wise. It's commonly used in toothpaste, sugar-free chewing gum, etc.

Saccharin

Per Hale ( Medications and Mothers' Milk, 2012), milk levels of saccharin tend to accumulate over time, but still are considered minimal. Moderate intake should not be a problem for nursing mothers. Hale classified it in Lactation Risk Category L3 (probably safe).

A 2015 study ( Non-nutritive sweeteners in breast milk: Perspective on potential implications of recent findings) indicates that non-nutritive sweeteners (NNS) are passed through to breastmilk, and concludes that "because the effects of prolonged infant exposure to sucralose, ace-K, and saccharin on their current and future health are not well understood, we encourage caution in concluding that NNS are appropriate for consumption by lactating mothers."

Stevia (Stevia rebaudiana)

Stevia is a very sweet herb that is used by many as a zero-calorie sugar substitute. Rebaudioside A (purified from Stevia rebaudiana) is "generally recognized as safe" (GRAS) as a sweetening agent for foods by the US Food and Drug Administration, but no studies have been done on pregnant or breastfeeding women. Hale ( Medications and Mothers' Milk, 2012) recommends caution when it comes to using stevia while breastfeeding because many different herbs in the same genus are being used as natural sweeteners, and because there are no studies on the use of stevia in breastfeeding women. He classifies stevia in Lactation Risk Category L3 (probably safe).

More information:

Safety of sucralose from the Splenda website

Artificial sweeteners by William Sears, MD (general info, not breastfeeding related)

Artificial sweetener info from Dr. Jay Gordon (general info, not breastfeeding related)

Butchko HH, et al. Aspartame: review of safety. Regul Toxicol Pharmacol. 2002 Apr;35(2 Pt 2):S1-93.

Spiers PA, et al. Aspartame: neuropsychologic and neurophysiologic evaluation of acute and chronic effects. Am J Clin Nutr. 1998 Sep;68(3):531-7.

Can a nursing mother eat honey?

Honey is not a problem for mom to eat. The gut flora of adults and children over a year old are able to fend off the botulism spores that may be present in honey, and render them harmless. Since the spores would be killed in your gastrointestinal tract, they would not make it into your bloodstream and therefore cannot be present in your milk.

A baby's gut can't defend itself against the botulism spores, and so they can colonize the intestinal tract, germinate and release botulinum neurotoxin. As a result, honey is not recommended for babies under a year old. It's recommended that you avoid giving baby anything that contains honey, or make sure that the cooking process kills any botulism spores that might be present. Botulism spores are very heat resistant - the toxin is less resistant.

More information:

Tanzi MG, Gabay MP. Association between honey consumption and infant botulism. Pharmacotherapy 2002 Nov;22(11):1479-83.

Infant botulism from FamilyPracticeNotebook.com

Can I eat foods containing MSG (monosodium glutamate)?

Human milk normally contains free glutamates (avg. of 22 mg/100g milk). Breastmilk levels are only modestly affected by moms ingestion of MSG. [FSANZ 2003, IFICF 2001, Stegink 1972]

The American Academy of Pediatrics considers MSG to be compatible with breastfeeding [AAP 2001].

References and additional information:

Food Standards Australia New Zealand (FSANZ). Monosodium Glutamate: A Safety Assessment. Technical Report Series No. 20. Canberra, Australia: Food Standards Australia New Zealand; 2003 June.

International Food Information Council Foundation (IFICF). Glutamate and Monosodium Glutamate: Examining the Myths [PDF]. Washington, DC: International Food Information Council Foundation; 2001 Nov. 12 pp. [See p. 2-3.]

Stegink LD, Filer LJ Jr, Baker GL. Monosodium glutamate: effect of plasma and breast milk amino acid levels in lactating women. Proc Soc Exp Biol Med. 1972 Jul;140(3):836-41.

Committee on Drugs, American Academy of Pediatrics. The Transfer of Drugs and Other Chemicals Into Human Milk. Policy Statement. Pediatrics. 2001 Sept;108(3):776-789. [See Table 7: Food and Environmental Agents: Effects on Breastfeeding.]

General information:

MSG: A Common Flavor Enhancer by Michelle Meadows, from FDA Consumer magazine, U.S. Food and Drug Administration, January-February 2003

Should I be avoiding certain kinds of fish?

Due to the risk of too-high levels of methylmercury affecting an unborn child, the US Food & Drug Administration advises pregnant women to avoid eating several types of fish: shark, swordfish, king mackeral and tilefish (these are longer-lived, larger fish that feed on other fish and are thus more likely to accumulate higher levels of mercury). Per the FDA, "While it is true that the primary danger from methylmercury in fish is to the developing nervous system of the unborn child, it is prudent for nursing mothers and young children not to eat these fish as well." They recommend that your consumption of other kinds of fish (shellfish, canned fish, smaller ocean fish or farm-raised fish) average no more than 12 ounces per week.

Others recommend that the FDA list of unsafe fish be expanded. See Mercury In Your Fish by Ken Cook, President of the Environmental Working Group, for additional information and suggested lists of safe and unsafe fish during pregnancy.

What about tuna? Per the FDA, you can safely include tuna as part of your weekly fish consumption. The varieties of fish that the FDA suggest we avoid contain methylmercury in amounts ranging from 0.96-1.45 PPM (parts per million). Fresh tuna averages 0.32 PPM and canned tuna averages 0.17 PPM. Tuna steaks and canned albacore tuna generally contain higher levels of mercury than canned light tuna. On the other hand, the Environmental Working Group suggests that pregnant mothers avoid eating tuna steak altogether, and eat canned tuna no more often than once a month.

References and additional information:

Breastfeeding and Mercury Exposure @

Fish: What Pregnant Women and Parents Should Know US Food & Drug Administration.

What You Need to Know About Mercury in Fish and Shellfish: Advice For Women Who Might Become Pregnant, Women Who Are Pregnant, Nursing Mothers, Young Children . (March 2004). US Food & Drug Administration.

Mercury Levels in Fish from the Maine Environmental Health Unit

Mercury In Your Fish by Ken Cook, President of the Environmental Working Group
State Advisories on Methylmercury in Fish
Mercury Levels in Commercial Fish and Shellfish from the US FDA. Lists various varieties of fish and seafood along with methylmercury levels in each.

Environmental contaminants and breastfeeding @

Can I eat sushi?

Yes; just make certain that you are comfortable with the source and care of the raw fish (reputable sushi bars are very careful about this). Like any raw food, sushi can carry carry parasites or a bacteria called listeria monocytogenes (see below for more on listeriosis), and some species of fish should be avoided due to mercury levels. The consensus among breastfeeding experts seems to be that eating raw-fish-sushi doesn't pose a problem for a breastfeeding baby (though it has the potential to make mom sick).

Can a nursing mother eat unpasteurized soft cheeses?

Yes, nursing mothers can eat soft cheeses. Unpasteurized soft cheeses (and other unpasteurized dairy products) can carry a bacteria called listeria monocytogenes. Cheese made in the United States must be made from pasteurized milk (pasteurization kills the listeria organism), but imported cheeses may be a problem. Listeriosis is usually a minor flu-like illness in healthy adults, but can cause serious problems for pregnant women and may be linked to stillbirth and miscarriage (as it can be passed to baby via the placenta). Although eating unpasteurized dairy products is not recommended during pregnancy, it is not considered a problem for nursing moms.

Per Lawrence (Breastfeeding: A guide for the medical profession 1999, p 569), "No evidence in the literature suggests transmission of Listeria through breastmilk." This reference indicates that the only thing that might interfere with breastfeeding is a mother's inability to nurse due to severe illness.

Other foods that can carry listeria that considered safe for nursing moms (but not during pregnancy):

hot dogs, luncheon meats, bologna, or other deli meats unless they are reheated until steaming hot

soft cheese such as Feta, queso blanco, queso fresco, Brie, Camembert cheeses, blue-veined cheeses, and Panela unless it is labeled as made with pasteurized milk. Make sure the label says, "MADE WITH PASTEURIZED MILK."

refrigerated pâté, meat spreads from a meat counter, or smoked seafood found in the refrigerated section of the store. Foods that don't need refrigeration, like canned tuna and canned salmon, are okay to eat. Refrigerate after opening.

salads made in the store such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad

raw (unpasteurized) milk or foods that have unpasteurized milk in them
Source:Protect Your Baby and Yourself From Listeriosis

More information:

Is it safe to eat peanuts and peanut butter while nursing?

Current research indicates that avoiding peanuts during pregnancy or breastfeeding does not help to prevent peanut allergies in your child.

Until recently, allergists recommended that children not get peanuts or peanut products until at least 36 months old, but recent studies tell us that this delay does not help to prevent peanut allergies..

More information:

Peanut allergies, children and pregnancy from the March of Dimes

Greer FR, Sicherer SH, Burks AW; American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics. 2008 Jan;121(1):183-91.

Thompson RL, Miles LM, Lunn J, Devereux G, Dearman RJ, Strid J, Buttriss JL. Peanut sensitisation and allergy: influence of early life exposure to peanuts. Br J Nutr. 2010 May;103(9):1278-86. Epub 2010 Jan 26.

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Can a nursing mother eat this food? FAQs * KellyMom.com

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Is there a list of foods that I should avoid while breastfeeding? There are NO foods that a mother should avoid simply because she is breastfeeding. It is generally recommended that you eat whatever you like, whenever you like, in the amounts that you like and continue to do this unless you notice an obvious reaction in your baby to a particular food.

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Excellent series of videos about latching

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Excellent series of videos about latching

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One of our favourite videos about latching. The filmed illustrations are really useful for comparison and reference

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Attaching Your Baby at the Breast – Breastfeeding Series

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Lots of helpful articles to help your breastfed baby take a bottle 

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Lots of helpful articles to help your breastfed baby take a bottle 

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https://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/

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Breastfeeding Getting a good latch with Dr. Jack Newman

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Some evidence suggests that mums who give birth by caesarean can find it more difficult to establish breastfeeding and are more likely to stop breastfeeding earlier. But other research has found that the type of birth has very little effect on the numbers of mums still breastfeeding when their babies are six months old (Prior et al, 2012; Hobbs et al, 2016).

We discuss why a caesarean birth might make breastfeeding more difficult. And here are some helpful suggestions for breastfeeding your baby after a caesarean birth, including how some positions can make it easier.

How to get breastfeeding off to a good start after a caesarean birth

Skin-to-skin contact between mum and baby are recommended immediately after birth (NICE, 2021; UNICEF, no date). This means your baby is placed naked onto your bare chest. This helps babies adjust to the world, begin bonding and start breastfeeding.

Babies in skin-to-skin contact with their mums soon after birth are more likely to have a successful first feed and are more likely to be breastfeeding at four months (Moore et al, 2016). Mums who give birth by caesarean are more likely to stop breastfeeding earlier than those who give birth vaginally (Hobbs et al, 2016). Yet there is no difference in breastfeeding rates with different types of birth in babies who have early skin-to-skin contact (Lau et al, 2018).

Skin-to-skin contact within the first hour after a caesarean birth is more challenging, but mums who request this - and who are supported by health professionals to achieve this - are more likely to have a positive outcome (Stevens et al, 2018). Guidelines on caesarean birth recommend that women who want to breastfeed should be supported to have skin-to-skin contact with their babies as soon as possible after birth (NICE, 2021).

The many benefits for you and your baby of holding them skin-to-skin include:

(Stevens et al, 2019)

If a baby can't have skin-to-skin contact with their mum, skin-to-skin with the other parent is also beneficial (UNICEF, 2019b).

Tips: how to get the breastfeeding support you need after a caesearean

After a caesarean birth, early skin-to-skin contact should be encouraged and extra support offered (Beake et al, 2017; NICE, 2021). Extra support could include the following...

You can ask your midwife to help you to find positions that are comfortable for breastfeeding (NICE, 2021).

Your midwife or someone on the infant feeding team should support you with keeping your baby as close to you as possible. They should also support you to help your baby to have as much skin-to-skin contact and access to your breasts as possible (NICE, 2021).

They can check whether your baby is latching effectively, especially if they're drowsy from medication. They'll also help to make sure your baby feeds frequently and will continue to support you with breastfeeding your newborn.

If your baby is unable to breastfeed directly, they should show you how to express your milk. This is so that your baby can have your milk and your milk supply will be maintained (UNICEF, 2014).

Women do experience pain after a caesarean birth, which can have a negative effect on establishing breastfeeding. It is usually necessary to take pain relief. It's fine to take paracetamol and ibuprofen to help with the pain but aspirin and codeine are not recommended when breastfeeding (Karlström et al, 2007; NICE, 2021).

Babies born by caesarean absorb some of the IV fluids given to the mum during surgery, increasing the baby's weight at birth. These babies urinate more in the first 24 hours, which restores their weight to normal. That means it's more accurate for babies born by caesarean to have their birth weight recorded at 24 hours and for this to be used as a baseline to compare their progress with (UNICEF, 2019).

Do give yourself and your baby time to adjust, you've just been through an amazing but huge change in your life and your baby needs time to get used to life outside the womb. Plus, it takes time for you and your baby to recover physically from the caesarean birth and from any medications you had (NICE, 2019).

Do accept all offers of help and certainly don't be afraid to ask for it - you've just had an operation and a baby after all. Help isn't just good for you, it's good for your baby too. Research says that mums who 'look after themselves' by asking for more help are more likely to breastfeed for longer (Tully and Ball, 2014).

Breastfeeding positions

It's important to find a breastfeeding position that's comfortable for both you and your baby. This helps your baby to latch well and helps you to maintain the position for as long as your baby is feeding.

Some mums like to cover their caesarean scar to protect it, others prefer positions that keep their baby away from it. Some mums find the position of the cannula in their hand or arm from the caesarean can affect how easy it is to find a comfortable breastfeeding position. So it might be worth discussing this with midwives or breastfeeding supporters.

When your baby is breastfeeding, they should come to your breast chin first, nipple pointing up the nose, body in a straight line, nipple aimed towards the roof of their mouth and their body very close to you. Read our article How to help your baby attach and breastfeed for more information.

Here are some positions you could try...

Lying down on your side

Laid-back breastfeeding

Rugby-ball or underarm position

Why a caesarean birth might make breastfeeding more difficult

Frequent, effective removal of milk from a mum's breasts ensures she produces the amount of milk her baby needs. That's because the more milk your baby takes, the higher your levels of breastfeeding hormones (prolactin and oxytocin) will be and the more milk you'll make. We also know that the earlier breastfeeding starts, the more likely it is to continue. A caesarean birth could affect this in a variety of ways...

Pain - from the scar and from the baby not latching well at the breast because the mum finds it harder to get comfortable (Tully and Bull, 2014). This could cause her not to feed as often or for as long.

Loss of mobility - can make it harder to get into a comfortable position to feed and to pick the baby up when they want feeding (Tully and Bull, 2014).

Not going through labour - if a mum has an elective caesarean birth before labour starts, she will not have produced labour hormones. This might lead to lower levels of breastfeeding hormones in the mother and babies being less prepared for feeding (Prior et al, 2012; Zanardo et al, 2013; Hobbs et al, 2016).

Long and stressful labour - an emergency caesarean birth can leave women feeling tired and anxious for themselves and their baby. This stress can lead to lower levels of breastfeeding hormones (Hobbs et al, 2016).

Exhaustion - in both mum and baby can lead to the baby feeding less often and less effectively.

Medication - can lead to a mum feeling drowsy or unwell, which can make early breastfeeding less likely. Medication can also affect the baby, making them drowsy and less able to breastfeed effectively (Brown and Jordan, 2013; UNICEF, 2019).

Separation - if mum and baby are separated, this can mean less chances for early breastfeeds.

Less opportunities for early skin-to-skin and a delayed first breastfeed - caesarean births might mean less opportunities for skin-to-skin contact. Skin-to-skin contact and the baby having their first breastfeed as soon as possible after birth help breastfeeding to become established (Moore et al, 2016).

Effects of a caesarean on the baby - babies born by caesarean are more likely to have mucous in their lungs, which can affect how interested they are in feeding (Tully and Ball, 2014). The IV fluids during labour can also boost a baby's birth weight, which can lead to worries that they've lost too much weight and to early formula supplementation and less breastfeeding (Noel-Weiss, 2011; Chantry et al, 2014).

Loss of confidence - mums might be less likely to believe their bodies can nurture and feed their baby and that breastfeeding is going well. Well-meaning family members might also be more likely to suggest a mum gives her baby formula (this makes breastfeeding more difficult) so she can rest after her caesarean. Early formula supplementation reduces a mother's milk production and confidence in her ability to feed her baby (Tully and Ball, 2014).

Night feeds - feeding at night can be particularly difficult after a caesarean birth if family members or supporters are not available to help with picking the baby up. Some mums say they feel asking midwives for help is a sign of failure.

Take a look at our articles for more about the practicalities of recovering from a caesarean birth and for tips to help you recover more quickly.
This page was last reviewed in December 2021.
Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of our Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Beake S, Bick D, Narracott C, Chang YS. (2017) Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. Matern Child Nutr. 13:e12390. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27882659 [Accessed 30th December 2021]

Chantry C, Dewey K, Peerson J, Wagner E, Nommsen-Rivers L. (2014) In-hospital formula use increases early breastfeeding cessation among first-time mums intending to exclusively breastfeed. J Pediatr. 164:1339-1345. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120190/ [Accessed 30th December 2021]

Hobbs A, Mannion C, McDonald S, Brockway M, Tough S. (2016) The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth. 16:90. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s1288... [Accessed 30th December 2021]

Karlström A, Engström-Olofsson R, Norbergh K-G, Sjöling M, Hildingsson I. (2007) Postoperative pain after cesarean birth affects breastfeeding and infant care. JOGNN. 36: 430-440. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17880313 [Accessed 30th December 2021]

Lau Y, Tha PH, Ho-Lim SST, Wong LY, Peng IL, Nurfarah BZMC, et al. (2018) An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. Matern Child Nutr. 14(1):e12492. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866048/ [Accessed 30th December 2021]

Moore E, Bergman N, Anderson G, Medley N. (2016) Early skin-to-skin contact for mums and their healthy newborn infants'. Cochrane Database of Systematic Reviews. (11):CD003519. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003519.pub4/full [Accessed 30th December 2021]

NICE. (2021) NG192 Caesarean birth. Available at https://www.nice.org.uk/guidance/ng192/chapter/Recommendations#care-of-... [Accessed 30th December 2021]

Noel-Weiss J, Woodend AK, Peterson WE, Gib W, Groll DL. (2011) An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Int Breastfeed J. 6:9. Available at: http://www.internationalbreastfeedingjournal.com/content/6/1/9 [Accessed 30th December 2021]

O'Brien M, Buikstra E, Fallon T, Hegney D. (2009) Strategies for success: a toolbox of coping strategies used by breastfeeding women. J Clin Nurs. 18:1574-1582. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19220615 [Accessed 30th December 2021]

Prior E, Santhakumaran S, Gale C, Philipps L, Modi N, Hyde M. (2012) Breastfeeding after caesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr. 95(5):1113-1135. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22456657 [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen HG. (2018) Who owns the baby? A video ethnography of skin-to-skin contact after a caesarean section. Women Birth. 31(6):453-462. Available at: https://pubmed.ncbi.nlm.nih.gov/29496385/ [Accessed 30th December 2021]

Stevens J, Schmied V, Burns E, Dahlen H. (2019) Skin-to-skin contact and what women want in the ﬁrst hours after a caesarean section. Midwifery. 74:140-146. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30954633 [Accessed 30th December 2021]

Tully K, Ball H. (2014) Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth. Midwifery. 30:712-719. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451198/ [Accessed 30th December 2021]

UNICEF. (no date) Skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/implemen... [Accessed 30th December 2021]

UNICEF (2014) The Baby Friendly Initiative - The ten steps to successful breastfeeding. Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2014/... [accessed 30th December 2021]

UNICEF. (2019) Research on skin-to-skin contact. Available at: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/ [Accessed 30th December 2021]

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Breastfeeding after a caesarean birth | Baby & toddler, Feeding articles & support | NCT

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A caesarean birth can affect breastfeeding at first so here are some helpful tips on how to get breastfeeding off to the best start.

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Facts and information about Infant Milk on the UK Market

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Facts and information about Infant Milk on the UK Market

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INFANT MILK INFORMATION | Types of infant milks on the UK market

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we provide information about the types of infant milks on the UK market and for infant formula, follow-on formula and infant milks marketed

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Formula prep machines are marketed as a quick and easy way of preparing formula milk with feeds ready at the correct temperature in minutes.
They claim to simplify the process and are an attractive prospect for sleep-starved new parents, especially considering newborn babies need to be fed at least 8-12 times every 24 hours, but are they worth investing in?

Below we explain how prep machines work, their key features and take a look at NHS guidance as well as key concerns about whether they are safe to use. Plus, where to buy them if you want compare prices at key retailers.
- cut through the confusion with our comprehensive look at formula milk, follow-on formula and toddler milk
What is a bottle prep machine?

Prep machines are intended to make formula bottle feeding quicker and easier than the standard kettle method.

Manufacturers claim they can produce formula feed at the correct temperature and consistency within minutes, meaning you don't need to faff around or wait for the formula to get to the right temperature.

Simply choose the amount of formula you want to be produced and the machine dispenses a hot shot of water above 70°C that kills any bacteria in the formula and helps to dissolve the powder. Then cooler water is added to produce a bottle at body temperature that you can feed to your baby straight away.

Some prep machines are designed slightly differently and boil water like a standard kettle, then quickly cool the boiled water to 70 or 40˚C, or keep it heated at a set temperature for making formula later.

As always, you'll need to test the temperature of the formula on your wrist before feeding your baby.

Make sure to follow the manufacturer guidelines in terms of cleaning and maintenance if you own a prep machine. Run the cleaning cycles often, change the filter when needed, and it's advised to regularly flush sterilising fluid or boiling water through the pipes of the machine.

The most popular prep machines include the (£165), (£260) and (£80). We've rounded some of the most popular retailers further down the page and below we go into detail about some of the concerns.

Does the NHS recommend prep machines?

Some NHS Hospital Trusts do not recommend using prep machines. This is because some models do not heat water at a high enough temperature (70°C) to kill harmful bacteria and germs.

Dr. Vicky Sibson, director of First Steps Nutrition Trust explains, 'There are many different baby formula preparation and feeding devices on the market, designed and advertised to make life easier when bottle feeding hungry babies who just can't wait, or who need a feed in the middle of the night. The marketing typically seeks to reassure parents that these gadgets are safe and adhere to NHS guidance.

'Unfortunately a lot of the time such claims are not true, or there is a lack of evidence available in the public domain to be sure. It's important that parents/carers who bottle feed their babies understand the and the risks to their baby's health it seeks to address. We would advise parents to talk to their midwife, health visitor or GP if they want more information so that they can make a fully informed decision about how they make up their baby's bottles knowing the risks of different ways of doing this, especially if they choose to use a device.'
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Concerns around formula bottle prep machines

If the water is not at least 70°C when added to the powder, any bacteria intrinsic to the formula powder will not be killed. Some prep machines require you to decant the powder in to the machine so that it can be mixed with the water internally, and this also creates extra risks of contamination.

In addition, some machines repeatedly boil water and this concentrates elements, which again is not safe and against NHS advice that fresh water should always be used when preparing powdered infant formula.

A study by Swansea University revealed that 85% of the 74 Perfect Prep Machines tested by parents in UK homes did not appear to produce water that would be hot enough, and this could pose a serious risk to infant health.

If you have any concerns about your prep machine you're advised to buy a food thermometer and test the temperature of the hot water that comes out of the machine. Do not use this tested water in a feed due to potential contamination.

If the temperature is below 70°C, do not use the machine to prepare infant formula and contact the machine manufacturer. We recommend following the NHS' step-by-step guide on .

For further information on this, take a look at the and the best way to prepare formula for your baby.

Can you use any type of formula milk with a prep machine?

Prep machines should be compatible with all types of formula milk.

Tommee Tippee says their machine works with any brand of powdered formula milk while Baby Brezza says their machine works with virtually all formula brands.

If you're using a specialist baby formula it is worth checking with the manufacturer to confirm that it is suitable.

Can you use any bottles with a prep machine?

Key brands claim to work with any brand of baby bottle.

Baby Brezza says their machine works with virtually all bottle brands and sizes, while Tommee Tippee says its machine has an adjustable base that's designed to accommodate different bottle shapes and sizes.

Double-check the specification details of the prep machine before purchasing to make sure your bottle is compatible.
: our guide to feeding explains all of the options and what you need to know
How long can you keep a bottle made by a prep machine?

Formula milk should ideally be made when needed to reduce the risk of infection. The NHS advises parents to use formula stored in the fridge within 24 hours.

If it's stored in a cool bag it should be used within four hours and if it's stored at room temperature it should be used within two hours.

There are a number of portable products available to help with preparing formula milk on the go.

The and claim to cool fresh formula feed to the right temperature in two minutes.

Alternatively there are lots of portable bottle warmers to choose from, which will heat up pre-made formula bottles.

Where to buy a prep machine

There are plenty of retailers to choose from, below we round up five of the most popular high street brands and online retailers.

Whether you're shopping online or in-store, make sure you pay attention to the shop's returns policy.
Not sure what you do and don't need? Read our expert advice on buying baby bottles, sterilisers, warmers and other feeding essentials

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Perfect prep and formula bottle prep machines - Which?

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Find out if it's worth investing in a baby bottle prep machine such as the Tommee Tippee Perfect Prep Machine or the Baby Brezza Formula Pro Advanced, plus we explain NHS and medical expert concerns around formula bottle prep machine temperatures

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Are you experiencing pain while breastfeeding, possibly combined with slow weight gain for your baby? While the vast majority of such breastfeeding problems can be resolved by adjusting positioning and attachment, and with good breastfeeding management, occasionally tongue tie might be the cause of the problem.

Tongue tie (ankyloglossia) is caused by a tight or short lingual frenulum (the membrane that anchors the tongue to the floor of the mouth). The frenulum normally thins and recedes before birth. Where this doesn't happen, the frenulum may restrict tongue mobility. Tongue tie often runs in families and is thought to be more common in boys than girls. There is an association between high or unusual palates and tongue tie, because restricted tongue movement can affect the shape of the palate.

Breastfeeding challenges can also occur for other reasons. Identifying the cause is important when deciding on appropriate solutions, so seek help from someone skilled.

Identifying tongue tie

When your baby tries to lift their tongue or move it forwards it may appear misshapen, short or heart-shaped, with the frenulum clearly pulling its centre down and restricting its movement. Or you may be able to see or feel firm tissue where their tongue meets the floor of his mouth. Degrees of tongue tie vary and it can be difficult to diagnose accurately. A short, tight, posterior tongue tie is rarer, but may be particularly hard to spot.

How breastfeeding may be affected

Tongue tie affects tongue movement to varying degrees. The shorter and tighter it is, the more likely it is to affect breastfeeding. Some babies with a tongue tie breastfeed well from the start, others do so when positioning and attachment are improved. But any tongue tie that restricts normal tongue movement can lead to breastfeeding difficulties. A baby needs to be able to move their tongue freely and extend it over the lower gum with their mouth open wide to be able to breastfeed well. The symptoms below are all associated with poor attachment that may be caused by tongue tie.

A baby may:
* Be unable to latch on to the breast at all.
* Be unable to latch on deeply, causing nipple pain and damage.
* Have difficulties staying on the breast, making a clicking sound as he loses suction.
* Splutter and choke when coping with fast flowing milk.
* Breastfeed constantly to get enough milk.
* Have poor weight gain or need supplementation to maintain adequate weight gain.
* Develop jaundice that needs treating.
* Be fussy at the breast when the milk flow slows.
* Develop colic.

A mother may experience:
* Pain during feeds, with damaged nipples. Her nipple may be compressed or distorted into a wedge shape like that of a new lipstick immediately after feeding, often with a stripe at its tip.
* Engorgement, blocked ducts and mastitis because of ineffective milk removal.
* Low milk production because of ineffective milk removal.
* Oversupply-if her baby compensates for not being able to breastfeed well by nursing very frequently.
* Tiredness, frustration and discouragement.
* A premature end to breastfeeding.

Breastfeeding is important for every baby

Though sometimes needed as a temporary supplement if your milk production is very low, introducing infant formula is not the answer. It has short-term and long-term health risks for both your baby and you. A baby with tongue tie can also have difficulties with bottlefeeding. Milk may leak from his mouth during feeds and he may suffer from colic.

Treatment

Where a tongue tie is causing breastfeeding problems, treatment options are available and effective- especially if the treatment is prompt. Although attention to positioning and attachment can help maintain breastfeeding and improve comfort to a certain extent, there is evidence that treating tongue tie by frenotomy (see below) is effective in resolving breastfeeding difficulties. Weight gain can improve dramatically. As well as the continued breastfeeding benefits, continuing to breastfeed after frenotomy maximises a baby's chance of normal mouth (palate), speech and dental development. This includes tongue mobility for licking and moving particles of food around the mouth, helping prevent tooth decay.

Keeping breastfeeding going

Mastering the art of breastfeeding can sometimes be a challenge and it takes determination to keep going if you are in pain. The information here can help you keep breastfeeding, both before and after treatment.

Soften your breast

A baby with tongue tie may find it easier to latch on if your breast is soft so breastfeed frequently to avoid engorgement. When your baby bobs their head and licks the nipple, they naturally makes it easier to latch on. Or you can use reverse pressure softening to move fluids away from the nipple area so your baby can latch on well. Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be. Gently hand express a little milk if needed.

Biological nurturing™
A baby often instinctively attaches more deeply and comfortably if they can snuggle up close to their mother's chest for periods of time. Try letting your baby lie on your body as you recline so both their chest and tummy are against you. This kind of 'laid-back' breastfeeding contact is known as Biological Nurturing™ and can be done skin-to-skin or with you and your baby lightly clothed-whatever is more comfortable and convenient for you both. Because gravity helps a baby keep their tongue forwards, this can make a real difference to how well your baby feeds and how much milk you make. See picture above and Online Information section for details of an online video.

A deeper latch
Help your baby get as deep a latch as possible at the breast. This will maximise the amount of milk they get and minimise nipple pain.

If your baby retracts (pulls back) their tongue when they open their mouth, try sliding their chin a little further from the nipple so he can feel the 'fatter' part of the breast with his tongue. Denting the breast at the edge of the areola with a finger and placing your baby's chin in the dent may also help.

You could also try placing your thumb or finger near the base of the nipple where your baby's upper lip will be. If you press, your nipple will tilt away from your baby, presenting them with your breast rather than your nipple. As they open wide, snuggle them in close and use your thumb or finger to tuck the breast into their mouth. Your nipple will be taken in last and unroll in their mouth. If needed, you can then slip your finger out. An LLL Leader can give you further suggestions to help you improve your baby's positioning and attachment

Encourage tongue mobility

To encourage your baby to move their tongue forward, you can also try:
* Reclining with your baby on top of you. Try leaning forward and back yourself to understand how gravity affects tongue position.
* Encouraging them to lick milk from their lips or from your nipple before and after feeds.
* Sticking your tongue out at your baby to encourage them to copy you.

Maintain milk production

If your baby is sleepy or has jaundice, or if you have engorgement or inverted nipples, then a tongue tie can make things worse. If they are not able to take enough milk directly at the breast then you will need to express it and give it to your baby until they are able to breastfeed effectively. Express by hand and/or with a pump at least 8 times a day if your baby is not draining the breast well. This will maintain your milk production and ensure they get enough milk.

Small amounts of expressed milk can be offered by spoon, cup or syringe while you both learn how to breastfeed. Bottles or dummies can confuse your baby's sucking technique so consult an LLL Leader about breastfeeding friendly ways to bottlefeed or about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

An unusual palate

Restricted tongue movement caused by tongue tie may affect the shape of a baby's palate, leading to a high palate or a bubble palate with a high spot. These may be a factor in broken suction, a clicking sound and pain during breastfeeding. A baby with an unusual palate may also resist a deeper latch due to gagging.
The following may help.
* Start with a clean finger with closely trimmed nail.
* Touch your baby's lips and wait until they open their mouth.
* Gently slide in your finger, pad side up along his hard palate, stopping just before the gag reflex is triggered.

Make this a pleasant game and, over a few days, gradually move your finger back to overcome sensitivity. After a tongue tie is divided, a baby's increased tongue movement helps the palate shape become more normal

Treating Tongue Tie

What can be done?
Frenotomy-dividing the tongue tie-can dramatically improve breastfeeding comfort and efficiency for both mother and baby. Dividing a tongue tie is a quick and simple procedure. No anaesthetic is needed for a baby under six months of age.

There are health professionals around the UK who have been specifically trained to divide tongue ties. For treatment on the NHS, you will need a referral from your midwife, health visitor or GP. Knowledge about tongue ties and how they affect breastfeeding varies, so it is worth persisting and seeking a second opinion. In areas where only GPs can refer, your midwife or health visitor may be able to give a recommendation to your GP or suggest seeing a particular GP. Private treatment may also be an option. See Further Reading for information on finding a practitioner trained to divide tongue ties

Is waiting an option?
Sometimes a very thin tongue tie breaks spontaneously or can be stretched by gentle massage of the frenulum. The earlier a tongue tie is divided, the easier it is to resolve any breastfeeding difficulties. Dividing a tongue tie in a baby over six months old is also a more complicated procedure and usually requires a general anaesthetic.

Frenotomy-what will happen?
After the health professional's initial assessment, your baby will be swaddled and held (often by an assistant) so they stay still during the procedure, which only takes a minute or two. The health professional lifts the tongue and divides the frenulum by cutting it with a pair of round-ended sterile scissors or by cauterising it.

Does it hurt?
No anaesthetic is needed for a very young baby as having a tongue tie divided only hurts a little, if at all. Some babies protest more at being swaddled than about the treatment. Others sleep right through the procedure! You will be asked to breastfeed your baby as soon as the procedure is over, to offer comfort, clean the wound and get their tongue moving as soon as possible. The inside of a baby's mouth heals very quickly. The only treatment usually needed is to breastfeed to keep the wound clean and keep his tongue mobile. There may be a white patch under your baby's tongue, but this heals within 24 to 48 hours.

If things don't resolve
Usually a mother notices an instant improvement in her comfort during breastfeeds. Sometimes it takes a week or two for a baby to adjust to their tongue's greater mobility. An older baby may find it harder to adjust to increased tongue mobility and tongue exercises may be recommended. Occasionally a baby's frenulum needs dividing a second time, usually because the division was not quite extensive enough the first time. If you suspect that the initial procedure has not resolved your baby's breastfeeding problems arrange another consultation. Do persist with finding solutions. If several factors are involved it can take time and expertise to resolve the problem. An LLL Leader can suggest further paths to explore and provide ongoing support.

Painful nipples

Using different feeding positions can help if breastfeeding is painful. Or use the position you find most comfortable until your nipples heal. Check your baby's attachment later in the feed-if they slip down your nipple, this may cause you pain. Reclining breastfeeding positions or extra support under your arms may help.

Ask your LLL Leader about breast compression, which can help your baby get more milk quicker. An increase in milk flow may also help them breastfeed more effectively.

Hand express to stimulate milk flow before feeding. Or start on the least painful side, switching sides once your milk lets down. Pain can reduce milk flow, leading to engorgement and mastitis. Ask your doctor, midwife or health visitor about using a suitable painkiller. Applying warmth and using gentle massage and relaxation exercises just before feeds can help milk to flow.

Moist wound healing

When the underlying problem is corrected, moist wound healing can help your nipples heal without scab formation. After each feed gently pat your nipples dry to remove surface wetness. Apply a tiny smear of ultra pure modified lanolin to each nipple, dabbing it on rather than rubbing. Hydrogel pads without a cloth backing can also be used.

Blood from cracked nipples
Blood from cracked nipples is not harmful to your baby. You can continue to breastfeed whilst working to improve positioning and attachment.

If healing is slow
Once your baby starts latching on well you should feel more comfortable and notice signs of healing within a few days. If not, visit your GP-sometimes a bacterial or fungal infection can prevent healing. Continued pain may be a sign that treatment (or further treatment) of your baby's tongue tie is needed.

Seek support

This is a time when the support of other mothers in your local LLL group can be invaluable. You can find your nearest Leader or by calling our Helpline.

Further Reading

Find a tongue tie practitioner- Association of Tongue Tie Practitioners, has details of both NHS and Private Practitioners
Biological Nurturing™
Lactation Consultants of Great Britain

The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010: p63-81, 428-430.
Comfortable Breastfeeding
Engorged Breasts - Avoiding & Treating
Expressing Your Milk
Hand Expression of Breastmilk
My Baby Needs More Milk
Nipple Know-How
Nipple pain
Nursing Supplementers
Sleep Baby - Why and What To Do
Storing Your Milk
LLLI Resources
Tongue Tie & the Breastfed Baby
References

Hazelbaker, AK. Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment. Columbus, OH: Aidan and Eva Press, 2010.

Mohrbacher, N. Breastfeeding Answers Made Simple. Amarillo Tx: Hale Publishing, 2010.

Watson Genna, C. Supporting Sucking Skills in Breastfeeding Infants. Burlington, MA. Jones & Bartlett, 2012.

Geddes, DT. et al. Frenulotomy for breastfeeding infants with ankyloglossia: Effect on milk removal and sucking mechanism as imaged by ultrasound. Pediatrics 2008; 12(1):e188-94.

Hogan, M. Westcott, C. and Griffiths, M. Randomized, controlled trial of division of tongue-tie in infants with feeding problems. J Paediatr Child Health 2005; 41:246-50.

Hong, P. et al. Defining ankyloglossia: A case series of anterior and posterior tongue ties. Int J Ped Otorhinolaryngology 2010; 74:1003-6.

Knox, I. Tongue tie and frenotomy in the breastfeeding newborn. Neoreviews 11 (9) Sept 2010.

Miranda, BH. and Milroy, CJ. A quick snip-a study of the impact of outpatient tongue tie release on neonatal growth and breastfeeding. JPRAS 2010; 63:e683-5.

NICE Guideline s

Watson Genna, C. And Coryllos, EV. Breastfeeding and tongue-tie. J Hum Lact 2009; 25(1):111-2.

You can buy this information in printed form from the LLLGB Shop.

Copyright LLLGB 2016

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Treating and coping with breastfeeding a baby with tongue tie

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Find a registered tongue-tie practitioner

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Find a registered tongue-tie practitioner

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Association of Tongue-tie Practitioners

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NCT Parent Hub - Pregnancy and parenting information exclusively for NCT Antenatal course attendees.

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Baby Led Bottle Feeding - Wendy Lever IBCLC

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Baby Led Bottle Feeding - Wendy Lever IBCLC

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Helpful video

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Baby Led Bottle Feeding - Wendy Lever IBCLC

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If a baby is producing plenty of wet and dirty nappies and their weight is gaining, the baby is getting enough to eat. Period!

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An IBCLC explains in this Instagram post

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View this post on Instagram

A post shared by Charlie | IBCLC (@milk_matters)

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Responsive parenting builds your baby's brain!

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Responsive parenting builds your baby's brain!

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Center on the Developing Child at Harvard University

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Useful guide to expressing, when to express, why its useful, and how to do it! Details of hand expressing and pump, and how to use Expressed breast milk.

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The only thing you REALLY need to avoid is shark.

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You don't need to eat anything special while you're breastfeeding. But it's a good idea for you, just like everyone else, to eat a healthy diet.
A healthy diet includes:

at least 5 portions of a variety of fruit and vegetables a day, including fresh, frozen, tinned and dried fruit and vegetables, and no more than one 150ml glass of 100% unsweetened juice

starchy foods, such as wholemeal bread, pasta, rice and potatoes

plenty of fibre from wholemeal bread and pasta, breakfast cereals, rice, pulses such as beans and lentils, and fruit and vegetables - after having a baby, some women have bowel problems and constipation, and fibre helps with both of these

protein, such as lean meat and chicken, fish, eggs, nuts, seeds, soya foods and pulses - no more than 2 portions of fish a week is recommended, including 1 portion of oily fish

dairy foods, such as milk, cheese and yoghurt - these contain calcium and are a source of protein

non-dairy sources of calcium suitable for vegans include tofu, brown bread, pulses and dried fruit

drinking plenty of fluids - have a drink beside you when you settle down to breastfeed: water and skimmed or semi-skimmed milk are all good choices

See more detailed advice about healthy eating.

Small amounts of what you're eating and drinking can pass to your baby through your breast milk.

If you think a food you're eating is affecting your baby and they're unsettled, talk to your GP or health visitor, or contact the National Breastfeeding Helpline on 0300 100 0212.

Find out more about the helpline on the National Breastfeeding Helpline website.

Vitamins and breastfeeding

Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10mcg of vitamin D.

From late March to the end of September, the majority of people aged 5 years and above will probably get enough vitamin D from sunlight when they are outdoors. So you might choose not to take a vitamin D supplement during these months

You can get all the other vitamins and minerals you need by eating a varied and balanced diet.

Ask your GP or health visitor where to get vitamin D supplements. You may be able to get free vitamin supplements without a prescription if you're eligible for the Healthy Start scheme.

Find out more about getting vitamins on the Healthy Start website.

You're entitled to free NHS prescriptions for 12 months after your baby is born. You will need to show a valid maternity exemption certificate to prove your entitlement.

If you did not apply for a maternity exemption certificate while you were pregnant, you can still apply at any time in the 12 months after your baby is born.

Healthy snack ideas for breastfeeding mums

The following snacks are quick and simple to make, and will give you energy and strength:

fresh fruit

sandwiches filled with salad, grated cheese, mashed salmon or cold meat

yoghurts and fromage frais

hummus with bread or vegetable sticks

ready-to-eat dried apricots, figs or prunes

vegetable and bean soups

fortified unsweetened breakfast cereals, muesli and other wholegrain cereals with milk

milky drinks or a 150ml glass of 100% unsweetened fruit juice

baked beans on toast or a baked potato

Healthy Start vouchers

You can get Healthy Start vouchers if you're pregnant or have a young child under 4 and are getting certain benefits or tax credits, or you're pregnant and under 18.

These can be spent on milk and fresh or frozen fruit and vegetables, or they can be put towards formula milk if you're not breastfeeding.

You can't use vouchers to buy fruit and veg with added fat, sugar and salt or flavourings, such as oven chips and seasoned stir fries. You can also get Healthy Start vouchers for free vitamin supplements.

For more information or an application leaflet, visit the Healthy Start website, or call the helpline on 0300 330 7010.

If you're already receiving Healthy Start vouchers, ask your midwife or health visitor where you can exchange the vouchers for vitamins.

Eating fish while breastfeeding

Eating fish is good for your and your baby's health, but while you are breastfeeding you should have no more than 2 portions of fish a week. A portion is around 140g.

Make 1 of them oily fish such as fresh mackerel, sardines, trout or salmon.

All adults should also eat no more than 1 portion a week of shark, swordfish or marlin.

Caffeine and breastfeeding

Caffeine can reach your baby through your breast milk. Caffeine is a stimulant, so if you have a lot, it may make your baby restless and keep them awake.

Caffeine occurs naturally in lots of foods and drinks, including coffee, tea and chocolate. It's also added to some soft drinks and energy drinks, as well as some cold and flu remedies.

There's not enough information to say how much caffeine is too much, and babies respond to caffeine differently. But it's a good idea to reduce how much caffeine you drink, especially when your baby is less than 6 months old.

If you're breastfeeding, it's recommended that you have no more than 200mg a day. This may include 1 mug, 1 can or 1 bar of:

instant coffee (100mg)

filter coffee (140mg)

tea (including green tea, which can have the same amount of caffeine as regular tea) (75mg)

cola (40mg)

energy drink (a 250ml can is 80mg)

plain dark chocolate (a 50g bar is less than 25mg)

plain milk chocolate (a 50g bar is less than 10mg)

You could also try herbal teas, 100% fruit juice (but no more than one 150ml glass per day) or mineral water.

Peanuts and breastfeeding

If you'd like to eat peanuts or foods containing peanuts, such as peanut butter, while breastfeeding, you can do so as part of a healthy, balanced diet (unless, of course, you are allergic to them).

There's no clear evidence that eating peanuts while breastfeeding affects your baby's chances of developing a peanut allergy. If you have any questions or concerns, you can talk to your GP, midwife or health visitor.

See more about food allergies.

Got a breastfeeding question?

You can message the Start4Life Breastfeeding Friend chatbot on Facebook Messenger for fast, friendly, trusted NHS advice anytime, day or night.

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Advice on eating a healthy diet while you are breastfeeding, including advice on what vitamins you need.

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Unicef recommend all mothers shown this useful skill - exressing colustrum antenatally to tempt sleepy baby, to help clear a duct or ease full breasts. Great easy video

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Unicef UK Baby Friendly Initiative | Hand expression

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Engorged breasts - avoiding and treating

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Engorged breasts - avoiding and treating

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Put these ideas into action as soon as you can.

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Engorged Breasts - avoiding and treating - La Leche League GB

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Engorged breasts are painful. They feel heavy, hard, warm and sensitive -as if they are ready to burst! As well as being painful, engorgement can lead to other breastfeeding problems if not treated. Being able to recognise engorgement will help you to treat it promptly, avoiding complications.

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For that weird "I have two melons stuck to my chest" moment 3-5 days after birth....this technique helps soften breast

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Reliable websites and sources about feeding your baby

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Think about how you want health professionals to support you

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This is the website of Sarah Johnson and Lou Toosey's perinatal services business. We offer feeding support, baby massage, doula services and the Back to Work Baby Experience - a program of interactive information sessions for employees on parental leave.

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Feeding intervals - the great Emma Pickett explains the “dangerous game”

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Feeding intervals - the great Emma Pickett explains the “dangerous game”

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Emma is one of the best-known IBCLCs in the UK and I recommend her book, “You’ve Got It In You” to anyone hoping to breastfeed. This is a famous article of hers which has been reprinted by UNICEF

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day.

It seems to matter beyond all logic and reason. They see this magic number - 90 minutes, 2 hours, 3 hours - as a measure of something sacred.

And it's crap.

There are mums sitting at home, relaxing and nesting with their gorgeous new baby. There's a disk from a box set in the DVD player, a cup of tea on the go, a recent chat with a friend. Breastfeeding is going well. Weight gain is fine. Baby is content. But when baby shows hunger cues after only 40 minutes instead of the hoped for 1hr 30 minutes, their heart sinks and they feel a sense something is fundamentally wrong. They aren't 'doing it right'. Their friend's baby 'goes longer'. Doubts creep in.

As adults, we grab a cup of tea, a glass of water, a sweet, a snack. We respond to our personal cues and we're flexible depending on time of day, the temperature, our mood, our energy levels. Many go to bed with a glass of water or sip from a bottle throughout the day. I don't know any adults that look at their watch and say, 'Only 30 minutes till my next sip of water or mint! Not long now'. But yet we expect teeny growing babies to be governed by this artificial notion of time.

I spoke to a new mother last week who was perfectly HAPPY with her feeding routine but wondered if she should start to stretch her baby's intervals because 'that's what you do'. When I explained that it wasn't necessarily, she said she was more than happy to go on as she was.

Where do these ideas come from? They don't come from anyone with any breastfeeding education, nor antenatal classes with breastfeeding professionals, nor books written by those trained to support breastfeeding.

They come from popular baby care books and relatives and peers.

They seem to come from a fundamental misunderstanding of the science of breastfeeding and breastmilk production. Often they come from mid-20th century ideas based around the norms of formula-feeding and pseudo-science. And that's all incredibly dangerous.

There are still people out there, surrounded by breastfeeding, who believe that a baby who feeds after 4 hours rather than 3 hours will 'take more milk'. There are people who believe that you need to wait and hold a baby off to let your breasts 'refill'. There are people who believe that when a baby does want to return to the breast after only an hour that must reflect a 'problem' and perhaps the mother even has a supply issue.

It's scary and extremely frustrating that basic messages about how milk production works don't reach the people who need them.

So what is normal? Well, how long have you got? Because there's a lot of normal. A newborn should feed a minimum of 8-12 times in 24 hours. That means some might be going every 3 hours and others will be feeding more frequently than 2 hourly. Some babies may feed every 10 minutes every hour. Some may feed for 10 minutes every 2 hours. Some may feed for 40 minutes every 2 hours. For periods in the day, a younger baby will often cluster feed and not be happy away from the breast for any longer than a few minutes at a time. This natural cluster feeding may dominate an evening.

A very common call to the National Helpline goes like this: "My baby used to sleep in the evenings and now he's awake for 3-4 hours. The only thing that seems to settle him is the breast. I feel like I must not have enough milk as he's on there for ages. Surely there can't be anything there." As the baby swaps from breast to breast, getting small quantities of very high fat content milk and decompressing at the end of a long day, they know exactly what they are doing.

And soon their patterns will change again. Some babies will start to longer intervals in the day as the months go by. But NOT all will.

One of the most popular baby care books (which I better not name) gives a strong direction that while frequent feeding might be occasionally acceptable during growth spurts, this holy cow of the interval between feeds matters greatly. A 3 month old baby might be going 3 hourly intervals but if this isn't increasing at 4 months, then oh dear. This same writer believes a woman can measure her milk supply by doing a yield test and using a pump to extract milk which apparently will be the equivalent amount to what her baby extracts during a feed using an entirely different process. What this woman doesn't know about breastfeeding could fill an encyclopaedia.

What I find particularly dangerous about her message that longer intervals are 'better' and 'correct', is that is means new mothers doubt their milk supply with absolutely no justification. And I know from having spent time on the message boards associated with this writer, many mothers will end up supplementing with formula to try and reach these magic numbers of minutes.

Why?

Babies are no longer being exclusively breastfed and parents are not following Department of Health recommendations because of incorrect information in a baby care book.

There are parents who choose to use formula for a whole host of complex reasons. Some do so happily and some do so miserably. But to do so, merely because you have read a lie in a book, seems tragic to me.

Our knowledge about breasts has been transformed over the last 20 years. Much of the pioneering work has been done in Australia by scientists like Professor Peter Hartmann and Dr. Donna Geddes, Steven Daly and their teams.

We used to think most women had a pretty similar number of milk ducts but the ultrasound research revealed there were less than previously thought and the range was big. One woman had 4 ducts at the nipple. One had 18.

But it's the findings about breast storage capacity that we need to talk about here. When a baby feeds, some milk is manufactured during the feed itself and some is taken from milk that has been stored in the breasts between feeds.

Ultrasound revealed that a mother's storage capacity cannot be guessed from breast size. Breast size is obviously not just about glandular tissue. The range in breast storage capacity was huge.

One mother was able to store about 2.6oz per breast. Another woman stored more than 20oz. That's not a typo.

Women with a smaller breast storage capacity had a healthy milk production over a 24 hr period and their babies had good weight gain. But their babies might need to feed more frequently to access this healthy milk production.

Is this a mother with a supply problem?

No, it is not.

Her baby may continue to feed 2 hourly or even more frequently for a few months during the day, cluster feed at certain points and perhaps continue to wake a couple of times hungry at night. Her friend's baby may settle into a pattern of feeding less frequently over a 24 hour period. This friend's baby may not be receiving more milk overall.

When breasts are fuller, milk production slows. When breasts are emptier, we make more milk. When babies feed more frequently and from emptier breasts, they receive milk with a higher fat content. Frequent feeding has value. And as human milk has a fat content of around 3-5% compared to some mammals who have a fat content of 40% +, it seems pretty clear we're designed as a species to need feeding more frequently.

But let's imagine the mother with the smaller breast storage capacity has read this baby care book. She might become distressed that her baby still wants to feed 2 hourly. She might even try and stretch the interval between feeds in the mistaken belief this will increase her baby's intake. And in doing so, her breasts spend longer at full storage capacity and their milk production slows and her breasts receive the signal to decrease milk supply.

So in her attempt to stretch between feeds as the advice she is reading suggests she does, she may actually be decreasing her overall milk production in 24 hours and be doing some actual harm.

So what should we suggest to this mum who never seems to be able to stretch her baby to longer intervals in the ways that her friends seem able?

First off, we should congratulate her for responding to her baby's cues. Thankfully she knew not to try and impose some routine early on and therefore her milk supply is at its maximum capacity. Let's check breastfeeding is otherwise going well: that feeds are comfortable for her, baby does settle for periods of contentment after a feed (though it may only be an hour or even less, rather than 3), weight gain and nappies are fine and latching and positioning is at maximum efficiency. If all this is true, and never reaching a magic 'interval' is her only concern, then we need to make sure she knows as much as possible about how milk production works. It is possible she is one of the mothers who has a minimal breast storage capacity and she will need to feed more in 24 hours to maximise the volume of milk her baby receives. And there might be nothing she can do about that. What happens next is about acceptance and support and attitude.

She has to keep that up for ideally around 6 months if her baby is going to get the full benefits of exclusive breastfeeding. She might need greater support with feeding outside the home - perhaps learning how to feed in a sling or experiment with different positions for different environments. It's possible she may be woken at night more than her friend with the longer intervals - though we would expect night time intervals to be longer and for her to get a block of longer rest. She may benefit from support on safe bed-sharing practices.

And it is just a matter of months. After solids have been established, patterns will change. It's surprising what we can cope with for just a few months. We have jars of pickle in our fridge significantly older than that. We may even have toothbrushes that are around that long. In terms of an adult lifetime, it's a blink of an eye.

What won't help these mothers is the relentless message that they just need to stretch their baby a little more. That if they leave him to cry for 15 minutes, magically he will take more milk and life will change. That just isn't what science tells us is true for all women.

Of course breastfeeding isn't just about milk anyway. Apparently there are people who think that a baby comes to a breast primarily to get milk but I've not met a parent of a baby who thinks that's true. Just as we don't measure our sips of water, sweets and snacks, we also don't measure every time our family smiles warmly at us, communicates with us, looks for comfort, hugs us, checks in, helps us to feel safe. No smart phone app can measure all the complexities of our relationship with our baby and all the things that responsive feeding can do. You are trying to count and measure love. That's not going to achieve much other than a flat phone battery. And you could miss out on some magic that you can't go back and live again.

And I'm talking about myself here, by the way. My children under 6 months never went longer than 2 hours between feeds in the day and not much longer at night. My red record books records me feeding at 3 months every 90 minutes or so. So I learnt to feed while babywearing. I went to friendly groups and friendly places and met up with people at home. I read about safe co-sleeping practices which I know beyond a shadow of a doubt saved my bacon. And thankfully, I never felt anything was 'wrong'. I just trusted my body. I trusted my baby and we worked as a beautiful team. I sat at home on the sofa and fed relatively frequently, enjoyed my box sets and my healthy and not-so-healthy snacks and that was OK. It really wasn't for long. But the benefits of exclusive breastfeeding will be.

Why should a watch or clock tell me how to be a mother? I'd rather pay attention to my baby.

Sources:

Anatomy of the lactating human breast redefined with ultrasound imaging. DT Ramsay, JC Kent, RA Hartmann, and PE Hartman. 2005.

The magic number and long-term milk production. Nancy Mohrbacher IBCLC

Studies on Human Lactation: Development of the computerized breast measurement system. D.B Cox, R.A Owens, Peter E. Hartmann

Originally written 2011. Updated July 2016.

The article is featured also in UNICEF: https://www.unicef.org.uk/babyfriendly/breastfeeding-the-dangerous-obsession-with-the-infant-feeding-interval/

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The Dangerous Game of the Feeding Interval Obsession - Emma Pickett IBCLC

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day. It seems to matter beyond all logic and reason.

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This academic article explains why sterilising baby items is important, and has a handy table summarising pros and cons of different methods.

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Pamela Mason1*, Gill Jenkins2, Mark Burdon3

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Sterilisation of Infant Feeding Bottles: Focus on the Cold-Water Method Using Chlorine Containing Compounds

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Sterilisation of infant feeding equipment is fundamental to reduction in microbial contamination and protecting infants from the risk of infection. Th

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Which position do you and your baby like?

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Which position do you and your baby like?

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The way you hold your baby or position them will affect how easy it is for them to breastfeed effectively. You can breastfeed your baby in many different positions, so it's good to try different ones. This helps you find what's most comfortable for you and allows your baby to get just the right mouthful of breast to feed effectively and easily.

Breastfeeding positions for newborns

When you first start breastfeeding, you and your baby may take a while to master this new skill. Patience and trying different positions will help you find a position that works for you both.
Our video has some great tips on different ways to hold your baby.
If you're having problems breastfeeding, or with latching or attachment, do call our infant feeding support line on 0300 330 0700 to talk to a breastfeeding counsellor. Your midwife or health visitor may know about local breastfeeding support groups.

Getting some support with breastfeeding can help you to get comfortable in one or more of the breastfeeding positions that we describe in this article.

Here's how to get started...

Preparing to feed

Your baby will be happier and will latch more easily if you can identify and respond to their early feeding cues. If they are crying or upset, they need to be calmed before they are ready to feed.

Holding them against you, talking to them, walking around or gently rocking might help if they need to be calmed. Most babies like to have their hands free to touch and stroke your breast; this helps to reassure them that they are in the right place.

Read more about getting started with breastfeeding in our article here.

Laid-back position

Sitting upright

Lying down

Underarm or rugby ball

Holding your baby under your arm may be suggested to women who have given birth by caesarean, to avoid pressure on the wound. This position might also be suggested to mothers of twins. However, it can be difficult to maintain this position as the baby's weight is being taken by the mother's hand. Babies soon outgrow this position, and it doesn't allow them to use their instincts and reflexes to attach on to the breast (NHS, 2020; La Leche League, 2022).

Breastfeeding positions for a fast milk flow

If you have a fast milk flow, this could be due to a large supply of breast milk. A fast milk flow can make your baby cough, splutter and come off the breast, which is sometimes similar to reflux symptoms. If they're having problems, it could be that the baby needs more control when they're feeding. If this is the case, laid-back feeding, where the baby is more in control, could be useful as it helps your baby to attach better and pull back if they need to take a break.

Breastfeeding your baby as they grow

As your baby grows, they become more active in getting themselves into position, and they're longer and heavier. So you might need to adjust you and your baby's position to continue to feed comfortably and effectively.

A laid-back breastfeeding position could be useful with larger or older babies as you do not have to use your arms to hold their weight. You can always ask a breastfeeding counsellor for support with finding positions that suit you and your baby.

Breastfeeding position tips

Whichever breastfeeding position you choose, remember...

Get comfortable before you start.

Tuck your baby in closely to you.

Bring your baby to your breast or let them attach themselves rather than leaning towards them.

Avoid putting the breast in your baby's mouth; let them take it in themselves.

Check that their ear, shoulder and hip are all in a line - not twisted round.

If you are bringing your baby to your breast, make sure they are turned towards your breast, with your nipple level with baby's nose - they shouldn't have to turn their head.

Cushions, special breastfeeding pillows and other supports can prevent your baby's body from getting close enough to your body or may raise your baby's body too high for effective attachment. It's best to get your baby attached to the breast, then if support is needed tuck a pillow in under your arm at the point where you are feeling strain from the weight of the baby.

(UNICEF and NHS, 2022)

Many women and babies take a while to get used to breastfeeding and it can take a while to find the position(s) that work best for you. Experimenting with different positions can help you find the ones that work best for you and your baby.
Page last reviewed December 2022.
Further information

NCT supports all parents, however they feed their baby. If you have questions, concerns or need support, you can speak to a breastfeeding counsellor by calling our helpline on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions. You can also find more useful articles here.

National Breastfeeding Line (government funded): 0300 100 021.

For further information on how to breastfeed, including positioning and breastfeeding attachment, and a section on expressing your breastmilk by hand, visit Unicef's Baby Friendly Initiative support area for parents.

Bump to Breastfeeding DVD: available from your midwife or library - see more at www.bestbeginnings.org.uk

Coulson S. (2012) Biological nurturing: the laid-back breastfeeding revolution Midwifery today. 101. Available at: https://midwiferytoday.com/mt-articles/biological-nurturing/ [Accessed 7th November 2022]

La Leche League. (2022) Positioning. Available at: https://www.llli.org/breastfeeding-info/positioning [Accessed 7th November 2022]

Milinco M, Travan L, Cattaneo A, Knowles A, Sola MV, Causin E, et al. (2020) Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial. Int Breastfeed J. 15(1):21. Available at: https://doi.org/10.1186/s13006-020-00261-4

NHS. (2020) How to breastfeed. Available at: https://www.nhs.uk/start4life/baby/feeding-your-baby/breastfeeding/how-... [Accessed 7th November 2022]

UNICEF; NHS. (2022) Off to the best start. Available at: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfe... [Accessed 25th November 2022]

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Breastfeeding positions: which are best for you? | NCT

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Here we provide tips on breastfeeding positions, including laid-back, lying down, sitting upright and underarm positions.

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"I think I just don't have enough milk" - the problem of perceived low milk supply

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"I think I just don't have enough milk" - the problem of perceived low milk supply

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This is Emma Pickett's brilliant blog post summarising all the behaviours and factors which people imagine must mean the woman "does not have enough milk" - words which the formula milk manufacturers love to hear!

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Low Milk Supply 101 — Emma Pickett IBCLC

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Forgive me for asking but... Do you REALLY have low milk supply? This is a very important place to start. Please bear with me. I don’t mean to doubt your situation and be annoying patronising lactation consultant woman but it’s crucial to note that the MAJORITY of new mothers who fear they have lo

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Top IBCLC based in Haringey, NW London. Does support but only in her area. However her blog is sheer genius. Annoyingly much younger than me

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Breastfeeding may be natural but that doesn't mean it's easy for everyone.

I know how frustrating it can be to be told five different things by five different people.
Finding the right support from someone able to devote time to your situation seems much harder than it should be.

My packages include face-to-face sessions and on-going email and phone support.

I charge £60 for a 90 minute session at my consultation space in London N6, although this can be flexible depending on your circumstances.

I can also offer a SKYPE consultation for £40 (of up to an hour). However SKYPE may not be an ideal choice if you are primarily struggling with latching and positioning issues or you suspect your baby might have tongue tie.

Please contact me to find out more about how I can help you to reach your breastfeeding goals. If you use the term chestfeeding, please know that I am also here to support you.

My book is available now from Amazon.co.uk and from other retailers.
http://www.amazon.co.uk/dp/B019JE5E44
"You may be worried about breastfeeding and worried that it might 'not work'. This is a common feeling when you live in a society where breastfeeding is often sabotaged by incorrect information, patchy support from a stretched health service and powerful messages from formula companies. But it's not a feeling that is entirely logical. We are mammals. We get our name from the dangly milk-producing bits. It defines us.

This book aims to make you as well-prepared as possible. I would like you to breastfeed for as long as you want to and as happily as possible. I want you to feel supported.

Some of this new life with baby will be about flexibility, responsiveness and acceptance. If you are used to a world of schedules and decisions and goals, it may be a bit of a shock. Learn about human biology before you think it sounds a bit too scary! Babies are the products of millions of years of evolution, and we are too; if we can just tap into our instincts and trust them a little bit.

Success comes when we tap into those instincts and when we know when to get help when our instincts aren't answering all of our questions.

Can everyone who wants to breastfeed make it work? No. Not everyone may be able to exclusively breastfeed due to medical issues. Most of these people can give their baby breastmilk, though, which the book also covers. (And let's not start this journey by imagining you'll be someone who won't make it...!)"

After spending 9 years as a primary school teacher and Deputy Head in inner London, I then became a mother and realised how desperately breastfeeding support was needed by so many. I qualified as a Breastfeeding Counsellor with the Association of Breastfeeding Mothers in 2007. I started volunteering on the Department of Health's National Breastfeeding Helpline when it first opened, alongside offering support for families at home and at drop-in groups.I became an

International Board Certified Lactation Consultant in 2011. I recertified in 2016 and I continue to offer voluntary support at groups across West Haringey and volunteer on the National Breastfeeding Helpline and ABM national helpline alongside my private lactation consultant work. Lactation consultants have a professional requirement to constantly update their knowledge and skills and we re-certify every five years.

My work in Haringey requires me to have a full and current DBS check (previously known as a CRB check).

On this site, you can also find videos to offer some information and suggestions and articles on a range of breastfeeding issues including fears about low supply, positioning and attachment, making too much milk, breast refusal and intervals between feeds.​

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Breastfeeding may be natural but that doesn't mean it's easy for everyone. I know how frustrating it can be to be told five different things by five different people. Finding the right support from someone able to devote time to your situation seems much harder than it should be.

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Kathryn Stagg also talks about why this might be done.

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Antenatal hand expressing colostrum - short guide

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Ideas for increasing milk supply

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Does your baby need more milk?
How to know your baby is getting enough breastmilk
Increasing your milk production
If supplements are needed
Feeding methods
Expressing your milk

Does your baby need more milk?

Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk production. Perhaps you and your baby had a difficult start, or were not given the support you needed to establish breastfeeding. Or maybe things were going well until your baby's weight gain faltered.

If others question your milk production and your baby is fussy, wants to feed much of the time, seems small, or gains weight slowly, you may be wondering whether you have enough milk.

Follow your baby not the book

Young babies need to nurse frequently to get enough milk and establish their mother's milk production. Following feeding schedules, using regular supplements, nipple shields, or a dummy can really reduce your milk production.

Breastmilk is also a drink and frequent nursing is normal. Adults rarely go longer than two hours without a drink, snack or meal. Your baby's tummy is tiny and breastmilk is quickly digested, so they need frequent feeds to help them grow. It is recommended that your baby is weighed no more than once a month for the first six months, unless there are concerns.

Sleepy Baby
A baby who sleeps a lot rather than waking to feed every 2-3 hours may need to be woken up to nurse, particularly if they have jaundice or aren't gaining enough weight. If this is difficult or your baby is lethargic, ask your midwife, health visitor or GP to check that all is well.

See our article Sleepy Baby - why and what to do for more information.

How to know your baby is getting enough breastmilk

Weight gain
It is normal for newborns to lose up to 7% of their birth weight in the first few days. Once your milk production increases, usually on day 3-4, expect your baby to begin gaining weight. Most babies regain their birth weight by the age of 10-14 days. You may also find it helpful to see Is my baby getting enough milk?

Plot your baby's weight gain on a UK-WHO growth chart based on the growth rates of breastfed babies (see examples below and Further Reading). Although they will be growing at their own individual rate, it will give you an indication of how they are doing.

Monitor your baby's weight over a period of time rather than week by week. Your baby's weight may generally follow the chart, or climb up, crossing the percentile lines. A gradual drop from one percentile line to the next (or the equivalent distance) is unlikely to be a problem unless their weight is low for their age. Heavier newborns often show 'catch-down' growth - they gain weight steadily but drop gradually against the chart lines.

Dropping against the chart is more of a worry for lower weight babies
If your baby's growth curve drops across two lines of the chart (or the equivalent distance), or if their weight is below the lowest line of the chart:

Follow the suggestions here to ensure they get more milk.

Seek help from your GP to rule out an underlying medical reason for your baby's slow weight gain.

If you have doubts about your baby's growth, you may find it reassuring to talk to an LLL Leader.

Wet and dirty nappies
If your baby receives enough milk, the thick and sticky black meconium poos will be passed within three days of birth, followed by at least 6-8 wet and 3-5 dirty nappies in each 24 hours. Expect yellow, loose, unformed poos at least the size of a 2p coin. From about six weeks, some babies have abundant poos once every few days. This isn't a problem when a baby has plenty of wet nappies.

Look at your baby
You may instinctively know how your baby is doing. Are they nursing vigorously? Is their skin firm? Do they look healthy and seem active and alert? Are they meeting developmental milestones?

Remember
Even if your breasts feel empty, there's always some milk there. Full breasts and engorgement slow milk production - you may need to nurse more often. Removing even small amounts of milk from soft breasts increases milk production.

Babies nurse for comfort as well as for food. Those little 'snack' comfort feeds can really increase your milk production and their calorie intake.

Expect your baby to want to breastfeed very often from time to time. Your breasts will quickly adjust to making more milk if you follow your baby's cues.

Every baby has a unique feeding pattern. If your baby is gaining weight adequately, following their own feeding pattern is the best way of ensuring you are meeting their needs. It's rare that a mother cannot produce enough milk for her baby, and there are lots of ways to increase the amount of breastmilk your baby gets.

Increasing your milk production

After the first few weeks, supply and demand drives milk production. To increase your milk supply, focus on feeding more often and getting more milk out at each feed. For more information about how breasts make milk, see our article How milk production works and also How to increase your milk supply.
Breastfeeding basics

Breastfeed as often as possible - at least 10 times in 24 hours. Wake your baby if necessary.

Switch sides when your baby's suck-swallow pattern starts to slow. Continue to switch sides (four times or more) until they reject the breast.

Use breast compression (see below).

Instead of breastfeeding at set intervals, encourage 'cluster feeding' - breastfeeding very often at times when your baby is willing to.

Encourage breastfeeding for comfort as well as for food. It can really help your milk production. Stop using dummies - breastfeed instead.

Ensure you are meeting your baby's needs for milk during the night, feeding at least once every four hours.

Cut back a little on your baby's solid foods if your milk production is dropping (see below).

An effective latch
A baby may spend a long time at the breast but not get very much milk if they are not latched on effectively. Check your baby is well attached - watch and listen for swallowing which is frequent at the start and then slows down.

Contact an LLL Leader for one-to-one support and see Further Reading for more information. It's important to seek skilled help early on if you are finding breastfeeding difficult, uncomfortable or painful.

Take a 'baby moon'
Get some help with the housework and eat simple, easily-prepared meals for a week or two so you can concentrate on breastfeeding your baby. A couple of days' bed rest together, feeding your baby on demand can really boost your milk production. Or at least take some time each day to rest with them and concentrate on breastfeeding.

Try laid-back breastfeeding
Many babies instinctively seek the breast and feed frequently if they can snuggle up close to their mother's chest.

Try letting your baby lie on your body, skin to skin (with a blanket if needed) as you recline, so both their chest and tummy are against you. This close body contact gives your baby lots of opportunity to breastfeed, even in a light sleep, and boosts levels of the hormones that increase your milk. A soft carrier or sling helps to keep your baby close and encourages breastfeeding. (see Positioning and Attachment for more on laid back breastfeeding)

Breast compression
This technique puts pressure on the milk ducts and can help to make feeding more efficient:

1. Support your breast with one hand - thumb on one side, fingers on the other.

2. Wait while your baby breastfeeds actively, their jaw moving all the way to their ear. When their swallowing slows, compress your breast firmly to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around the breast and repeat step 2 on different areas of the breast.

Go gently - this should not hurt.

Other foods
Babies need only human milk for the first six months (human milk is higher in calories than many weaning foods). Too much solid food replacing human milk can affect weight gain in older babies. Breastfeed before offering solid foods if your baby is under 12 months old. Even at 12 months, both human milk and solids are equally important. Breastfeed frequently and, rather than spoon-feeding, offer your baby a variety of foods, letting them feed themselves to ensure they take only what they need.

Continued low milk production
If you've tried all these suggestions and your milk production has not increased enough, there may be a medical reason. Some medical conditions can lead to low milk production, though appropriate treatment can reduce the impact. These situations are rare, but you can discuss possibilities with an LLL Leader. For more information see our article How to increase your milk supply and Further Reading.

Signs your milk is increasing
Watch for weight gain and an increase in your baby's wet and dirty nappies. Your breasts may feel fuller before feeds and begin to leak.

Looking after yourself
Don't forget to be kind to yourself, especially if you're feeling under pressure. Now is the time to call in favours from friends and relatives so you can concentrate on your baby. If your baby needs more milk, talking to your local LLL Leader will help. You can share your concerns with other mothers at an LLL meeting, who will be able to give you encouragement and support.

If supplements are needed

It can be a challenge fitting in breastfeeding, supplementing and expressing. You could try the following approach, aiming for at least 8 feeds in 24 hours. At each feed:

1. Start with breastfeeding, observing your baby's swallowing pattern. Use breast compressions to maximise the flow. When swallowing slows, switch sides and repeat. If your baby has enough energy, you can repeat this process (known as 'switch nursing'). This part of the feed might take 10-30 minutes, but use swallowing as your guide. A baby who is not swallowing isn't taking in any milk so move to step 2.

2. Give your supplement with a spoon, syringe, nursing supplementer, finger feeding tube, or bottle. Give stored breastmilk first, then supplement with other milk. Follow your baby's lead until they are satisfied. A baby who is underweight may become extra hungry for a while. By giving them extra milk, you will help them gain weight and get the energy they need to breastfeed better. To save time, this step could be done by your support person while you express. For more on ways to give your baby more milk, see our article on Bottles and other tools.

3. Express both breasts using a combination of pumping and hand expression, switching back and forth as milk flow slows. Store this milk in the fridge ready for the next feed. By removing the milk your baby couldn't, you build your future milk production and have milk to supplement the next feed. This is an important step, especially if you are working to eliminate formula supplements.

4. Finish at the breast. The whole feed may take 60-90 minutes. If it works for you, you might offer the breast at the end of the feed so your baby associates the breast with being calm, happy and satisfied. Suckling can help them settle to sleep, too.

Keep a record of the amounts of each supplement your baby takes at each feed and also what you express. This can help you see your progress and maybe useful for anyone supporting you with breastfeeding.

Feeding methods

Cup, spoon and syringe feeding can work when small amounts are needed.

A nursing supplementer can be used to give larger amounts while your baby is at the breast. Another option is finger feeding, using an infant feeding tube. One end of the tube is taped to your finger. As your baby sucks on your finger, milk flows along the tube from a container which can be raised or lowered to change flow. An LLL Leader can help you find out more and choose an option that works best for you.

If using a bottle, paced bottle feeding can help ensure your baby doesn't take more milk than they need.

A smaller teat hole prevents a baby taking milk too quickly.

Hold them in an upright position, using your hand to support their neck and head.

To encourage your baby to open wide, place the teat across their lips with the tip between the upper lip and nose.

Allow your baby some control. Let them take the bottle teat into their mouth themself. Avoid pushing the teat into their mouth.

Tilt the bottle just enough to fill the tip of the teat and give a gentle flow so your baby isn't overwhelmed with milk. As the bottle empties, gradually tilt the bottle more and lean your baby back.

Encourage frequent pauses to mimic breastfeeding, and allow your baby to decide when they have had enough.

For more information see Bottles and other tools.

Expressing your milk

A baby nursing well at the breast is more effective than any pump. But while your baby isn't breastfeeding well or you're giving supplements, expressing your milk will stimulate milk production. Give any expressed milk before you give infant formula, so none of your precious breastmilk is wasted.

Nurse your baby frequently so they get the extra milk you make. An increase in the amount you can express is a sign that you can reduce supplements if your baby is nursing well and often.

Hospital-grade pumps are the most effective for mothers needing to increase their milk, but any pump that works well for you is fine.

Try hands-on pumping: use breast massage and breast compressions while pumping, then hand express afterwards to get the last few drops of milk. For more on hand expressing see our article: Hand expression

Pumping on both sides at the same time boosts milk-producing hormones. When pumping one side at a time, switch back and forth several times as milk flow slows.

Consider power pumping: experiment with pumping very frequently for short periods to mimic cluster feeding.

Wash your pump with hot soapy water, or sterilise it once a day. Pump equipment can be left at room temperature for short periods, or stored in the fridge for longer periods. For more information, see our article Expressing Your Milk.
Good times to express milk

After feeds while your baby sleeps - 'putting in an order' for more milk later. Milk expressed after a feed may be small in quantity, but is high in calories.

Between feeds if your baby is too sleepy to nurse frequently.

While holding your baby, or with them nearby. Expressing little and often can be better than long sessions. Try some 'power pumping' during the evening, or fit in some extra pumping sessions one day. You should notice an increase in milk production a couple of days later.

Using donor milk and formula to support breastfeeding
The use of donor milk or infant formula is sometimes essential to meet a baby's nutritional needs. You may need to use donor milk or formula as a short-term measure while you work to increase your milk production. See our article Using donor milk & formula to support breastfeeding for more information.

Supplementing with donor milk or formula without protecting your milk supply may reduce the duration of your breastfeeding journey.

Powdered infant formula is not a sterile product. To reduce health risks associated with using infant formula, carefully follow the NHS guidelines for preparing it. La Leche League does not recommend the use of homemade formula. The NHS guide to bottle feeding is available online (see Further Reading).

Written by Karen Butler and mothers of LLLGB

Further Reading

How to increase your milk supply
How milk production works
Using donor milk and formula to support breastfeeding
Dummies and Breastfeeding
Hand expressing of breastmilk
Comfortable Breastfeeding
Is my baby getting enough milk?
Nursing Supplementers
Positioning & Attachment
Rhythms and Routines
Safe sleep and the Breastfed Baby
Sleep baby - why and what to do
Storing your milk
After a difficult start

Books
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Making more milk, second edition, Marasco, L. and West, D. New York: McGraw-Hill Education, 2019.
Other websites
Natural (laid-back) breastfeeding naturalbreastfeeding.com
Biological nurturing™ www.biologicalnurturing.com
Maximising milk production when expressing https://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html
UK-WHO Growth Charts These charts are based on the growth rates of breastfed babies and can be found in your baby's Personal Child Health Record (red book). Further copies, the more detailed hospital 0-4 charts and specialised charts for low weight babies can all be downloaded from: www.rcpch.ac.uk/growthcharts
NHS guide to bottle feeding

This information is available to buy in printed form from our shop.

Copyright LLLGB 2022

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My baby needs more milk - La Leche League GB

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Does your baby need more milk? How to know your baby is getting enough breastmilk Increasing your milk production If supplements are needed Feeding methods Expressing your milk Does your baby need more milk? Although most mothers are able to produce enough milk for their babies' needs, you may have concerns about your own milk [...]

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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These factsheets have been compiled by our Drugs in Breastmilk information service team of pharmacists. If you are unable to find the information you are looking for below, or you still have questions, you can contact the team by sending a private message via our Facebook page or via email. Please provide as much information as possible (age […]

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A lovely series of photos showing this extremely helpful and natural position for breastfeeding.

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In praise of the baby-led breastfeeding positionBy Cordelia Uys, Breastfeeding Counsellor

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Milk bank at Queen Charlotte’s & Chelsea Hospital

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The milk bank at Queen Charlotte’s & Chelsea Hospital is the oldest continuously operating milk bank in the world and provides much-needed breast milk to preterm babies and babies who are unwell.

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If you have an abundant supply, have you thought about donating milk for a premature baby? Here’s how to donate milk

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Milk bank at Queen Charlotte’s & Chelsea Hospital

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The milk bank at Queen Charlotte’s & Chelsea Hospital is the oldest continuously operating milk bank in the world and provides much-needed breast milk to preterm babies and babies who are unwell.

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How to. laid back feeding position(biological nurturing)

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Some babies need breast tissue compressed to achieve a deeper latch and prevent nipple trauma. This is commonly known as the sandwich hold....

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Understanding oversupply and mother and baby gut health

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Oversupply, forceful let-down, foremilk/hindmilk imbalance ... all of these strike fear in the heart of new mothers because they translate to an inconsolable, visibly uncomfortable, crying baby. He may want to nurse all the time, because the sucking behavior soothes him when his tummy hurts, but the more he nurses, the more miserable he becomes. There may be blood in his diapers, maybe he chokes when he starts breastfeeding, or he spits up a lot after every feeding. You're desperate for a solution that won't threaten your milk production, because you really want to continue breastfeeding your baby - but your baby doesn't seem to "like breastfeeding" and you're feeling rejected and discouraged. What causes this constellation of circumstances? There is a lot of information out there about oversupply, overactive milk-ejection reflex (OAMER), and what has been called foremilk/hindmilk imbalance. I will do my best to help you understand WHY your breasts are so eager, WHY this is so irritating to your sweet baby, and offer you some resources for how to find the solution that works for you and your baby.

First, it is very important that you ensure your breastfeeding management is optimal and you are "watching baby, not the clock." Some mothers unintentionally create an overproduction of breastmilk when they, perhaps out of concern that they'll make enough milk, or maybe to make bottles so grandma and daddy can feed the baby, pump or express more milk than their babies are actually taking. Most mothers, if feeding on demand and not by a schedule, and not over-stimulating milk production, will make the milk their babies need. Hormonal imbalances are another reason for overproduction of milk; if you have a history of PCOS, you may be susceptible to oversupply. Postpartum thyroid issues can also have an effect on milk production. Be sure to rule out medical causes of hyperlactation first.

You may have been told that your baby is fussy, has a skin rash, is gassy, spits up, has diaper rash, a red ring around his anus, or green poop because of something you're eating, oversupply, or foremilk/hindmilk imbalance. You may also be hearing that "gassy foods make gassy babies" when you're breastfeeding, and you're confused and concerned that you will have to somehow satisfy your ravenous appetite on salad and air.

A note about how you make milk: your milk is synthesized from ingredients in your bloodstream, not in your digestive tract. Gassy baby after that stir-fry? It probably wasn't the broccoli ... yet, you've read something or someone has told you that eliminating certain foods from your diet may be the answer to your crying, uncomfortable baby. How can this be possible?

A healthy, mature digestive tract (or "gut") is "sealed;" nutrients are absorbed and wastes are contained until they are eliminated. This "sealing" takes place in a healthy, breastfed baby sometime around the middle of the first year (immunoglobulin from your milk helps to coat your baby's small intestine in the meantime), which is why it is advised that we hold off on introducing solid foods until then; also, the first foods we introduce are hopefully less likely to be allergenic and irritating to your baby's gut. This is where the claims that breastfeeding protects babies from allergies and eczema come from, IF our own (maternal) gut is healthy.

For many of us, though, our gut is not healthy and sealed, and is known as a "leaky gut." Perhaps we were formula fed as babies, or we've been on antibiotics; maybe we have a food allergy or intolerance we don't know about, or our diets are full of processed, irritating ingredients we've been led to believe are "foods" because we can buy them in the grocery store ... whatever the reason, our bodies mistakenly allow proteins from foods we eat to pass into the bloodstream, where they can then pass into your milk. So, if your gut is leaky or less healthy than ideal, irritating proteins are passing into your milk and being fed to your baby, creating many of the same symptoms commonly seen in babies fed cow's milk or soy preparations: eczema, gas, diaper rashes, and later, reactions or sensitivity to allergenic foods.

A Google search or a Facebook page may tell you your baby's problems are caused by foremilk/hindmilk imbalance. This was once a commonly accepted explanation and "block feeding" (offering the same breast at every feed for a prescribed number of hours, then offering the other breast for the same number of hours, regardless of how many times the baby wants to feed in that time) was the preferred method for dialing down milk production and encouraging the baby to consume the fatty, satisfying "hindmilk." Now, however, the idea that a mother makes two different kinds of milk is being challenged and the practice of block nursing doesn't seem so vital. Nancy Mohrbacher, IBCLC, FILCA published this blog post on the foremilk/hindmilk misconception and what current research tells us.

Today, we are also thankful that the Academy of Breastfeeding Medicine Clinical Protocol #24 is available to us: Allergic Proctocolitis in the Exclusively Breastfed Infant.

From this, we learn that an exclusively breastfed baby can experience allergic symptoms as a result of maternal intake. Cow's milk is the primary offender cited, and this is consistent with my clinical experience. All of the mothers I have worked with who had symptomatic babies reported some, if not complete, improvement after eliminating dairy products from their diet. Other mothers needed to eliminate soy, eggs, and/or gluten to bring their babies to complete relief. Some very detailed analyses of gut health, with some commentary on breastfeeding mothers and babies, can be found at this link.

Does this even relate to oversupply? If so, how? It's clear that the symptoms in babies are similar. Some professionals suspect a cause and effect relationship, that something about the mother's gut health causes both oversupply AND allergic sensitivity in the breastfed baby. There is no current, specific research linking maternal gut health to oversupply, but it has been my experience that most mothers with oversupply also have babies with allergic reactions to something in their milk. (Tongue tie in the baby is also very often present, but this goes beyond the scope of this post.) To me, this suggests that the mother's digestive issues (which she may or may not be aware of - she may feel perfectly healthy and well), can result in a host of abnormal outcomes, among them oversupply and forceful let-down. While not "evidence-based practice," rather, "practice-based evidence," I've noticed over the last 7 years that the mothers who eliminated one or more allergens from their diets were delighted not only with their happier babies and normalized milk production, but with how terrific they felt without the allergen! Caring for a newborn and feeling terrific! Years later, many of these mothers tell me they never went back to the offending ingredient, or introduced it in far reduced amounts once their babies got older and/or weaned.

Do you see yourself and your baby in this post, but feel discouraged because you just went through a pregnancy where you couldn't drink alcohol or caffeine, eat sushi, soft cheeses, or deli sandwiches, or enjoy a medium rare steak? It may feel unfair that now, you need to give up ice cream, cereal with milk, and your favorite candy bar (read the label, it has soy in it!). Don't worry! There are so many wonderful foods you can eat! I've written on my blog about delicious, wholesome, healthful, real foods that won't make your baby cry in pain.

Of course, you may choose to try other measures to resolve oversupply before changing your diet. If you've already ruled out possible medical reasons for hyperlactation, changing your breastfeeding position to one that makes the milk flow against gravity is one (side-lying and "laid-back" are two options) measure that is gaining popularity. "Block feeding" is still commonly recommended, but some IBCLC's report that the method is either incorrectly communicated or not well understood, and mothers can jeopardize their milk production capability if they are not closely monitored during the block feeding period. If your IBCLC suggests block nursing, be sure to ask her to be specific about how long each block should be, and for how long you should continue the regimen. Antihistamines, sage, and mint (for example, tea made from steeping fresh mint leaves) are also ways to reduce milk production. These methods, however successful they may be, represent a resolution of the symptoms, not of the cause, therefore, even if the oversupply is corrected, sensitivities may still persist in your baby.

Breastfeeding your baby can be a pleasurable, memorable experience, definitely worthy of any adjustments you may make to ensure your baby's health and comfort. The best news: there are resources for you, and you will find solutions that work for you and your baby.

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Oversupply, forceful let-down, foremilk/hindmilk imbalance ... all of these strike fear in the heart of new mothers because they translate to an inconsolable, visibly uncomfortable, crying baby. He may want to nurse all the time, because the sucking behavior soothes him when his tummy hurts, but the more he nurses, the more miserable he becomes.

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an oversupply of milk can be troublesome. It often leads to a mother who is uncomfortable and at an increased risk of blocked ducts and mastitis, and a fussy baby who is being overwhelmed with milk.

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Unicef UK Baby Friendly Initiative | Hand expression

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Breastmilk and formula storage guidelines

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Breastmilk and formula storage guidelines

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful. I did a quick google and really could not find anything useful to help a mum select an appropriate breast pump from the vast array on offer. This reaffirmed to me the difficulties mothers in this situation face. I see families daily who are using a breast pump that is not appropriate to meet their needs or who have spent hundreds of pounds on a pump that remains in its box unused.

Why do you need to express?

So, as a parent how do you choose a breast pump? There are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.

In the early days after birth you may find you need to pump frequently to provide milk for your baby who, for whatever reason, is not able to latch and feed directly at the breast. Or your baby may be struggling to drain the breast effectively. Frequent expressing will be needed to stimulate milk production and manage engorgement as the milk starts to come in. Later, you may need to express because of inefficient feeding and/or slow weight gain to provide top ups and/or boost a low supply. As baby gets older you may want the flexibility of being able to leave her baby in the care of someone else so you can have a break, go to bed early or attend appointments. You may be returning to work and need to leave milk for your baby.

There may also be situations where a mother wishes to re-establish a milk supply after a break from breastfeeding ( relactation). More parents are now inducing lactation in situations where they are adopting a baby, or in same sex couples where the non-birthing parent wishes to share in the breastfeeding, or where a parent is transgender. Both these situations usually necessitate frequent expressing.

Not all breast pumps are the same

Not all breast pumps are equal, and some are designed for frequent use, whereas others are more suited to occasional use.

When a baby cannot latch and suckle effectively at the breast immediately after birth due, for example to prematurity, illness in the baby or mother, other additional needs, an oral abnormality such as a cleft palate or tongue-tie or simply because of a difficult birth then it is vital that expressing starts early. This will ensure a good milk supply is established and provide colostrum for the baby. Early stimulation and drainage of the breast helps to further develop the glandular tissue (the milk factory) within the breast.

Furthermore, once the milk comes in at day 3-6 milk production begins to switch from endocrine control (driven by hormones) to autocrine control (driven by the frequent and effective removal of milk from the breast).

Hospital grade pumps

So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a hospital grade pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production (Jones et al, 2001) .

Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
https://www.ardomedical.co.uk/shop/products/rent-a-breastpump/ https://www.medela-rental.co.uk/ https://www.anawiz.com/collections/breast-pump-rental
Some Children's Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are 'personal use' double pumps, not hospital grade. They are also loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.

Personal use double electric pumps

Personal use electric pumps come in double and single options. All double personal use pumps can be used as a single pump. However, most single electric pumps cannot be converted to double. Double personal use pumps are good for maintaining supply, returning to work or for boosting supply if for any reason it has dipped. Many mums will switch to a personal use pump, after the first month or so, when they have established a good supply with a hospital grade pump, if they are in a situation where ongoing frequent expressing is needed.

Sometimes, mothers experience a drop in supply after the early weeks due to illness, the use of formula, certain medications, an undiagnosed latching or sucking issue (commonly a tongue-tie), or because they have implemented scheduled feeding to get baby into a routine. Double personal use pumps can be extremely helpful in boosting supply in these situations. Generally supply recovers more quickly and efficiently than with a single electric pump. Double personal use pumps are also helpful when returning to work as pumping sessions at work will take less time.

Single electric pumps

Single electric pumps can be used for the same purposes as the double personal use pumps, but pumping will be less effective and more time consuming. They are more suited to mothers who only need to pump once or twice a day to stock the freezer or provide milk so someone else can feed the baby. Some single electric pumps, such as the Medela Swing Flex, retail for the same price as personal use double pumps, such as the Ardo Calypso, so this is something to be aware of.

Electric pumps, whether single or double, can be helpful in effectively draining breasts affected by engorgement, blocked ducts, or mastitis when a baby is struggling to do this, or the nipples are too sore for breastfeeding.

Hands free wearable pumping

What about hands free wearable pumps like the Elvie? These are relatively new to the market. They can be useful for mothers who need to pump on the go or discreetly and my feeling is that working mothers with established milk supplies are the ones who may benefit most from this type of pump. I have had a few mothers use the Elvie in the early days of their breastfeeding journey, but supply has been slow to pick up. This is probably because we know that double pumping is most effective at this stage. Plus, the design of hands-free pumps necessitates the use of a very small motor which is not likely to be as powerful as the much larger motors found in the hospital grade pumps. The size, shape, texture and contour of the breast will influence how well a wearable pump fits and works for individual users. For a single pump hands free designs are comparatively expensive. There are some cheaper models like the Momcozy and Fraupow which some of my clients have reported positive experiences with.

Some mums find the hands free wearable pumps don't fit particularly well to their breasts,

There are other ways to achieve hands free pumping. The simplest way is to use a 'pumping bra' or, if you have basic sewing skills, convert a standard nursing bra or close-fitting crop top for the purpose. Freemie cups are cups that can be worn inside your bra and in place of the flange and collection bottle on your usual pump. They are compatible with the major brands of pumps. Some pump companies, such as Spectra, make their own hands-free pumping kits.

Manual and silicone pumps

But what about manual pumps and the all-in-one silicone pumps? These are useful for the occasional pumping session for the occasional bottle feed or for softening up engorged breasts for making latching easier. Many mums get in to the habit of using the silicone pumps for collecting the milk that is ejected when the baby is feeding on the opposite breast, rather than allowing this milk to soak into a breast pad and be wasted. However, caution is needed when doing this. Unlike breast shells which are designed to simply collect 'drip' milk from the 'let down', the silicone pumps actually create suction at the breast and draw milk so frequent use can result in an oversupply. Over supply can be associated with engorgement, blocked ducts and mastitis for mum and latching difficulties, gulping and choking, wind and reflux for baby.

Flange fit

When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes. The cheaper pumps tend to come with just one flange size and if this does not fit there is no option to buy a different size. Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange supplied with your pump does not fit then you will need to buy a different size. Manufacturers have fitting guides on their websites and they usually suggest a flange that is about 4mm larger than the diameter of your nipple. But recent research and teaching on this suggests a snugger fit with a flange that is just 2mm larger than the nipple diameter is better. One nipple may be much larger than the other, so some mums find they need a different size flange on each breast.

Spare parts

The availability and cost of spare parts is also something to investigate before you buy. With cheaper pumps it is unlikely you will be able to obtain spares in a situation that a part gets lost or damaged. The cost of spare parts for some brands of pump are higher than for others.

Portability

Some electric pumps work just off the mains. But others have the option to work off a battery, making them more portable, or can be powered via the 12-volt socket in a car which means you can pump in locations away from home and mains electricity.

Quality

The quality of a pump is something to consider too. Generally speaking pumps made by companies whose core business is the manufacture of breast pumps are better in terms of reliability, efficiency and durability and they often offer better after sales service. They dedicate a lot of resources to research and development of their products. Pumps made by bottle manufacturers, such as Tommee Tippee, in my experience do not compare well. Why would they? Bottle manufacturers make their money from families who formula feed and the breast pump in their range is purely a complement to their other products, not their core business or main source of income.

Second hand pumps

Finally, a word about second-hand pumps. These may seem like a good idea as they are cheaper than a new pump and many mums are given second-hand pumps by friends and relatives. However, in my experience there can be problems with this. Some second-hand pumps have been very well used and may be third or fourth hand. Even if they have only had one previous owner, she may have used the pump for more than one baby. I have seen many situations where a mum has complained that she cannot pump much milk or her supply is not increasing and upon investigation I have found that she has been using a second-hand pump with a worn out motor or defective parts.

Parts, particularly the crucial but delicate valves, can easily get damaged during use and plastic can deteriorate with repeated cleaning and sterilising, and storage meaning that seal and therefore suction is compromised. For these reasons and for reasons of hygiene it is recommended that collection sets are replaced and not handed on. Furthermore, not all pumps are 'closed systems', notably personal use pumps in the Medela range. This means that it is possible for milk to be drawn up the tubing and into the motor housing and this poses a theoretical risk of cross infection. So, if you do opt for a second-hand pump ensure that it has not been overused, replace the collection sets and check that it is a 'closed system' pump.

Sarah Oakley Independent Nurse, Health Visitor and International Board Certified Lactation Consultant 25/10/20

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Choosing a breast pump - Sarah Oakley Lactation

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful.

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2: ...unless your baby is unable to breastfeed

If your baby can't feed directly from the breast, perhaps because she's premature or has special needs, or you are separated for any reason, start double pumping breast milk as soon as you can after the birth.

Research shows that starting to express within the first few hours (when a healthy newborn would usually have her first breastfeed) helps mums produce a higher volume of milk in the early days and weeks, 1,2 giving their babies the best chance of being fed exclusively on mother's milk.

If you're expecting your baby (or babies) to be born pre-term, in need of intensive care, or to have a condition that might make breastfeeding difficult, prepare yourself. Learn about expressing, source equipment you might need, and ask a healthcare professional, lactation consultant or breastfeeding specialist for support.

There will probably be a hospital-grade double breast pump at your hospital or birth facility, so ask staff to show you how to use it. It's important to remove milk from your breasts whenever your baby would normally drink - this means your breasts will still get the message to make milk. Aim for eight to 10 pumping sessions every 24 hours at first, ³ and continue this frequency once your milk comes in.

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How to use a breast pump: 12 top tips | Medela

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Learn how to use a breast pump effectively with our top tips for efficient milk expression and establishing a good milk supply. Learn more!

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Choosing a breThere are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.ast pump - Sarah Oakley Lactation

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I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful. I did a quick google and really could not find anything useful to help a mum select an appropriate breast pump from the vast array on offer. This reaffirmed to me the difficulties mothers in this situation face. I see families daily who are using a breast pump that is not appropriate to meet their needs or who have spent hundreds of pounds on a pump that remains in its box unused.

Why do you need to express?

So, as a parent how do you choose a breast pump? There are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.

In the early days after birth you may find you need to pump frequently to provide milk for your baby who, for whatever reason, is not able to latch and feed directly at the breast. Or your baby may be struggling to drain the breast effectively. Frequent expressing will be needed to stimulate milk production and manage engorgement as the milk starts to come in. Later, you may need to express because of inefficient feeding and/or slow weight gain to provide top ups and/or boost a low supply. As baby gets older you may want the flexibility of being able to leave her baby in the care of someone else so you can have a break, go to bed early or attend appointments. You may be returning to work and need to leave milk for your baby.

There may also be situations where a mother wishes to re-establish a milk supply after a break from breastfeeding ( relactation). More parents are now inducing lactation in situations where they are adopting a baby, or in same sex couples where the non-birthing parent wishes to share in the breastfeeding, or where a parent is transgender. Both these situations usually necessitate frequent expressing.

Not all breast pumps are the same

Not all breast pumps are equal, and some are designed for frequent use, whereas others are more suited to occasional use.

When a baby cannot latch and suckle effectively at the breast immediately after birth due, for example to prematurity, illness in the baby or mother, other additional needs, an oral abnormality such as a cleft palate or tongue-tie or simply because of a difficult birth then it is vital that expressing starts early. This will ensure a good milk supply is established and provide colostrum for the baby. Early stimulation and drainage of the breast helps to further develop the glandular tissue (the milk factory) within the breast.

Furthermore, once the milk comes in at day 3-6 milk production begins to switch from endocrine control (driven by hormones) to autocrine control (driven by the frequent and effective removal of milk from the breast).

Hospital grade pumps

So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a hospital grade pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production (Jones et al, 2001) .

Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
https://www.ardomedical.co.uk/shop/products/rent-a-breastpump/ https://www.medela-rental.co.uk/ https://www.anawiz.com/collections/breast-pump-rental
Some Children's Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are 'personal use' double pumps, not hospital grade. They are also loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.

Personal use double electric pumps

Personal use electric pumps come in double and single options. All double personal use pumps can be used as a single pump. However, most single electric pumps cannot be converted to double. Double personal use pumps are good for maintaining supply, returning to work or for boosting supply if for any reason it has dipped. Many mums will switch to a personal use pump, after the first month or so, when they have established a good supply with a hospital grade pump, if they are in a situation where ongoing frequent expressing is needed.

Sometimes, mothers experience a drop in supply after the early weeks due to illness, the use of formula, certain medications, an undiagnosed latching or sucking issue (commonly a tongue-tie), or because they have implemented scheduled feeding to get baby into a routine. Double personal use pumps can be extremely helpful in boosting supply in these situations. Generally supply recovers more quickly and efficiently than with a single electric pump. Double personal use pumps are also helpful when returning to work as pumping sessions at work will take less time.

Single electric pumps

Single electric pumps can be used for the same purposes as the double personal use pumps, but pumping will be less effective and more time consuming. They are more suited to mothers who only need to pump once or twice a day to stock the freezer or provide milk so someone else can feed the baby. Some single electric pumps, such as the Medela Swing Flex, retail for the same price as personal use double pumps, such as the Ardo Calypso, so this is something to be aware of.

Electric pumps, whether single or double, can be helpful in effectively draining breasts affected by engorgement, blocked ducts, or mastitis when a baby is struggling to do this, or the nipples are too sore for breastfeeding.

Hands free wearable pumping

What about hands free wearable pumps like the Elvie? These are relatively new to the market. They can be useful for mothers who need to pump on the go or discreetly and my feeling is that working mothers with established milk supplies are the ones who may benefit most from this type of pump. I have had a few mothers use the Elvie in the early days of their breastfeeding journey, but supply has been slow to pick up. This is probably because we know that double pumping is most effective at this stage. Plus, the design of hands-free pumps necessitates the use of a very small motor which is not likely to be as powerful as the much larger motors found in the hospital grade pumps. The size, shape, texture and contour of the breast will influence how well a wearable pump fits and works for individual users. For a single pump hands free designs are comparatively expensive. There are some cheaper models like the Momcozy and Fraupow which some of my clients have reported positive experiences with.

Some mums find the hands free wearable pumps don't fit particularly well to their breasts,

There are other ways to achieve hands free pumping. The simplest way is to use a 'pumping bra' or, if you have basic sewing skills, convert a standard nursing bra or close-fitting crop top for the purpose. Freemie cups are cups that can be worn inside your bra and in place of the flange and collection bottle on your usual pump. They are compatible with the major brands of pumps. Some pump companies, such as Spectra, make their own hands-free pumping kits.

Manual and silicone pumps

But what about manual pumps and the all-in-one silicone pumps? These are useful for the occasional pumping session for the occasional bottle feed or for softening up engorged breasts for making latching easier. Many mums get in to the habit of using the silicone pumps for collecting the milk that is ejected when the baby is feeding on the opposite breast, rather than allowing this milk to soak into a breast pad and be wasted. However, caution is needed when doing this. Unlike breast shells which are designed to simply collect 'drip' milk from the 'let down', the silicone pumps actually create suction at the breast and draw milk so frequent use can result in an oversupply. Over supply can be associated with engorgement, blocked ducts and mastitis for mum and latching difficulties, gulping and choking, wind and reflux for baby.

Flange fit

When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes. The cheaper pumps tend to come with just one flange size and if this does not fit there is no option to buy a different size. Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange supplied with your pump does not fit then you will need to buy a different size. Manufacturers have fitting guides on their websites and they usually suggest a flange that is about 4mm larger than the diameter of your nipple. But recent research and teaching on this suggests a snugger fit with a flange that is just 2mm larger than the nipple diameter is better. One nipple may be much larger than the other, so some mums find they need a different size flange on each breast.

Spare parts

The availability and cost of spare parts is also something to investigate before you buy. With cheaper pumps it is unlikely you will be able to obtain spares in a situation that a part gets lost or damaged. The cost of spare parts for some brands of pump are higher than for others.

Portability

Some electric pumps work just off the mains. But others have the option to work off a battery, making them more portable, or can be powered via the 12-volt socket in a car which means you can pump in locations away from home and mains electricity.

Quality

The quality of a pump is something to consider too. Generally speaking pumps made by companies whose core business is the manufacture of breast pumps are better in terms of reliability, efficiency and durability and they often offer better after sales service. They dedicate a lot of resources to research and development of their products. Pumps made by bottle manufacturers, such as Tommee Tippee, in my experience do not compare well. Why would they? Bottle manufacturers make their money from families who formula feed and the breast pump in their range is purely a complement to their other products, not their core business or main source of income.

Second hand pumps

Finally, a word about second-hand pumps. These may seem like a good idea as they are cheaper than a new pump and many mums are given second-hand pumps by friends and relatives. However, in my experience there can be problems with this. Some second-hand pumps have been very well used and may be third or fourth hand. Even if they have only had one previous owner, she may have used the pump for more than one baby. I have seen many situations where a mum has complained that she cannot pump much milk or her supply is not increasing and upon investigation I have found that she has been using a second-hand pump with a worn out motor or defective parts.

Parts, particularly the crucial but delicate valves, can easily get damaged during use and plastic can deteriorate with repeated cleaning and sterilising, and storage meaning that seal and therefore suction is compromised. For these reasons and for reasons of hygiene it is recommended that collection sets are replaced and not handed on. Furthermore, not all pumps are 'closed systems', notably personal use pumps in the Medela range. This means that it is possible for milk to be drawn up the tubing and into the motor housing and this poses a theoretical risk of cross infection. So, if you do opt for a second-hand pump ensure that it has not been overused, replace the collection sets and check that it is a 'closed system' pump.

Sarah Oakley Independent Nurse, Health Visitor and International Board Certified Lactation Consultant 25/10/20

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Choosing a breast pump - Sarah Oakley Lactation

# data[].attributes.attachment_link.description
I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful.

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Lou's videos with baby massage sequence to help wind and tummy issues 

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Lou's videos with baby massage sequence to help wind and tummy issues 

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Every parent dreads the witching hour in the evening when baby is crying, clearly in pain. It's "Colic" - but what can you do to help your baby?

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The Colic Sequence - Baby Night-Time Crying Ease

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All about Reflux & GERD - has your baby got it and what to do to help. 

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All about Reflux & GERD - has your baby got it and what to do to help. 

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Some babies do have GERD. These are very unhappy babies and they may need medication, but they are in the minority. Most families can be helped by a thorough look at feeding and baby care, at stress and coping strategies. Reflux is about a lot more than what happens in the stomach. Our babies deserve to have someone take the time to investigate their distress.

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Why Infant Reflux Matters - La Leche League International

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By Carol Smyth - Ballyclare, IBCLC, Northern Ireland If you have a new baby, it is likely you’ve heard about reflux or gastro-esophageal reflux disease

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Young babies, both breast and formula fed, are often fussy. It is not unusual for this to happen during the late afternoon and evenings, and is usually NOT due to hunger, wet/dirty diaper, or anything that mom or dad can fix. It is usually NOT related to milk supply, although some mothers may worry about this.

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KellyMom.com - Breastfeeding and Parenting

# data[].attributes.attachment_link.description
Young babies, both breast and formula fed, are often fussy. It is not unusual for this to happen during the late afternoon and evenings, and is usually NOT due to hunger, wet/dirty diaper, or anything that mom or dad can fix. It is usually NOT related to milk supply, although some mothers may worry about this.

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-and giving it to baby!

# data[].attributes.attachment_link.title
Colostrum Collection in Pregnancy: When to start and how to do it