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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth.

Why express while pregnant?

Being familiar with your breasts and how they work will give you confidence for after the birth.

You'll be able to express a small amount of colostrum onto your nipple if your baby needs encouragement to feed.

You'll be able to express colostrum for your baby if he has difficulty feeding or is cared for in the neonatal intensive care or special care baby unit.

Being able to hand express will help you avoid problems with engorgement and mastitis.

If your baby doesn't breastfeed well in the first few days, being able to hand express will help you:

Express your milk if needed.

Provide your own milk for your baby to prevent or treat conditions such as low blood sugar or jaundice.

Avoid the need to give infant formula.

Special circumstances

Learning to hand express while pregnant, and collecting and saving the colostrum can be helpful in some special situations, including:

Planned caesarean or induced birth
Consider expressing the day before birth so your milk is available if you and your baby are separated. This will be especially useful if your baby will be born early.

Babies with a cleft lip or palate
This may be diagnosed during pregnancy. Babies with any form of cleft can find it harder to breastfeed. Breastfeeding is particularly important for the first six months as it helps protect these babies against ear and respiratory infections. When the cleft is repaired, your milk helps promote healing and protects your baby against hospital germs.

Mothers with diabetes
In the first 24 hours after birth, babies of diabetic mothers risk developing low blood sugar levels (hypoglycaemia). A baby needs colostrum to maintain his blood glucose levels. Exclusive breastfeeding has been shown to reduce the risk of a baby developing diabetes later in life.

Mothers with breast abnormalities or who have had breast surgery
Stored colostrum can be helpful if you encounter problems establishing milk production.

Other medical conditions
Some medical conditions may make it harder for you and your baby to establish breastfeeding. Or, if you need to start medications that are incompatible with breastfeeding, your saved colostrum can still be given to your baby.

Talk to your midwife

Some NHS hospital trusts already have policies in place for sharing information on antenatal expression. Your midwife and other members of your antenatal care team may have information to share on breast massage and how to hand express. They should also be able to give you small sterile syringes with identity labels in which to save your colostrum.

Do ask if the hospital has an Infant Feeding Specialist who will be well informed about breastfeeding and a source of support in those early days.

A handy technique

Hand expression is a useful technique to learn even though most mothers find they rarely need to express and store their milk. It is effective, convenient and free. You may also find you can express more milk by combining hand expression with pumping than using just a pump.

When to start expressing

Is it safe?

Don't worry - following the suggestions to express for a few minutes each day is unlikely to trigger labour. Check with your midwife if you are at risk for early labour. If you experience any uterus cramps when expressing, stop immediately and contact your midwife.

Expressing during pregnancy

1. It helps to be warm and relaxed.

2. You could practise in the bath or shower at first. When you start collecting colostrum, express after a bath or shower.

3. Wash your hands.

4. Massage your breasts to help milk flow.

5. Hand express from one breast. Take care NOT to cause pain or discomfort.

6. You are likely to see small droplets or drips of colostrum appear as you express. Express directly into the container so you save every precious drop. If you've been given syringes and find it difficult to collect your colostrum, express into a small clean container (e.g. cup) and draw the colostrum up into the syringe.

You can express up to three times in the same day. If you plan to express again that day, store the syringe in the coldest part of the fridge. This is usually at the back.

Once you've expressed for the last time that day, seal the syringe in a bag. Label and date it before placing it in the freezer. The colostrum could be kept in the fridge if you're going to be induced or have a planned caesarean section within a day or two. Fresh colostrum inhibits the growth of bacteria and can be safely refrigerated for 48 hours.

Why hand express?

Hand expression is the best way to express colostrum. It is simple to learn and gets easier with practice. You'll only be expressing small amounts so using a pump will be impractical and may not be as effective. You may receive information and a demonstration on hand expression from your midwife.

Our article Hand Expression of Breastmilk also describes an effective method. Antenatally, you'll only need to express for three to five minutes - just until you have a few drops of colostrum. It may not seem very much, but a baby's first feed is no more than a teaspoon of colostrum. By expressing up to three times in a day, you can express enough for a feed. With practice and regular stimulation, you'll be able to express more colostrum.

When you go into labour

Take your stored colostrum with you to the hospital in a cool bag. The hospital can arrange to keep your colostrum frozen, possibly in the special care baby unit. Make sure you or your birth partner makes a note of where it is stored and that details are in your notes.

If you and your baby are likely to have difficulties or be separated, one of the containers can be defrosted once you're close to birth. This is then ready for the first feed, if needed.

When baby arrives

Your baby will need to breastfeed at least 8-12 times in 24 hours. If, for any reason, you are separated or unable to breastfeed your colostrum can be defrosted if needed, one container at a time to avoid waste. Your colostrum can also be used if your baby needs supplements.

The first few days

Frequent breastfeeding and keeping your baby close by will help establish your milk supply and get breastfeeding off to a good start. If you and your baby are separated, express milk eight times in each 24 hours including at least once at night, until your baby is able to breastfeed. Expressing as well as breastfeeding is important if your baby isn't feeding well, or needs supplements for any reason. This will help establish milk production and provide milk for your baby's next feed if needed. For any problems, seek skilled help from an LLL Leader - check our website for details.

Written by Karen Butler, Sue Upstone & mothers of La Leche League GB.
Updated February 2022
Further Reading
Beginning Breastfeeding
Caesarean Birth and Breastfeeding
Comfortable Breastfeeding
Diabetes and Breastfeeding
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk?
Jaundice in the Healthy Newborn
My Baby Won't Breastfeed
Sleepy Baby - Why and what to do

LLLI Stories
Cleft Lip & Palate Breastfeeding
Books
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
References
Cox, S. An ethical dilemma: should recommending antenatal expressing and storing of colostrum continue? Breastfeeding Review 2006; 14(3):11-6.
Cox, S. Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 2006; 14(3):11-6.
Oscroft, R. Antenatal expression of colostrum. Pract Midwife 2001;4 (4): 32-5.
Forster, D. et al. Diabetes and Antenatal Milk Expressing (DAME). Lancet, 2017; 389 (10085): 2204-2213.

This information is available to buy in printed form from the LLLGB Shop

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving your expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Why express while pregnant? Being familiar with your breasts and how they work will give you [...]

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Video

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How to make up a bottle of formula milk for your baby | Infant Feeding Team

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Breast milk is both healthy food and natural medicine for your baby. Breastfeeding is a skill you learn over time. A mother and her baby usually take a few weeks to get used to breastfeeding. Your family, friends and the baby’s father can support and help you when you’re breastfeeding.

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Expressing Information can be found on Page 31 onwards.

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It's never too early to start thinking about how you're going to feed your baby. But you do not have to make up your mind until your baby is born.
Some of the benefits of breastfeeding are:

your breast milk meets all of your baby's nutritional needs

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

breast milk is available for your baby whenever your baby needs it

breastfeeding can build a strong emotional bond between you and your baby

Formula milk does not provide the same protection from illness and does not give you any health benefits.

Health benefits of breastfeeding for your baby

Breastfeeding has long-term benefits for your baby, lasting right into adulthood.

Any amount of breast milk has a positive effect. The longer you breastfeed, the longer the protection lasts and the greater the benefits.

Breastfeeding can help to reduce your baby's risk of:

Giving nothing but breast milk is recommended for about the first 6 months (26 weeks) of your baby's life.

After that, giving your baby breast milk alongside solid foods for as long as you and your baby want will help them grow and develop healthily.

Breast milk adapts as your baby grows to meet your baby's changing needs.

Health benefits of breastfeeding for you

Breastfeeding and making breast milk also has health benefits for you. The more you breastfeed, the greater the benefits.

Breastfeeding lowers your risk of:

Got a breastfeeding question?

Sign in to Facebook and message the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

Get Better Health: Start for Life

Sign up for Start for Life weekly emails for expert advice, videos and tips on pregnancy, birth and beyond.

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Breastfeeding has lots of health benefits for your new baby, including fewer infections and a lower risk of obesity, as well as protecting you from some cancers and other health problems, too.

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This information is also available as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
There are many reasons that we become anxious at one point or another in our lives. Anxiety is a normal and healthy emotion which helps to tell us that something in our environment may be threatening, either physically or emotionally to either ourselves or the people we care about. Feeling anxious about these situations encourages us to act to make ourselves safe. Without it we would not be able to recognise danger or keep ourselves safe. It is only necessary to seek help if you find your feelings spiralling out of control. Tell your loved ones how you feel, a hug and an opportunity to express your frustration and worries may be all that you need.

Sometimes though we misinterpret situations and start to believe that they are threatening when they are not. This can be affected by;

the information we are given by others,

how confident we feel about coping with a situation,

our experiences from the past.

If we have been told that something will be difficult or upsetting, or have experienced struggling in a situation in the past we are more likely to be anxious about that situation again now.

It is important to know that 1 in 10 of us will experience a significant anxiety disorder at some point in our lives although this increases during pregnancy and the year after giving birth. It doesn't mean that you need medication, nor that you are a bad mother or a failure. You may benefit from access to Improved Access to Psychological Therapies (IAPT) services. You may feel better knowing that what you are feeling is perfectly normal and common in many mothers. We hope that this information gives you options to decide what is right for you.

Parenthood is a time when all experiences are new. We are given a lot of information (much of it conflicting) and advice. It feels like there is pressure to get everything 'right' every time - to keep our child healthy and to be seen as a 'good' mother. Add into the mix the fact that we are usually sleep deprived, exhausted and having difficulty concentrating, and it is very understandable that anxiety is common in mothers, especially those with young babies.

This information sheet is not designed to give a definitive answer that will immediately make the anxiety disappear - we wish it could. Anxiety is very much more complicated and the solutions will be individual to each one of us. Hopefully it will be able to provide some information on what anxiety is and how we may be able deal with this. It will also try to normalise anxiety and consider what a normal reaction to a situation is and when we may want to seek more help. It is important to recognize that anxiety may begin in pregnancy and that it can occur alongside other conditions such as depression and obsessive compulsive disorder (OCD) which can make it less readily recognized by you and your healthcare professionals.

Anxiety is a feeling of dread or fear about a real or imagined situation. It is often characterised by excessively worrying and focusing on thoughts and situations that scare or upset you and is accompanied by a range of physical sensations. We will often notice changes in three areas, our thoughts, our physical feelings and our behaviours. Below are listed some of the symptoms in these areas you may experience.

Racing heart beat

Changes in breathing (feeling breathless, holding your breath or rapid breathing)

Tightness or pain in your chest

Pins and needles or tingling in the arms and legs

Butterflies

Feeling sick (sometimes, although rarely, also being sick)

Stomach upsets and needing to go to the toilet frequently or urgently.

Wobbly legs

Feeling dizzy and light headed

Feeling as if things don't feel real/dream like (depersonalisation)

Difficulty concentrating

Head aches

Muscles tension, especially in the neck, shoulders and jaw

Irritability

Disturbed sleep, difficulty getting to sleep or waking frequently

Feeling exhausted

Worrying excessively, either about one thing or many things

Feeling that others are looking at you or judging you

Thinking that you will be unable to cope with a situation

Thinking you are not good enough in some way

Focusing on bad or upsetting experiences from your past Feeling unable to let go or stop thinking about something

Worrying that something is wrong or will go wrong in the future

Unpleasant thoughts about bad things happening that pop into our head.

Often these thoughts feel very out of control and we may find it difficult to concentrate on normal daily life because our head is so full of these thoughts. We may also find that no matter how much we think about the problems they don't get better, and often get worse. When someone asks what you are worrying about you may respond "everything and nothing". That's okay, it's how you feel that you are dealing with your thoughts that is important.

Reducing normal activities

Feeling unable to face talking to people

Avoiding crowded places

Repeatedly checking things, our children, information, locks, switches etc.

Avoiding thinking or doing things that make us anxious

Becoming withdrawn

Initially taking some time out may be helpful to give us time to rest and spend time with our baby. However in the long run by reducing enjoyable activities we have little else to distract us or balance the negative thoughts.

Anxiety is normal and a natural part of our biology which we share with all animals. It comes from our fight or flight response that is designed to keep us safe. When we were cavewomen, if we came across a sabre toothed tiger, to keep ourselves safe we would either need to fight it, or run away. In order to do this our brain reacts very quickly to give us the best chance of escaping or winning by making our bodies ready for action by releasing adrenaline. This causes several immediate changes:

Our hearts beat faster to help pump blood around the body

Our breathing rate increases to give our muscles oxygen

We get tingling in our arms, legs and stomach (butterflies) as our blood diverts away from our stomach where it's not needed and into our arms and legs instead

Our stomachs are not essential for fighting so we may feel sick or need to go to the toilet

Our muscles tense ready for actions

We feel on edge as our senses are on high alert for danger

We feel the urge to escape or leave a situation

In our modern life we rarely encounter sabre toothed tigers, but the same reaction can still be triggered if a situation or thought feels threatening to us. Our bodies are unable to differentiate whether something we just think is real or not. Even if you are just thinking about an anxiety provoking situation, what may or may not happen, or worrying that something might be wrong, this will still cause all the same physical reactions that a physical threat would.

Parents are anxious about doing their best for their child and as a result some level of anxiety is to be expected. Not only do we worry about our children, but we may also be facing massive changes to our lives; changes in our role within a family, greater responsibility, less time to ourselves, less money, less time with our partners and friends. The list is endless but below are some common worries you may experience:

Is my child eating enough?

Is my child gaining weight?

Am I feeding too frequently/frequently enough?

Is the baby's poo the right colour?

Are they safe where they are sleeping?

Will my baby nap today?

Everyone loves to give advice about how best we should care for our children, this is especially true when it comes to feeding. Over the past 100 years breastfeeding has become less common than it was and information about what is normal has been lost over time. Instead we are inundated with advice which is often unrealistic and related to old childrearing practices that we no longer regard as helpful or evidence based.

Advice may include ideas that every baby should sleep through the night from x weeks, that they should only be fed every y hours, if they cry or are fussy they are hungry, mums can't produce enough milk to feed a large baby and a million more opinions that you will be exposed to every day.

With breastfeeding it isn't as easy to see exactly how much milk a baby has consumed. We may question our ability to sufficiently feed the baby - especially if a healthcare professional questions baby's weight gain or feeding schedule. Concerns about breastfeeding or perceived lack of support may add to anxiety.

Breastmilk is completely absorbed so breastfed babies will be more likely to wake frequently throughout the night and for longer. This is not a bad thing for the babies, who are feeding effectively and naturally, however this may lead to more disrupted sleep for the parents. Feeling more tired may result in higher levels of anxiety as we struggle to think clearly when tired. Few babies sleep through the night for the first year, but the pressure that is given by society for them to do this may again lead to anxiety and self-doubt.

We may get very conflicting or incorrect advice about what is normal from a variety of sources. Our society also has limited knowledge about healthy breastfeeding practices so we may be more likely to encounter misinformed opinions from others which may make us feel uncertain about what we are doing. You may feel your wishes to breastfeed or indeed to give up, may not be listened to or respected. This may add to your feelings of loss of control.

There are several simple things we can do to balance our life and manage anxiety. The focus should be on reducing focus on the worrying thoughts and trying to refocus attention on life activities which are happening at the moment, rather than what may happen in the future.

Deal with or approach a problem if you can - if you can't do anything or it hasn't happened yet - let it go. The Exeter Worry Guide in the link below may give you some ways in which to do this. Mindfulness techniques may also be helpful with this and there are links to some helpful websites in the next section.

Talk to people - other mums in similar situations to get an idea of what is normal. This may be via baby groups, helplines, Facebook groups or online forums. However, you may find that the mood of a forum may be negative and make you feel worse. If that happens find somewhere that helps you feel positive. Keep talking to those who love you and let them know how you are feeling.

Keep doing enjoyable activities. These may need to be adapted to life with a baby but try to do something enjoyable every day e.g. baby groups, walks, playing with your baby or swimming. If you can get someone to babysit you may enjoy getting time out for half an hour to go for a run, have a bath, painting your nails, reading a book or even going to the toilet by yourself.

Get out of the house - get to the shops for some milk, walk around the block, go for a drive.

Staring at the same four walls will not help to distract you and your thoughts will go round in circles. Getting out even just for 15 minutes a day can be helpful to clear your head and may help your baby sleep too.

Focus on positives each day - try and write one positive thing in a daily diary or try 100 days of happiness on Facebook. Maybe if someone asks how things are going, try to think of the positives first before the problems. Also make a list of all the things you are doing well rather than where you might be struggling.

Take a breath and ignore those giving advice which doesn't feel comfortable - they are giving their opinion not facts. Their baby might be very different from yours, whatever they did was their choice but you do not have to conform to everyone else's ideas.

Stop googling! There is a place for internet searches, but you can also drive yourself mad looking at conflicting, inaccurate and catastrophic advice. Go to reliable sources and once you have found an answer, stop checking further - you will just start to doubt yourself and you keep yourself focused on the worrying thoughts rather than the solutions.

As we have said, some level of anxiety is normal in parenthood, however if you find that you are anxious most of the day, several days a week for more than 2-3 weeks then this can be signs that anxiety is becoming more of a problem for you. If it is impacting on your ability to continue your normal life then you may wish to seek further help from your GP or other voluntary services. Your health visitor and GP should both be checking on your mental health at each appointment and even if you do not feel you need help yet, if you are starting to feel anxious or low you can still discuss it with them so that they know to check up on you in the future.

Your GP may suggest a period of two weeks of watchful waiting to see whether your mood improves by itself. This is normally the first plan of action if anxiety or low mood is mild. They will normally suggest some self-help guides similar to the ones at the bottom of this page and then book a review appointment in two weeks.

If you and your GP decide you need some support, they may offer you a referral to a talking therapy service or discuss whether medication would be helpful.

Talking therapy services based within mental health teams are very different to how they were 20 years ago. They are designed to support people within the community with common mental health issues such as anxiety, depression and panic attacks. You will be offered an assessment during which you can discuss what difficulties you have been facing and what your goals are. After this you may be offered some treatment, the most common of which is counselling or Cognitive Behavioural Therapy (CBT). Counselling allows you to look at issues more commonly from your past which may be affecting you now, or issues around relationships with other people. Cognitive Behavioural Therapy comes in many forms, most of which is face to face, but it can be offered over the telephone or in group settings. CBT looks at cycles of thoughts, feelings and behaviours which may be keeping you stuck. It aims to help you understand what is happening and may offer practical steps to reassessing whether these thoughts are realistic and changing unhelpful behaviours.

CBT currently has the greatest evidence base for treating anxiety and is widely available within the NHS however there are other therapy options available in some teams such as Cognitive Analytical Therapy (CAT), Interpersonal Therapy and Mindfulness.

If you and your doctor decide that prescribed medication is the best route for you, there are several options which you can take and continue breastfeeding. They include, in no particular order:

1. SSRI antidepressants e.g. sertraline, citalopram, fluoxetine, paroxetine all have anti- anxiety activity. They take 4 to 6 weeks to exert full benefit.

2. Tri-cyclic antidepressants e.g. amitriptyline, imipramine.

3. Beta blockers e.g. propranolol act to reduce heart rate and slow the body and act very quickly. They can be taken regularly or when required. They cannot be taken if you have asthma.

4. Benzodiazepines e.g. diazepam, lorazepam, alprazolam act very quickly to reduce anxiety but cannot be taken long-term because they are addictive and can also accumulate in the breastfed baby leading to drowsiness and poor feeding.

The first thing most mothers prescribed with anti-anxiety medications worry about is whether the drugs will harm the baby in the short or long term. They are also concerned that they are 'bad' mothers for needing to take medication but they don't know how to cope without. They worry about long term use, addiction, withdrawal, development of the baby, whether formula milk may be a better option than breastmilk containing even a small amount of the drug. They 'google' madly trying to find the information which supports their concerns, but often don't trust those sites which support the safety. They may ask lots of people's opinions which can be even more anxiety provoking according to that person's experience of breastfeeding and medication. Often they fear that even admitting that they are anxious may lead to their baby being taken into care and them being labelled as an unfit mother. This is not going to happen but can sadly lead to delays in seeking treatment.

Information websites:

Although rarely talked about, when people have been feeling very anxious or depressed for long periods of time, they can feel that they are unable to cope and they can experience thoughts of suicide or self- harm. The intensity of these can vary significantly, some people experience fleeting thoughts of 'I just don't want to be here', for others they can start to imagine more in depth thoughts and plans about what they could do. Most of the time having these thoughts does not mean that you intend to act on them. It can be part of our brain's way of imagining one possible escape, and often we have many protective factors that would stop us ever acting on them, such as our children, partners, family, friends, faith or hope for the future. Normally once our mood improves, thoughts of harming ourselves reduce and disappear. However they can still be very distressing to experience so it can be helpful to talk to others if you feel able to. Although they may find it upsetting to hear that you feel this low, friends and family can often support you to manage these feelings when they occur and help you not to feel so alone. You can also talk to your GP or health visitor about them and they can decide with you what support would be helpful.

If you ever feel that you may be more seriously thinking about harming yourself or unable to keep yourself safe it is important that you speak to your GP or another health professional as soon as possible. Doctors, midwives and health visitors are aware that these are symptoms of depression and anxiety. They should support you to access help and appropriate treatment.

If you need immediate help you can go to any accident and emergency department or drop in clinics to help. Suicidal or self-harm thoughts are also seen as a priority and would be counted as a reason for an emergency appointment with a GP. You can also call NHS direct on 111 or in an emergency 999.

Antenatal and postnatal mental health: clinical management and service guidance. NICE guidelines [CG192] December 2014

Bauer A, Parsonage M, Knapp M, Lemmi V,Adelaja B Costs of perinatal mental health problems. October 2014 www.centreformentalhealth.org.uk/costs-of-perinatal-mhproblems

British National Formulary

CG192 Antenatal and Postnatal mental healthcare

Hale T. W Medications in Mothers Milk

Health Outcomes Paediatrics; 131(4):2013 http://pediatrics.aappublications.org/content/early/2013/02/26/peds.20122147.full.pdf+html

Jones W Breastfeeding and Medication 2018 Routledge

Khan L Falling through the gaps. Perinatal mental health and general practice. March 2015

Lactmed website http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Martindale, the Extra Pharmacopia 2007

Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS, Postpartum Anxiety and Maternal-Infant

Royal College of General Practitioners Practical Implications for Primary Care of the NICE guidelines

www.centreformentalhealth.org.uk/falling-through-the-gaps

This information was compiled by Beth Chapman Cognitive Behavioural Psychotherapist and Wendy Jones Pharmacist.
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019

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Anxiety and Breastfeeding - The Breastfeeding Network

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This information is also available as a PDF by clicking here. The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used.

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Maximising milk production - includes video

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Maximising milk production - includes video

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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This material was developed by Jane Morton, MD and produced for educational purposes only. Reproduction for commercial purposes is prohibited. Utilization of the materials to improve care of pregnant women and their newborns is encouraged with proper citation of source.

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Public Health Agency - Bottle feeding leaflet

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Public Health Agency - Bottle feeding leaflet

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First steps nutrition trust infant milks  - information for parents

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First steps nutrition trust infant milks  - information for parents

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Infant milks for parents & carers — First Steps Nutrition Trust

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First Steps Nutrition Trust is a charity which provides clear, evidence-based and independent information and support for good nutrition from pre-conception to five years of age.

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Safer sleeping - Reducing the risk of sudden infant death

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This updated version of the poster provides information on the risks of sudden infant death. The leaflet has also been updated to highlight the risk of co-sleeping. Access information for health professionals.

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Safer sleep information - The Lullaby Trust

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Our expert safer sleep information helps to reduce the risk of sudden infant death syndrome (SIDS), and gives you peace of mind.

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This book provides information on caring for children up to five years old and contact details for useful organisations. It is available to new parents resident in Northern Ireland through primary care services (antenatal clinics, GPs or health visitors).

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This book provides information on caring for children up to five years old and contact details for useful organisations. It is available to new parents resident in Northern Ireland through primary care services (antenatal clinics, GPs or health visitors).

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Lullaby Trust-Safe sleep information for preterm/ low birth babies, twins & multiples

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Lullaby Trust-Safe sleep information for preterm/ low birth babies, twins & multiples

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Premature babies and multiples - The Lullaby Trust

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Safer sleep for premature babies or twins and multiples is important. For twins and multiples, advice my include co-bedding your babies…

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding.

Key to achieving the Baby Friendly standards is a workforce able to support mothers to breastfeed effectively. This video provides some guidance on this.

You can see more of the 'From Bump to Breastfeeding' DVD on the Best Beginnings website.

Video not working? Contact us

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Positioning and attachment video - Baby Friendly Initiativ

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In this video, a breastfeeding counsellor helps a mother with her positioning and attachment whilst breastfeeding. Watch to learn more.

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping. While this is often a temporary solution to protect milk supply until the baby is able to nurse directly at the breast, some mothers may find themselves exclusively pumping long term. Some mothers may also actively choose to exclusively pump and some mothers may be unable to feed their baby directly at the breast because their baby is poorly or has medical difficulties.

The decision to exclusively express breastmilk usually stems from an awareness of the irreplaceable qualities of breastmilk. Mothers also find that providing their babies with breastmilk can help with the grief from not being able to nurse directly at the breast. If their baby has medical difficulties, many mothers feel strongly that providing human milk will give their child the best possible start, particularly if their baby is in hospital. Yet, exclusive pumping is a significant undertaking which requires dedication, information and support.

You might find the decision to exclusively express feels difficult, and that you don't feel you fit with breastfeeding mothers or with those using formula. Please be sure that you will receive a warm welcome and support at LLL meetings and from your local Leader, and that we understand the lengths you're going to, to make sure your baby has your milk.

This page concentrates on the practicalities of how and when to express your milk and feed it to your baby, to establish exclusive expressing as your feeding method. Sometimes it can help to focus on all these practicalities and, once you have a workable plan, to give yourself time too to process how you're feeling about it, as you settle into life with your new baby. If you have a partner or supporter at home with you, all the things that are useful in supporting a breastfeeding mother will apply to you too!

Getting Started

If you have recently given birth and your mature milk has not yet come in, hand expressing is the most effective way of collecting colostrum to feed to your baby. It is important to start expressing colostrum within six hours (ideally after one hour, if possible) of giving birth, though if this doesn't happen for you, it is still possible to get started.

A newborn would expect to feed 8-12 times in 24 hours, and the feeds might not be evenly spread over that time, though they do need to include some feeds in the night; it is important to try to express breastmilk just as frequently in order to lay the groundwork for a robust milk supply later on. If you can have skin to skin contact with your baby while you're expressing, it can really help, and a photo or something that smells of your baby can be a substitute. You can collect your colostrum in a syringe, a small clean cup or a spoon. See our article on Hand Expression of Breastmilk for more information on hand expressing, and you might also find this video on hands-on pumping helpful. This technique can be tricky to get the hang of, so please do ask your midwife or other breastfeeding supporter to help. It's very common to need an extra pair of hands to collect the drops of colostrum.

Equipment

As your milk starts to transition, you will probably notice it start to change colour and spray out as you are expressing; this is a good time to introduce a breast pump. Although some women respond better to hand expressing, using a hospital grade double electric pump is the most effective way of removing breastmilk when a baby isn't latching or is not nursing adequately. If you are planning on exclusively expressing for your baby long term, then it will be worth investing in a hospital grade double pump. If you would like to try one before deciding whether or not to buy it, your hospital or midwife may be able to provide you with one on a short-term loan. Alternatively, you can hire a pump, although it may turn out to be rather expensive if you are exclusively expressing long term.

A breast pump usually comes with a collection set and the part that sits over your nipple/areola, which is called a flange. As women's nipples and skin elasticity differ, flanges are available in different sizes. It's important to ensure you have the right size for your nipples, as flanges that are too large or too small may cause pain or nipple damage and reduce the amount of milk you are able to express. Finding the right flange size may be a bit of a trial and error process; you may want to start by trying the standard size that comes with the pump (which varies for different pump brands) and see how you respond. If the standard flange sucks in too much areola, or if your nipple is at the back of the pump, you may need to go down a size. If, instead, you are left with a white ring around your nipple, you may need to go up a size.

Many mums find being able to express handsfree invaluable in terms of allowing them to fit regular pumping sessions into their day. There are a small variety of pumps that provide milk collection cups that sit inside your bra, freeing you up to cuddle your baby without fear of spilling your milk. However, they tend to have a limited range of flange sizes. Alternatively, you can buy special bras designed to hold your pump flanges against your breasts, or you can even DIY your own by cutting holes in a stretchy bra that line up with your nipples.

There are several other things to consider when choosing which hospital grade double pump to purchase or hire:

- How often will you use it? If you are planning to exclusively pump long term, you may need to consider motor life, to make sure the pump you purchase will live up to its use.

- How portable is it? If it uses a battery, then it can be carried around the house or out and about with you. Some pumps have built-in rechargeable batteries, while others offer the option to purchase a power pack or a car charger. Some pumps use removable batteries which are easy to replace if you unexpectedly run out of charge while away from a plug socket. However, using removable batteries may end up being rather expensive long term. You might find you end up using two different pumps - an efficient hospital grade one when you're at home and a hand pump or battery pump when you're out and about.

- Can you purchase spare collection sets? Having a spare collection set or two can come in handy, as most mothers find that it is easier to stick to their pumping schedule if their pump is set up and ready to go at a moment's notice, especially at nighttime.

Setting your schedule

For the first three-four months, you will need to express regularly to build a robust milk supply, ideally 8-12 times in 24 hours. Although you do not always need to pump at regular intervals, it is best not to go more than two to three hours between pumping sessions, with one longer stretch of four-five hours at night if you can take this break without damaging your milk supply. You will need to have at least one pumping session overnight, ideally between 2am and 5am when prolactin levels are highest. If you are able to pump when your baby wakes up for a feed, you may find it easier to do so than setting an alarm. If you need to set an alarm, but are having difficulty waking up, it may be worth experimenting with setting it for different times to try and coincide with the periods in your sleep cycle where you are in a lighter sleep. Many mothers find that they are able to express the most milk first thing in the morning, and less as the day goes on. You will notice your own patterns. It's also common for one breast to produce more milk or have a faster flow than the other side.

Working out ways to fit pumping sessions into your routine is key to long-term success. Some mothers will express while cooking, or holding a sleeping baby, or while travelling; sometimes before they feed their baby, sometimes afterwards. Experiment to find out what works best for your family and your daily rhythms.

In the early days, you may find that you are producing more milk than your baby needs; this is common and it will settle down in a few weeks. It can be useful to freeze any excess milk in small portions for later on, should your baby suddenly require more milk, such as during a growth spurt or period of illness.

Once your supply has established, usually between three and four months, you may decide to slowly reduce your number of daily pumping sessions. If you are planning to exclusively express long term, however, you may decide not to make any changes to your pumping schedule. If you start to reduce your expressing sessions, you may like to keep a record of your daily pumping outputs so that you can monitor what effect it has on your overall milk supply. You could start by increasing the intervals between your overnight pumping sessions, although it will still be important to express once at night. After doing this for about three-four weeks, you may consider dropping one daytime session. This may require you to adjust the time of all your other pumping sessions, in order to avoid leaving a big gap in between them, which could make you vulnerable to experiencing blocked ducts or mastitis.

Once your baby starts eating solids reliably, around eight-nine months, you may start to notice a change in their milk requirements and can adjust your pumping schedule and milk supply accordingly. However, many mothers find that introducing solids does not affect milk intake for a lot longer (in some cases, 18 months). When your baby is sat in a highchair, it can be a good time to express your milk without them pulling on the pump tubes.

How long is an expressing session?

The length of each expressing session will vary for each mother, based on her breast storage capacity and the type of pump she uses. If you are able to express milk from both breasts at once, then you will find it much faster.

While some experts recommend pumping for about 15-20 minutes, others believe that specifying the duration of a pumping session may not be helpful, as some mothers may take up to 45 minutes. In her book Exclusively Pumping Breastmilk, Stephanie Casemore suggests spending two hours over the course of 24 hours expressing. However, this total pumping time may need to be adjusted for mothers who need long individual expressing sessions. Also, other experts believe the total number of separate sessions to be more important than total pumping duration, with shorter, more frequent expressing sessions usually being more effective than fewer, longer sessions.

As a general rule of thumb, you can express until your milk stops spraying, and then for an additional five minutes to stimulate another let-down. If you need to increase your supply, you can pump for 10 more minutes and use hand expression right after to remove as much milk as possible. Breast compressions and massage during sessions ( hands-on pumping) also help to stimulate let-downs and maximise milk output. Some mothers find that it helps to experiment with "power pumping", where they pump frequently for short periods, to mimic cluster feeding. This might be something to use on occasion rather than as part of a daily routine as it can be quite time-intensive.

If, on the other hand, you need to decrease your supply, then slowly reduce the length of time you are expressing for. In both cases, many of the techniques discussed in our articles " My baby needs more milk" and " Too Much Milk and Oversupply " can be adapted for use with a breast pump.

If you are worried that you do not have enough time to do a full session, then it is better to pump less time and have a longer session later, than to miss one entirely.

Over time, as you reduce the number of pumping sessions, you may find that you will need to express for longer to obtain the same amount of milk. Many women find that if they cycle through their pump settings again, they can trigger a second or even a third let-down over a period of 30-45 minutes.

The importance of Oxytocin

Oxytocin is the hormone that triggers your letdown (milk ejection reflex). It is especially important to be mindful of this when expressing, as even mildly stressful situations of feeling rushed can make it difficult to trigger a letdown when using a breast pump. Many mothers find looking at their baby - or at pictures of their baby if they are separated - while expressing helpful. Gently massaging your breasts before and during your pumping session, as well as applying warm compresses or taking a warm shower before expressing can also trigger a let-down. Other ways to boost your oxytocin might include listening to music, watching a comedy on TV, reading a book, or browsing social media on your phone.

If you are able to cuddle your baby while expressing, you may see an increase in your normal milk output! It is even possible to express while carrying your baby in a sling or baby carrier. As your baby gets older and more mobile, you may find it easier to remove yourself to a different room where you can relax without worrying about them pulling on your tubes, or getting into things they shouldn't.

It can feel disheartening if you are watching your collection bottles and feel that they are not filling up quickly enough. Covering the bottles with socks, or distracting yourself so that you are not watching, can be helpful. If you are struggling to get a let-down, it is ok to put your pump away and come back to it 10-20 minutes later and try again. If it is a persistent problem at certain times of day, try to remember that the stimulation you are giving your breast still has a valuable purpose.

How to pump

In order to keep pumping comfortable and avoid nipple damage, you may want to consider using lubrication, such as lanolin or olive oil, inside the pump flange to reduce friction. The flange needs to make a comfortable seal around the breast.

Pumps have different suction and cycles settings. You may want to start with a low suction and high number of cycles to stimulate your let-down. Once your milk starts flowing, you can decrease the number of cycles and increase suction. In order to avoid getting sore, it is a good idea not to use the same suction setting for long periods of time. Switching between low and high suction also helps to trigger more let-downs.

Once you are done pumping, you can massage both breasts and hand express to make sure your breasts are completely drained.

How much milk to pump

As breastmilk is highly digestible, breastfed babies tend to feed little and often. When babies nurse directly at the breast, milk intake varies from feeding to feeding, so the amount of breastmilk taken per bottle may also vary throughout the day. On average, babies need 750-1035ml of breastmilk per day between one and six months of age. You may want to pump slightly more than this to make sure you have enough milk when your baby goes through a grow spurt.

Feeding your breastmilk

Babies drink from a bottle and nurse from the breast in a completely different way. When drinking from a bottle, babies cannot control the flow of milk, which can be uncomfortable for them and can lead to overfeeding. In order to minimise this problem, you may want to feed your baby your expressed milk in a way that is as close as possible to nursing. This is often referred to as paced bottle feeding.

Rather than feeding your baby bottles of expressed milk according to a strict schedule, you may want to feed on demand, as you would if they were nursing at the breast, being aware of early hunger cues. Holding your baby upright and keeping the bottle in a horizontal position allows the baby to suck actively, as he would at the breast, and to control the flow of milk, taking a break whenever he needs to. Offering the bottle teat gently, letting the baby draw it into their mouth, and feeding to satiation also allow the baby to be more in control of his feed. You can find more information on how to feed your baby your expressed milk in our article ' Bottles and other tools '.

It's important to remember that breastmilk should not be warmed up in a microwave or in a pan on the hob, in order to avoid damaging its nutrients. Shaking breastmilk is also not necessary.

Storing your breastmilk

Breastmilk's antibacterial properties help it stay fresh, so it can be safely stored at room temperature for four-six hours and in the fridge for up to a week. If away from home, you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature, then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections, however all human milk is beneficial for you baby.

You may well see that your expressed milk is not always the same colour, and that it separates into layers when it has been stored for a while. Neither of these is a cause for concern, and a gentle swirl of the container before you feed your milk to your baby should make the layers mix again.

If you find that you are producing more milk than your baby needs, you might like to consider donating your milk by registering as a donor for your local breastmilk bank.

Stopping exclusively pumping

When you feel ready to stop expressing milk for your baby, it's important not to rush into dropping pumping sessions, in order to avoid the risk of experiencing blocked ducts or mastitis. Your breasts need time to adjust, so it's best to adopt a gradual approach. You could try to reduce the length of your pumping sessions by a few minutes over a few weeks, or you could try slowly increasing the intervals between sessions.

Exclusive pumping, while also doing the day to day work of looking after your baby, can be exhausting, and sometimes mothers and parents wrestle with feeling guilty about having stopped "too soon". By taking on the work of exclusive pumping, though, you gave your baby a wonderful gift.

Written by Nicola Sheldon (LLL Berkshire and Oxfordshire) and Eva Williams (LLL Oxfordshire), May 2020.
Thanks to Harriet Valentino for her input and to Lois Rowlands, Rae Vacher Lowe and Laura Loasby for the photos.

Further reading

https://www.laleche.org.uk/hand-expression-of-breastmilk/
https://www.laleche.org.uk/my-baby-needs-more-milk/
https://www.laleche.org.uk/too-much-milk-and-oversupply/
https://www.laleche.org.uk/bottles-and-other-tools/
https://www.laleche.org.uk/expressing-your-milk/#Pumps
https://www.laleche.org.uk/storing-your-milk/
A mother's story from our members magazine breastfeeding matters
https://kellymom.com/category/bf/pumpingmoms/pumping/
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

i Exclusively Pumping Breastmilk. Second edition. Casemore, S. Gray Lion Publishing, 2014

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Exclusively Expressing Breastmilk for Your Baby - La Leche League GB

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When babies cannot feed at the breast comfortably and effectively, and breastfeeding support is hard to find or not able to help, mothers may choose to use a breast pump to express all the milk their baby needs, and then feed via a bottle or feeding tube. This is known as exclusive pumping.

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How to latch a baby using the exaggerated latch technique.

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Baby product information - The Lullaby Trust

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It can be hard to know which products are safest for your baby to sleep in. We’re here to help you find the safest baby products…

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Attaching your baby at the breast - video

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Attaching your baby at the breast - video

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding success and what a mother can do to deeply attach her baby to her breast.

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Attaching Your Baby at the Breast - Video - Global Health Media Project

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Good attachment will help a baby get more milk and make breastfeeding more comfortable. This video shows why good attachment is so important to breastfeeding

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Remember, it can take a while to feel confident about breastfeeding, but you're not alone. Your midwife and health visitor are there to help, guide and support you.

There's also lots of advice available online or via support groups, helplines and websites.

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Breastfeeding help and support - Start for Life

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It can take a while to feel confident with breastfeeding, but there is lots of help and support available. Find out more.

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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.

Most mothers experience some engorgement in the first weeks after birth. With changing hormone levels, your breasts swell and enlarge as milk production increases. It may seem as though they are filling up with milk, but engorgement is more than milk storage. Your body directs extra blood and fluids to your breasts to boost milk production. This causes congestion and swelling which will decrease as your body adjusts.

Minimizing early engorgement
Treat engorgement to...
When to treat engorgement
After the first few weeks
Causes of engorgement
Treating engorgment
Be sure your baby is sucking effectively
Reverse pressure softening
Keep comfortable
Watch out for signs of mastitis

Minimizing early engorgement

New mothers vary in how engorged their breasts become in the weeks after birth; some experience little engorgement, others describe their breasts as feeling like watermelons!

Try these suggestions

Breastfeed your baby frequently from birth: at least 8-12 times in 24 hours. Keeping your baby close makes it easier to nurse every hour or two.

If your baby is sleepy, perhaps from a medicated birth, you may need to wake him and encourage him to nurse.

Aim to be comfortable while breastfeeding, and learn how to get your baby latched on well.

If your newborn is unable to breastfeed, electric hand express frequently until your milk 'comes in', then combine with using a hospital-grade help establish your milk production and relieve engorgement. Your milk breastpump to can be given to your baby until he is able to nurse.

Treat engorgement to...

Make breastfeeding easier
Even if you feel as though you have lots of milk, engorgement can make it harder for your baby to latch on to your breast and feed well. A poor latch-on can give you sore nipples. Your baby may also have trouble coping with the flow of milk from engorged breasts.

Protect milk production
When milk isn't removed from your breasts, you will produce less milk. Treating engorgement gives your baby more milk now and helps protect milk production for when your baby is older.

Avoid blocked ducts or mastitis
Engorgement can result in blocked ducts leading to mastitis.

When to treat

Take action to relieve engorgement if your breasts feel firm, hard, shiny or lumpy. When milk is removed, blood circulation improves and swelling reduces. Use the suggestions below to reduce swelling and keep your milk flowing. Many mothers have a slight temperature when their breasts are engorged. Temperatures under 38.4ºC are not usually associated with infection. Keep your baby close and continue breastfeeding.

Engorgement after the first weeks

Treat as outlined below while working out the cause so you can prevent it happening again.

Common causes of engorgement are:

A missed feed or expressing session.
This can easily happen during holidays and festivities or when visitors arrive. Encourage your baby to feed more often, or express more frequently if you're apart from your baby.

Feeding a baby on a schedule
Recent research has revealed that mothers vary in how much milk their breasts can store without becoming uncomfortable. Mothers following routines often suffer from engorgement, mastitis and low milk production because their breasts are not drained often enough.

Expressing milk.
Some books advise expressing to keep milk production one step ahead of a baby's needs. However, making more milk than your baby needs can increase your risk of engorgement and mastitis, especially if you go for several hours without feeding or expressing.

A baby who is unable or unwilling to nurse well for any reason
Expressing milk frequently until your baby can nurse well will help you maintain milk production and avoid blocked ducts or mastitis.

Weaning from the breast too quickly
If you experience engorgement duringweaning, you may need to slow down the process. This will give your breasts time to adjust to the reduced demand for milk. If breastfeeding more often is not an option, try expressing just enough milk to relieve the fullness by hand or pump.

Treating engorgement
Reduce swelling and keep milk flowing:

Aim to breastfeed every 1½ to 2 hours during the day, and at night every 2-3 hours from the start of one feed to the start of the next. Let your baby finish on the first breast before switching to the second

Avoid using bottles or dummies. If a supplement is needed try using a spoon, flexible feeding cup or syringe.

Between feeds, apply ice for 15-20 minutes at a time between feeds to reduce swelling. Use an ice pack, crushed ice in plastic bags or bags of frozen vegetables (that can be refrozen several times before being thrown away). Wrap them in a lightweight towel to protect your skin.

Just before feeding, apply moist warmth to your breasts for up to two minutes to help milk flow. Try a warm wet towel, warm shower or immersing breasts in a bowl of warm water. Then, express to comfort if your baby isn't ready to feed.

Use gentle massage from the chest wall toward thenipple area in a circular motion.

Be sure your baby is sucking effectively:

Position your baby with his chest and tummy in full contact with your body. With his cheek in close contact with your breast, your baby can easily tip back his head to latch on. This way he'll take a large mouthful of breast. Listen for swallowing as he feeds.

If your baby is finding it hard to latch on - when your baby bobs his head and licks the nipple, he naturally makes it easier to latch on.

For more information on getting your baby positioned and attached comfortably see here.

Reverse pressure softening

works by moving fluid away from the nipple area.

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 fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby's lips will be.

If this isn't enough, gently hand express a little milk before feeding to soften the areola. If you choose to use a breastpump, set it to minimum suction.

Keep comfortable:

Ask your midwife or GP to recommend an over-the-counter, anti-inflammatory medication suitable for breastfeeding mothers to relieve pain and swelling.

A well-fitting, supportive bra may help. Avoid bras (and underwires) that are tight or put pressure on specific areas of the breast.

Cold, raw cabbage leaves worn inside a bra can be soothing. Change when they become wilted or after about 2 hours. Use only until swelling goes down as long-term use may reduce milk supply. Stop use if a skin rash or other signs of allergy appear.

Watch out for symptoms of mastitis:

Inflamed, hot, red or darkened localised areas of your breast, depending on your skin tone. Changes in breast appearance may be harder to spot in darker skin. You may still have engorged breasts without a noticeable red or darkened area.

Temperature over 38.4ºC or flu-like symptoms.

Weaning can make a breast infection worse so continue to breastfeed frequently especially on the affected side and treat as for engorgement. Rest and drink fluids. If fever persists, continue breastfeeding and check with your GP as you may need antibiotics. More information on mastitis.

Engorgement should improve within a day or two. If not, contact an LLL Leader for further suggestions. You may need to improve your baby's breastfeeding technique or find ways to reduce your milk supply. These are not difficult problems to solve, especially if treated promptly.

Written by Karen Butler, Sue Upstone & mothers of La Leche League Great Britain

Further Reading

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

Beginning Breastfeeding
Comfortable Breastfeeding
Dummies and Breastfeeding
Hand Expression of Breastmilk
Mastitis
My Baby Won't Breastfeed
Nipple Pain - why and what to do
Positioning and Attachment
Sleepy Baby - why and what to do

This information is available to buy in printed format from our shop

Copyright LLLGB 2016

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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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Positioning and attachment video cover - Baby Friendly Initiative

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One of your most important roles as a new parent will be feeding your baby, but it's also a learning curve.

1. Newborns feed a lot!

In the early weeks, parents can be surprised at how often babies feed. A breastfed baby tends to feed at least eight to 12 times in a 24-hour period and if they are fed whenever they show they're hungry (read about feeding cues below), they can't be overfed.

At first, they often feed more at night than during the day. If you feel that your baby is rarely happy at the breast, even after frequent, long feeds, or feeding is uncomfortable, ask for help as a change in their position or attachment to the breast could make a real difference.

If you're using formula milk, the manufacturer will provide guidelines about the amount to give based on a baby's weight and age. It's also important to follow the instructions for the particular brand of formula you're using.

If your baby is still unsettled, and they don't appear to want more milk, you could try walking around with them, using a sling, singing and cuddling them.

"It's usually easier to feed your baby when they're calm so it's really useful to recognise their 'early feeding cues' - signals that they're hungry - which they normally show before they start crying."

Here's what you might notice...

2. Most babies lose weight in the first few days

But they normally regain their birth weight by two weeks old. Do check with your midwife or health visitor if you have concerns.

Your baby's weight is also just one indicator that they are feeding well. For example, a healthy baby has good skin colour, is alert when awake, makes signs when they are hungry and is usually satisfied after feeding. The contents of your baby's nappy can also tell you a lot.

3. It's not always easy

Feeding can be challenging. Whether breastfeeding, formula feeding or combining the two, many parents have questions or concerns. It's so important that you seek help as soon as you feel something isn't right.

Bex Smith from Welwyn Garden City NCT branch says: 'Ask for help straightaway and demand it if you need to. I gave up breastfeeding after one week even though I really wanted to breastfeed. With more help, I think I could have continued.' She recommends finding out what breastfeeding support is available in your area and visiting a drop-in before you have your baby.

Need help? Call our free Feeding support line on 0300 330 0700(choose option 1). The line is open every day from 8am to midnight, including bank holidays.

With the right help and support, it is possible to overcome most feeding difficulties. 'After the first three months and various problems, something clicked, and I completely loved breastfeeding my daughter. I wasn't prepared for how much I would enjoy it,' says one mum from Herts North NCT branch.

It's important to also say that no mum should ever feel pressured to continue to breastfeed if she doesn't want to carry on, for whatever reason.

One NCT mum from Brighton says: 'If you don't really get on with it, it's ok to stop. There are lots of reasons why some women do, so don't beat yourself up.'

4. A partner's support can make a difference

Talk to someone like your partner about feeding and share your thoughts and concerns.

Support and reassurance from your partner can make a huge difference, however you feed your baby.

If you're bottle feeding expressed milk or formula, your partner can also feed your baby and if you're exclusively breastfeeding, you're more likely to have a good experience if your partner supports you.

'It was equally important that my husband learnt about breastfeeding,' says Karen Hillmansen from Redditch NCT branch.

'I really concentrated on feeding in the first two weeks. It was intense and my husband helped me because he did everything else.'

5. Breastfeeding provides health benefits for mum and baby

Overall, babies who are breastfed suffer from less sickness and diarrhoea, and fewer ear and chest infections. Women who breastfeed have a lower risk of breast cancer, some forms of ovarian cancer, and diabetes in later life.

If you continue to breastfeed as well as feed formula, your breastmilk will continue to provide benefits to your baby.

6. But feeding is not just about milk

We don't want any new parent to feel unhappy or worried about feeding. Seeking support can help you find a way to feel positive and confident about feeding again.

Feeding is much more than just getting milk into your baby's tummy. It's also about the bond you form with each other. That's why having a positive experience of feeding - whether breastfeeding or bottle feeding - is so important.

'Make sure that you and your baby are both happy,' says Bex. 'When I started to struggle with breastfeeding, I panicked when I had to feed my son and began to not want to feed or cuddle him.'

We don't want any new parent to feel unhappy or worried about feeding. Seeking support can help you find a way to feel positive and confident about feeding again.

7. Try to find out about feeding before you have your baby

It can be really helpful to prepare for what feeding might be like before you have your baby. We have lots of information about feeding on our website and, if you attend an NCT antenatal course, topics such as breastfeeding, responding to your baby's feeding cues and the value of skin-to-skin cuddles, will be covered.

Karen says: 'It wasn't until after I'd had my baby that I was really grateful we'd covered breastfeeding in my NCT class. At the time, I didn't understand why we spent so much time covering it.'

Talking to other women about their experiences can also be invaluable.

Elena Harden, from Southampton NCT branch, says: 'What helped me most was talking to my friend about her feeding experience, which was very similar to my own. This set the tone for my parenting journey; friends with babies of a similar age became my rock.' You can meet other mums at local support groups and drop-ins, such as Baby Cafés, in your area as well as your local Children's Centres.

8. Many parents breastfeed and use formula

Feeding is not a question of just breastfeeding or only formula feeding. Many women do a combination of both, often called mixed feeding, or partial breastfeeding.

Replacing breastfeeds with formula milk will reduce the amount of breastmilk you make. If you're thinking about mixed feeding, talk to a breastfeeding counsellor, your midwife or health visitor about your options.

9. There is no 'right' time to introduce bottles

Babies don't have to take a bottle by a certain age in order to avoid rejection later on.

Some parents decide to bottle-feed their baby from birth, others introduce a bottle before going back to work, or because they plan to leave their baby with someone else, while some don't use bottles at all.

There's no evidence that babies have to take a bottle by a certain age in order to avoid rejection later on and no need to give a bottle at all if you don't want to.

Don't feel rushed and equally don't worry if your baby refuses a bottle in the beginning. There are different things you can try, such as experimenting with different teats, to help them if they struggle at first.

10. Look at your baby's poo

Yes, the contents of your baby's nappies can reveal a lot! We have a useful visual guide about what to expect in your baby's nappy.

If your baby's nappy contents are causing you concern, seek advice from your midwife or health visitor.

Be confident in yourself

Finally, feel confident about your feeding decisions and try not to be persuaded or influenced by others to do something you're not comfortable with. This may be easier said than done, but with the right information and support, you can do it.

Feeding support from NCT

We support all parents, however you feed your baby. You can call our Feeding support line on 0300 330 0700 (option 1) to talk to a breastfeeding counsellor about your questions or concerns, whether you're breastfeeding, using formula milk or introducing solids.

They have had extensive training, will listen without judging or criticising, and will offer relevant information and suggestions. We have lots of helpful feeding information on our website

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The reality of feeding: 10 things you need to know | Baby & toddler, Feeding articles & support | NCT

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We look at 10 things that are useful for every parent to know when it comes to feeding their baby.

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How can I tell if my baby is hungry - feeding cues

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How can I tell if my baby is hungry - feeding cues

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Your baby’s nappy can tell you a lot - find out more here.

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Published by Better Health Start for Life and the Baby Friendly Initiative and updated in 2022, this leaflet provides mothers and health professionals with key information about breastfeeding.

The leaflet is a teaching aid for health professionals when discussing the benefits and management of breastfeeding with pregnant women, and when teaching new mothers how to breastfeed. Health professionals may also find our breastfeeding assessment tools and practical skills review forms useful when talking to new mothers.
To enquire about printed copies of this leaflet, please visit the Department of Health & Social Care campaign resource centre. The UNICEF UK Baby Friendly Initiative is unable to assist with printed leaflets for this resource.

Off to the Best Start leaflet - A guide to help you start breastfeeding

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Off to the best start leaflet - Baby Friendly Initiative

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This leaflet from the Department of Health and the Baby Friendly Initiative provides key information about breastfeeding.

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Skin-to-skin contact is a key part of the UNICEF UK Baby Friendly Initiative standards. It helps babies adjust to life outside the womb and supports mothers to initiate breastfeeding and develop close, loving relationships with their baby.

What is skin-to-skin contact?

Skin-to-skin contact is usually referred to as the practice where a baby is dried and laid directly on the mother's bare chest after birth, both of them covered in a warm blanket and left for at least an hour or until after the first feed. Skin-to-skin contact can also take place any time a baby needs comforting or calming and can help boost a mother's milk supply. Skin-to-skin contact is vital in neonatal units where it is often known as 'kangaroo care'. Here it helps parents bond with their baby and supports better physical and developmental outcomes for the baby.

Why is skin-to-skin contact important?

There is a growing body of evidence that skin-to-skin contact after the birth helps babies and their mothers. The practice:

calms and relaxes both mother and baby

regulates the baby's heart rate and breathing, helping them to better adapt to life outside the womb

stimulates digestion and an interest in feeding

regulates temperature

enables colonisation of the baby's skin with the mother's friendly bacteria, thus providing protection against infection

stimulates the release of hormones to support breastfeeding and mothering.

Skin-to-skin contact also provides benefits for babies in the neonatal unit, in that it:

improves oxygen saturation

reduces cortisol (stress) levels, particularly following painful procedures

encourages pre-feeding behaviour

assists with growth

may reduce hospital stay

improves milk volume if the mother expresses following a period of skin-to-skin contact, with the expressed milk containing the most up-to-date antibodies.

What happens during skin-to-skin contact?

When a mother holds her baby in skin-to-skin contact after birth, it initiates strong instinctive behaviours in both. The mother will experience a surge of maternal hormones and begin to smell, stroke and engage with her baby. Babies' instincts after birth will drive them to follow a unique process, which if left uninterrupted will result in them having a first breastfeed. If they are enabled to familiarise themselves with their mother's breast and achieve self-attachment, it is very likely that they will recall this at subsequent feeds, resulting in fewer breastfeeding problems.

After birth, babies who are placed skin-to-skin on their mother's chest will:

briefly cry a very distinctive birth cry

enter a stage of relaxation where they display very little movement as they recover from the birth

start to wake up, opening their eyes and showing some response to their mother's voice

begin to make small movements of the arms, shoulders and head; as these movements increase, the baby will draw up their knees and appear to move or crawl towards the breast

often rest once they have found the breast (this can often be mistaken as the baby not being hungry or not wanting to feed)

begin to familiarise with the breast after a period of rest, perhaps by nuzzling, smelling and licking around the area (this familiarisation period can last for some time and is important, so should not be rushed; try to remain patient and allow the baby to work out how to best attach themselves)

self-attach and begin to feed (it may be that mother and baby need a little help with positioning at this stage)

come off the breast once they have had a chance to suckle for a period of time. Following this, often both mother and baby will fall asleep.

Most term healthy babies will follow this process, providing it is not interrupted by anything, for example taking the baby away to weigh or the mother going for a shower. Interrupting the process before the baby has completed this sequence or trying to hurry them through the stages may lead to problems at subsequent breastfeeds. If the mother has been given a lot of analgesia during labour, the baby may be drowsy and this process can take longer.

Skin-to-skin contact in the Baby Friendly standards

The Baby Friendly standards require that skin-to-skin contact is valued and supported in hospitals.

Maternity units are required to ensure that:

all mothers have skin-to-skin contact with their baby after birth, at least until after the first feed and for as long as they wish

all mothers are encouraged to offer the first feed in skin contact when the baby shows signs of readiness to feed

mothers and babies who are unable to have skin contact immediately after birth are encouraged to commence skin contact as soon as they are able, whenever or wherever that may be.

Neonatal units are required to ensure that:

parents have a conversation with an appropriate member of staff as soon as possible about the importance of touch, comfort and communication for their baby's health and development

parents are actively encouraged to provide comfort and emotional support for their baby, including prolonged skin contact, comforting touch and responsiveness to their baby's behavioural cues

mothers receive care that supports the transition to breastfeeding, including the use of skin-to-skin contact to encourage instinctive feeding behaviour.

Safety considerations

Vigilance of the baby's well-being is a fundamental part of postnatal care immediately following and in the first few hours after birth. For this reason, normal observations of the baby's temperature, breathing, colour and tone should continue throughout the period of skin-to-skin contact in the same way as would occur if the baby were in a cot (this includes calculation of the Apgar score at 1, 5 and 10 minutes following birth). Care should always be taken to ensure that the baby is kept warm. Observations should also be made of the mother, with prompt removal of the baby if the health of either gives rise to concern.

Staff should have a conversation with the mother and her companion about the importance of recognising changes in the baby's colour or tone and the need to alert staff immediately if they are concerned.

It is important to ensure that the baby cannot fall on to the floor or become trapped in bedding or by the mother's body. Mothers should be encouraged to be in a semi-recumbent position to hold and feed their baby. Particular care should be taken with the position of the baby, ensuring the head is supported so the infant's airway does not become obstructed
Notes - Mothers

Observations of the mother's vital signs and level of consciousness should be continued throughout the period of skin-to-skin contact. Mothers may be very tired following birth and so may need constant support and supervision to observe changes in their baby's condition or to reposition their baby when needed.

Many mothers can continue to hold their baby in skin-to-skin contact during perineal suturing, providing they have adequate pain relief. However, a mother who is in pain may not be able to hold her baby safely. Babies should not be in skin-to-skin contact with their mothers when they are receiving Entonox or other analgesics that impact consciousness.

Notes - Babies
All babies should be routinely monitored whilst in skin-to-skin contact with mother or father. The following observations should be included.

Checking that the baby's position is such that a clear airway is maintained - observe respiratory rate and chest movement. Listen for unusual breathing sounds or absence of noise from the baby.

Colour - the baby should be assessed by looking at the whole of the baby's body, as the limbs can often be discoloured first. Subtle changes to colour indicate changes in the baby's condition.

Tone - the baby should have a good tone and not be limp or unresponsive.

Temperature - ensure the baby is kept warm during skin contact.

Always listen to parents and respond immediately to any concerns raised

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Skin-to-skin contact - Baby Friendly Initiative

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Skin-to-skin contact is important for babies and mothers to develop close, loving parent-infant relationships and to initiate breastfeeding.

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Positive touch is a way of communicating your love and reassurance to your baby and hearing your baby's needs in return. Babies do communicate, and by watching and listening to your baby you can learn what kind of touch to use and when it is appropriate, safe and pleasurable for your baby.

It's harder for your baby to communicate when exposed to too much noise, too much light, too much cool air, or an uncomfortable lying position. See whether the environment can be calmed down first. In time, you will get to know your baby's individual ways and you may find your baby responding more often and for longer.

Comfort holding

Comfort holding is one of many ways for you and your baby to get to know each other. Your baby may be more comfortable lying in the incubator than being held. In this case, the staff may suggest that you try comfort holding if they think your baby is well enough. Comfort holding is 'still touch'. Cradling your baby with still, resting hands can be more comforting than stroking or massage, which are more stimulating.

Comfort holding can:

soothe your baby during uncomfortable procedures.

settle a restless baby.

help your baby to get back to sleep after feeds and care.

encourage your baby to be quietly awake and responsive.

Comfort holding is a way to experience loving touch when your baby is not ready to be held.

Talk to your baby's nurse about comfort holding. Together you can watch for signs from your baby that will guide you as to when and how to do it.

Be careful to:

Remove watches and jewellery, pull your sleeves up to the elbows, and wash your hands and lower arms. This reduces the risk of infection inside the incubator.

Always make sure that your hands are warm before touching your baby.

If your baby has difficulty keeping warm, make sure there is a layer of fabric (a hat, vest or blanket) between you.

Speak to your baby before touching, so that they are aware of your presence before you start.

Cradle one or both hands around your baby's feet, head or body, and keep them still. Your baby may also like to grasp one of your fingers.

Wait and watch for signs that tell you that your baby is relaxed.

You can continue for as long as you are both comfortable. When you finish comfort holding, move your hands away from your baby very slowly.

Kangaroo Care

Kangaroo Care is skin-to-skin contact when a baby is placed against the parent's chest. Benefits include improvements with lactation and with establishing breastfeeding, and better weight gain for the baby. In the longer term, it helps parents to feel closer to their babies and more confident in caring for them. Kangaroo Care can be used with babies with high medical needs, but this will require careful planning and collaboration with the neonatal staff.

Talk to staff and plan a good time and comfortable place for you to try Kangaroo Care.

While Kangaroo Care is based on direct skin-to-skin contact, removing your baby's clothes is not vital if this is upsetting for him or her. A hat and a blanket for extra warmth might be necessary for very small babies.

Hold your baby chest-to-chest tucked inside your clothes, enclosing him/her to keep his/her temperature stable. Check that the head is well supported and if you can't see your baby easily, try using a hand mirror.

Explore what you both like to enjoy together. Some babies like to have their eyes shielded, others like to be sung to softly or while having a tube feed. Allow time for your baby to settle and get the full benefit.

If you baby is happy, you can cuddle for as long as you are both comfortable. Lie back, relax and enjoy.

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Premature and sick babies undergo many medical procedures that can cause them some discomfort. As your baby's parents, you are the best people to balance this with a positive, reassuring touch.

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This video guides mothers on how to hand express and talks about the times when hand expression might be useful.

See the Breastfeeding Network website for FAQs and a leaflet all about expressing and storing breastmilk.

Problems viewing this video? Contact us.

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Hand expression video - Baby Friendly Initiative

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This video guides you through how to hand express, and talks about the times when hand expression might be useful for you.

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This leaflet is for parents whose baby has been born prematurely (before 37 weeks gestation) or for parents whose baby may be born prematurely.

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Videos to help expressing mums. At Ardo, we understand what it is like to be a new mum and feel overwhelmed by having a new born baby and the need to express. That is why we have produced a comprehensive range of videos to help you navigate your breastmilk feeding journey.

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A Video about Baby Feeding Cues and Behaviours

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Image Healthy babies will take what they need, as long as you respond to their feeding cues. Here is a video to learn about what those cues are and what

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Is your milk supply really low?

New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds. There are many reasons for babies to be unsettled and breasts usually get softer after the first few weeks - these are not proof of low milk supply. If your baby is growing as expected (at least 20-30g a day, on average, during the first three months) just on your milk, then your milk supply is fine. If your baby does not grow well on your milk alone, then you may be making less milk than your baby needs.

The most common reason for genuine low milk supply is a slow start with breastfeeding, when not enough milk was removed from your breasts in the early days after birth. It may be possible to turn this around, with prompt action. Some other causes of low milk supply, such as previous breast surgery and some hormonal conditions, may mean that there is a limit to how much milk you can produce. Many nursing parents can make more milk than they are making, and you never know what you can do until you try!

Increasing low milk supply is hard work. It takes time, energy and commitment. It is important to be realistic from the start about your goal and how much time and energy you are able to invest. It works best when you have lots of practical and emotional support, so you can concentrate on your baby and your milk supply. Remember that this won't be forever - it is a short-term investment for long-term gain. Set yourself short-term goals, e.g. 48-72 hours, then review your progress. If you are not able to increase your milk supply as much as you would like, or decide that it is not realistic to try, you can still have a close, happy feeding relationship with your baby.

While you are working on your milk supply:

Find skilled feeding support. LLL is here to help! You can find information about ways we can support you here. We can also help you connect with other women who have experienced low milk supply.

Track how you are doing. Keep a record of how much milk you express and the amount of formula or donated breastmilk your baby takes (if relevant) and how many wet and dirty nappies your baby produces. Tracking changes over time is useful to show how well your plan is working and can help you decide what to do next.

Monitor your baby's health and growth. Your baby needs to be weighed regularly while you are working on your milk supply. Your midwifery or health visiting team will usually do this. For more complex feeding issues, you may be referred to a local specialist infant feeding team or clinic. Any baby who is not growing as expected should be under the care of a doctor. This is because occasionally, slow growth can be caused by underlying health issues in the baby, rather than low milk supply.

How milk production works

Milk production starts in the middle trimester of pregnancy. After birth, milk continues to be made in the breasts in response to milk being removed. The most common reason for low milk production is a slow start with breastfeeding - not enough milk being removed from the breasts in the early days after birth.

Milk supply usually reaches its peak around four weeks after birth, with most of the increase happening in the first two weeks. If not enough milk is removed during this time, your breasts may end up making less milk than your baby needs. It may be possible to increase milk production, by removing more milk from your breasts. The earlier you start this, and the more energy you put into it, the higher your chances of making more milk. Even if more time has passed, it may still be possible to increase your milk production to some extent, but unfortunately there is no guarantee of being able to make a full milk supply.
Any amount of milk you are able to produce is valuable to your baby. Breastfeeding is about much more than just milk and you can enjoy nurturing your baby at the breast, however much milk you are making.
For more detailed information about how milk production works see How Milk Production Works.

Risk factors for low milk supply

These include:

Previous breast surgery (especially reduction) or radiation

Retained placenta

Unusually small/thin/unequally sized/widely spaced breasts

A history of infertility with hormonal cause

Hormonal conditions like thyroid problems or polycystic ovary syndrome (PCOS).

If you have any risk factors for low milk supply, you may be referred to an infant feeding specialist. Some of these conditions are treatable. Even if you have underlying factors that can't be treated, you may still be able to make more milk than you are currently making.

Effective attachment

A baby who isn't deeply attached at the breast may not be able to get enough milk, and feeding may also be uncomfortable for you. Squashed ("new lipstick") nipples after a feed, skin damage and pain that lasts throughout feeds are all signs of shallow attachment. You can read more about positioning and attachment here.

Face to face help (including via video call) is usually best when working on attachment. If feeding doesn't become more comfortable and/or effective even with skilled help, your baby may be referred for an oral assessment (a thorough examination of their mouth) to check for tongue tie, which is a problem for a small number of babies and can be treated. You can read more about this here and here.

Hold your baby skin to skin

This helps your milk-making hormones to work well, keeps your baby calm and happy, helps you and your baby feel connected and encourages interest in feeding. You can read more about holding your baby skin to skin here.

How often and when to feed

While you are working to increase your milk supply, you will want to encourage your baby to feed as often as possible. Signs of interest in feeding include your baby turning their head and opening their mouth (rooting), licking lips, mouthing hands, restlessness and making small sounds. Try to offer a feed when your baby is first interested, before they become upset. If your breasts are feeling full or you just feel like feeding your baby, you can offer your baby a feed, even if they are not asking.

You may want to avoid using a dummy, a baby swing, or swaddling your baby, as these can make it difficult to tell if your baby is interested in feeding.

Don't give your baby water, tea or any other non-milk drinks.

Breastfeeds don't have to be regular (e.g. every 2-3 hours). Your baby just needs to have enough feeds in 24 hours, whenever they are awake enough and interested. Most young babies need at least 8-12 feeds in 24 hours. Don't watch the clock - watch your baby and count feeds.

Keep your baby feeding actively when they are at the breast

Knowing when your baby is feeding actively at the breast, with deep sucks and swallowing after every one-two sucks, can be very helpful. While you are working to increase your milk supply, you will want to make sure that milk is removed from your breasts as effectively as possible. If your baby is mostly doing light, fluttery sucks with very little swallowing (three or more sucks per swallow), they are not removing much milk. If your goal is to increase the amount of milk removed from your breasts, you may want to end the feed and use a breast pump instead to maximise efficient milk removal.

Breast compressions and switching sides can help to keep your baby actively feeding for longer. Start compressing your breast as soon as your baby stops actively feeding. You can read about how to do compressions here. When your baby is no longer actively feeding even with compressions, repeat on the other side. Offer as many breasts as your baby will take - it can be more than two!

Some babies seem to want to feed all the time and protest when you take them off the breast. If they are not growing well, it may be because they are not yet breastfeeding effectively. To increase your milk supply, you may temporarily need to limit their time at the breast, to give you more time to express your milk.

Increasing breast stimulation by expressing your milk

If the steps above do not result in increased milk supply, the next step is to increase stimulation of your breasts by expressing your milk:

An LLL Leader and/or your local infant feeding specialist will agree with you how many times in 24 hours to aim for at first. For more impact, you can increase the number of sessions. For maximum effect, you would aim to express 8-12 times in 24 hours (this is the number of times most babies need to feed).

A double electric breast pump, preferably a large "hospital grade" pump, is usually the best tool for this job. Smaller single electric and manual pumps are designed for occasional expressing, not the big task of increasing milk supply.

You don't need to pump after set intervals (most babies don't feed after set intervals either), just as often as you can. The important thing is how many times you express in 24 hours - it's up to you when you do it. It's fine to take a break for a few hours to go out or to sleep! More, shorter expressions often work better than fewer, longer ones and it's fine to stop in the middle of pumping, if you need to do something. Even if you only have a few minutes, it's worth pumping. Notice the times of day or night when you can express most and aim to pump more often then. First thing in the morning and in the quiet hours of the night can work well. Experiment to see what works best.

Use your hands as well as your pump. Try massaging your breasts before and during pumping. You might want to buy or make a "hands-free pumping bra" to hold your pump in place. Some women find that they can express lots of milk by hand after they have finished pumping. You can see how to use your hands to express more milk in this video.

Try covering the collection bottle with a sock so you can't see it. Frustration about how slowly it is filling with milk can make it even slower!

Try visualisation, e.g. a flowing fountain, or milk pouring into a bottle.

Many women find that they get most milk in the first few minutes of pumping. To make the most of this, it can work well to pump very frequently for short periods, stopping and starting as many times as possible. This is sometimes called 'power pumping'.

Try pumping with a piece of your baby's clothing near enough to smell, or while looking at your baby, or holding your baby skin to skin.

You can find more tips on how to express milk here.

Balancing breastfeeding and expressing

The priority at this stage is to increase your baby's milk intake and your milk supply. This may mean limiting your baby's time at the breast, for now, to free up enough time to express. Your baby has lots of time to learn to breastfeed. Your milk supply will become more difficult to increase as time goes on, so it is important to act quickly. This might feel all wrong - you want to breastfeed, not pump! Remember that it is an investment of your time now to help your baby breastfeed later. As your milk supply increases, breastfeeding will get easier and more rewarding for your baby. When breastfeeding is going well, you will be able to let your baby feed as much as they want.

How to feed expressed milk to your baby

There are lots of options - an LLL Leader can help you choose some to try, including paced bottle feeding and more, , and at-breast supplementers (lactation aid).

Keeping the breast a happy place for your baby

If your baby is upset, try offering some extra milk before offering the breast. This helps your baby to associate the breast with feeling full and happy, rather than hungry and frustrated.

Babies enjoy ending a feed by falling asleep at the breast. You can offer expressed or formula milk between breasts, allowing your baby to finish with the second breast.

You can give milk by bottle or cup with your baby's cheek against your breast.

If a supplementer is used, your baby can drink expressed milk while breastfeeding.

Domperidone

This is a prescription medication that can help to increase milk supply in some women, whilst they are taking the tablets. It is not suitable for everyone, e.g. it is not safe for those with certain heart conditions. Because of this, doctors are currently discouraged from prescribing domperidone to anyone. However, the NHS states that domperidone may be appropriate in some cases, so if you would like to try it, it's worth discussing with your GP, and taking along some information for them to read.

The most important thing to do to increase milk supply is to remove more milk from your breasts, so don't worry if you can't or prefer not to take domperidone.

Formula milk

Some babies need extra milk for a short time or longer term if their mother is not making a full milk supply. If donated human milk is not available, the only safe alternative is infant formula milk. You can find LLLGB's information on milk sharing here.

It is never safe to suddenly stop or reduce supplements of formula or donor breastmilk. This needs to be done gradually, to allow your own milk supply time to increase. and it is very important that your baby is weighed regularly, to make sure that they continue to get enough milk. It would usually be appropriate to weigh your baby every 1-2 weeks while working on reducing supplements. You can read about how to use donor milk or formula to support breastfeeding here.

Whether or not you are producing all the milk your baby needs, you can still have a great feeding relationship with your baby. The breast can still work beautifully to calm, comfort and soothe your baby, even if your milk supply remains low. Any amount of your milk that your baby gets will be beneficial to them. Some of the immune components of milk become concentrated so that babies get the same amount, no matter how much of your milk they get each day. Whatever feeding looks like for you and your baby, we are here to support you.

Summary
Stage 1 - make sure your baby is feeding as effectively as possible

1. Consider risk factors for low milk supply.

2. Make sure that your baby is well positioned and attached at the breast. This will include checking for any reason the baby might not be able to attach and feed well (e.g. tongue tie).

3. Hold your baby skin to skin as much as possible.

4. Offer the breast as soon as your baby shows any signs of interest in feeding, at least 8-12 times in 24 hours, waking baby if necessary.

5. Switch sides and use breast compressions to increase milk flow.

Stage 2 - if milk supply has not increased enough

1. Express your milk at a frequency agreed with an LLL Leader and/or infant feeding specialist.If your baby is still not growing well, increase the number of expressions. For maximum effect, aim for at least 8 times in 24 hours. This may mean temporarily limiting your baby's time at the breast, to give you enough time to express.

2. Feed as much expressed milk as your baby wants to drink by cup, paced bottle-feeding, finger feeding or nursing supplementer.

3. Aim to keep your baby's time at the breast happy and relaxed, and to end feeds with your baby at the breast (if necessary, after giving your baby extra milk at the start or in the middle of the feed) as often as you can.

4. Consider using the medication domperidone, which may help increase your milk supply.

5. If necessary, use enough formula milk to make sure your baby grows as expected and seems satisfied.

Further reading

Getting breastfeeding back on track after a difficult start
How milk production works
My baby needs more milk
Expressing your milk
Relactation and induced lactation - bringing back milk supply after a break or bringing in a milk supply when you haven't been pregnant.

Books
Making More Milk, by Diana West & Lisa Marasco (2019)
Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West (2001)
Breastfeeding Without Birthing by Alyssa Schnell - for non-gestational parents who are inducing lactation.

Written by Jayne Joyce and Emily Tammam, LLL Oxfordshire, February 2021

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How to increase your milk supply - La Leche League GB

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Is your milk supply really low? New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds.

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Your breast milk is important to your baby at any age. Giving your premature baby your breast milk benefits their health as well as yours.
Breast milk:

helps protect your baby from infections, particularly of their gut - premature babies are more likely to get infections

contains hormones, nutrients and growth factors that help your baby to grow and develop

is easier for your baby to digest than formula milk, because it's human milk specially designed by your body for your baby

See other benefits of breastfeeding.

If your baby is very small or sick, they may not be able to breastfeed from your breast at first. But you can start regularly collecting your breast milk (called expressing) as soon as possible after your baby is born.

This will help get your milk supply going and the milk you express can be frozen so you can give it to your baby later. Then you can start breastfeeding from the breast once you and your baby are ready.

Even if you were not planning to breastfeed, you could express your breast milk for a while to help boost your baby's immune system in the early weeks after birth.

Spending lots of time close together with your baby can help boost your breast milk supply and establish breastfeeding.

Skin-to-skin contact with your premature baby

If your baby is well enough, you'll usually be encouraged to spend time holding them against your skin as soon as possible. This is sometimes called kangaroo care.

Your baby will usually be dressed just in a nappy, hat and socks and then placed inside your top, under a blanket, or in a soft sling so they can be held securely against your skin. If it's cold outside, you can also put them in a sleeveless vest with an open neck.

This skin-to-skin contact helps you feel close to your baby. Your partner can enjoy this kind of contact as well.

For your premature baby, skin-to-skin contact:

reduces stress and pain

promotes healthy weight gain

helps to establish breastfeeding

helps them sleep better

helps to regulate and support their heart rate and breathing

For mums, skin-to-skin contact:

helps reduce your chance of developing postnatal depression

increases your confidence as a new parent

can help make breastfeeding easier and increase the amount of milk you make

For dads and partners, holding your baby skin to skin:

helps you bond with your baby - babies can hear both parents' voices in the womb and will be calmed by the sound of your voice as well as their mum's

helps you feel more confident as a parent

Expressing milk if your baby is premature

It's recommended you express often, ideally at least 8 times a day to begin with - including at least once at night - to keep your milk supply up.

In the early days, it's often easier to express your milk by hand. Your midwife or a breastfeeding supporter can show you how.

You'll probably only express a few drops to begin with but, if you hand express often, this will increase. Even if you are only expressing a small amount it will still help your baby.

In the early days you can collect your breast milk in a small, sterile cup and store it in a syringe.

Once you are producing more milk, you could try using a breast pump. If your baby is in a neonatal unit, the hospital will usually be able to lend you an electric breast pump for expressing your milk. If they cannot lend you one, you can hire one.

Read more about breastfeeding help and support to find out about hiring a pump, or phone the National Breastfeeding Helpline on 0300 100 0212.

The staff, your midwife or a breastfeeding supporter can give you advice about how to increase your milk supply. They can also show you how to encourage your milk to flow and how to use a breast pump.

Always ask for help early if you have any worries or questions.

Tube feeding your baby

Babies do not normally learn to co-ordinate the sucking, swallowing and breathing needed for feeding until about 34 to 36 weeks of pregnancy.

If your baby is born before this time, they may need to have breast milk through a feeding tube to begin with. This goes through their nose or mouth into their stomach. The staff in the neonatal unit can show you how to feed your baby this way.

Babies who are very premature or sick may need to be fed through an intravenous (IV) line to begin with. A fluid containing nutrients is fed straight into your baby's vein.
The Bliss website has more information and advice about tube feeding

Using donor breast milk

Some hospitals can provide donated breast milk for your baby to have until your own supply is established.
See the United Kingdom Association for Milk Banking (UKAMB) website for more information about donor breast milk
If donor breast milk is not available, your baby can have formula milk until you're producing enough breast milk.

It's recommended you do not buy donor milk over the internet. This is because the source cannot be confirmed and you cannot be sure whether the donor or the milk has been screened for infections.

Moving on to breastfeeding your premature baby

While holding your baby, you may notice them try to move towards your breast. Gradually, as they develop and get stronger, they will be able to breastfeed directly.

The first time you try it, the hospital staff may ask you to express first, then put your baby to your breast. This is so your baby is not overwhelmed when your milk lets down.

At first, your baby may only lick the breast, then next time take a few sucks until they gradually become happy and confident feeders.

You can combine tube feeding with breastfeeding until your baby is getting everything they need from the breast only.

Using a lactation aid (supplementer)

You could also consider using a lactation aid. This is a way of supplementing your baby's breastfeeds with either expressed breast milk or formula.

A tiny tube is taped next to your nipple so your baby can get milk through the tube as well as from your breast while attached to your breast. This helps to support your baby as they get used to attaching to the breast.

Got a breastfeeding question?

Sign into Facebook, or use an Amazon Alexa or Google Home and use the Start4Life Breastfeeding Friend chatbot for fast, friendly, trusted NHS advice anytime, day or night.

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Find out about breastfeeding your premature baby, including using expressed breast milk to start with before moving onto feeding them directly from the breast.

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Safe sleep advice for babies - Start for Life

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Find out which products your baby needs to sleep safely and when co-sleeping is not advised.

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst. There are many versions of normal, and we will share some of these below.

When your baby is born, your colostrum (first milk) has laxative and diuretic compounds in it to make your baby wee and poo. In the first few days your midwife and health visitor will ask how many wet and dirty nappies your baby has had, so you may find it helpful to take note of how many nappies you change.

Your baby may not poo much at first but this will increase as your milk comes in. For an idea of how many poos to expect, see https://www.laleche.org.uk/is-my-baby-getting-enough-milk/#dirtynappies

It can be tricky to tell if disposable nappies are wet - after five full days, when copious milk comes in, they should be heavy.
Many disposable nappies have a faint line down the middle of the nappy which changes colour when wet.
You can feel what a properly wet nappy should feel like by putting three tablespoons (45ml) of water onto a clean, dry one. Urine should be pale and mild smelling.
This post on signs of effective feeding has more information.

Pictures 1-9 below show the contents of one baby's nappy in the first few days of their life, to give you an idea of what to expect from a healthy, full-term baby. If you have any concerns about your baby's poo, or if you see blood in the nappy (beyond the first few days, when baby girls can have a mini period caused by birth hormones), don't hesitate to contact your midwife, health visitor or GP.

Picture 1
Baby's first bowel movement, called meconium, is tar-like, sticky and hard to remove.

Picture 2
Baby's second bowel movement.

Picture 3
Poo from the first day of baby's life. Reddish pink urate crystals are visible in this nappy; see picture 10 for more about urates.

Picture 4
Bowel movement on day two. Your baby's poo will gradually change colour, from black to green to brown. It becomes a lot easier to wipe off as your baby begins to drink more milk.

Picture 5
Day three bowel movement. Looking a lot paler, heading towards a yellowish colour, and much less sticky.

Picture 6
Day four bowel movement.

Picture 7
Day five bowel movement.

Picture 8
Day six bowel movement.

Picture 9
Day ten bowel movement. By this age most fully breastfed babies' poo will be this pale yellow colour. It is common for babies to have what are described as "explosive" poos, which may take you by surprise if your baby poos while you are changing their nappy!
The following pictures show some ways in which your baby's poo may look different from the typical pattern shown above.
Picture 10
In the first few days, you may see reddish pink crystals called urates in your baby's nappy. They are often described as looking like brick dust. As your baby begins to take more milk, the urates should stop appearing in her nappy.

Picture 11
Sometimes your baby's poo may be light green rather than yellow, and have small lumps in it like cottage cheese. This is common and not significant by itself, unless your baby has other symptoms that you are worried about.

Picture 12
This poo came from a three-week-old baby who was given Gaviscon because of reflux. When the medication was stopped, the baby went back to having runny yellow stools.

Picture 13
After the 12-week injections this baby had green poo, which went back to being yellow after a few days.

Picture 14
This dark green poo came from a baby who was later diagnosed with cow's milk protein intolerance.

Picture 15
This poo, containing mucus, came from a baby diagnosed with allergies. Mucus in the poo is also common when a baby has a heavy cold, but this should be temporary and should stop when the baby is well again. If your baby's nappy has persistent or unexplained mucus in it, seek medical advice.

Picture 16
As your baby starts to eat solid foods, you will see the results in his nappy. It is common for your baby's very first foods to come out looking almost exactly as they did when they went in, as his digestive system is not used to dealing with these other foods yet. This is much easier to spot if your baby is eating finger foods rather than mashed food; the mashed foods are passing through semi-digested in the same way, but are less obvious in the nappy.

With time, your baby's poo will gradually change from yellow liquid to soft brown lumps, and you won't generally see pieces of food. However, some foods are hard to digest and tend to pass through the body unchanged (even for older children or adults). This picture shows an 11-month-old's nappy with partially digested grapes visible in it. Strongly coloured foods (like blackberries or beetroot) can also affect the appearance of your baby's wee and poo.

Written by Amanda Dunbar and Emma Taylor for LLLGB, 2017

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As new parents, we suddenly find ourselves examining our babies' poo more closely than we could ever have imagined. We pay attention to the colour, quantity, texture and smell, and notice the slightest changes. We then go to the internet looking for answers and fear the worst.

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

When a baby can't breastfeed
Return to work or separation
Making more milk
Storing breastmilk
Pumps
Tips for expressing
Expressing when out and about
Support and Encouragement
Feeding your baby your milk

When a baby can't breastfeed

Breastmilk is especially important for babies who are unwell. And if your baby can't breastfeed because of prematurity he will benefit from every drop of breastmilk you can give him. Some babies have conditions which mean they can't feed at the breast, they can still have your milk. If your full term baby is taking a while to learn to breastfeed, expressing protects your milk production and gives you both time to practice.

The prospect of expressing might seem daunting at first but giving your milk is something you can do that will make a real difference to your baby's short and long term health.

Return to work or separation

When you can't be with your baby, expressing maintains your milk production and helps you avoid engorged breasts during the separation. It also means your baby can continue to have his familiar milk when you're away.

See Working and breastfeeding, and When mum can't be there.

Making more milk

You teach your breasts to make more milk by removing milk. Full breasts signal to your body to slow down milk production, so don't wait for your breasts to 'fill up' before expressing, as this will mean a lower milk supply over time. The more thoroughly and frequently you remove milk from your breasts, especially in the early days and weeks, the more milk you will make and the greater the benefit for your long term supply. If you're expressing to establish milk production, making extra milk in the early days can make it easier to produce more milk later on to keep up with your baby's needs. Milk can always be frozen and used later.

If you are expressing to increase milk production remember a well-attached baby is far more effective than any pump, so do seek help to improve positioning and attachment so your baby can feed more effectively when at the breast.

See How to increase your milk supply.

Storing breastmilk

Breastmilk's antibacterial properties help it stay fresh so it can be safely stored at room temperature for up to 4 hours and in the fridge for up to a week. If away from home you could use a cool bag with ice packs. Our page Storing Your Milk has comprehensive details on safe periods for storing expressed milk for healthy babies. If your baby is unwell or premature then follow hospital guidelines. Your baby will benefit more from fresh than frozen breastmilk because its living properties will help him fight off possible infections.

Pumps

You can simply use your hands to express, or you can buy or rent a pump. Your choice of pump will depend on your reasons for expressing and your circumstances.

If your baby can't yet feed directly from the breast, or if you need to greatly increase your milk production then consider a hospital-grade double electric pump. Such a pump lets you adjust the suction and pumping speed (cycling) and is designed for long-term use. Many hospitals have these pumps available for use on the ward. Some have pumps that you can hire and take home for use during the night, or you could rent from a pump manufacturer.
Even if you rent a hospital-grade pump you may also find a smaller, portable pump useful for when you are out and about.

For expressing while out at work mini electric pumps are a popular choice. These usually come in a carry case for portability.

For occasional pumping a smaller electric or hand pump may be sufficient. Or you could just hand express.

Double pump set: hire pumps and some mini electric pumps come with two pump sets. Double pumping (expressing from both breasts at once) improves milk flow and saves time.

Check fit: check that your pump flange and nipple tunnel fits you comfortably. If too much of your areola is pulled into the tunnel during pumping it can cause rubbing and soreness. If the tunnel is too tight it can inhibit milk flow. Size varies between different makes and models, with some available in a choice of sizes. You may need a different size for each breast.

Suction and cycling controls: look for a pump with separate controls for suction and cycling (speed) so you can vary these to suit yourself.
Cleaning the equipment:
Always wash your hands before expressing milk.
If you're expressing for a premature or sick baby who is still in hospital then you'll need to follow the hospital procedures for cleaning and sterilizing the pump parts.
If your baby is healthy, pump manufacturers generally recommend washing with hot soapy water. Just like your milk, pumping equipment can safely be left at room temperature for short periods and refrigerated in a clean container or bag for longer periods, giving you more time for your baby.

Tips for Expressing

Relax!
Successful expressing has a lot to do with your emotions and how you are feeling. The hormone oxytocin causes the milk in your breasts to be released (let-down). Oxytocin is released when you feel happy and relaxed. It can be difficult to relax if your baby is very ill and in hospital, or if you feel rushed or under pressure. Make a conscious effort to put your mind at ease and use your senses to help trigger milk release. Hold or sit near your baby, or look at a picture or video of him, listen to a sound recording or hold and smell an item of his clothing. Relax your shoulders and take a deep breath to calm yourself before you begin. Try not to think about how much milk you are producing-instead, try distracting yourself by reading, listening to music or a relaxation CD, watching TV or even chatting on the phone. Some mothers who express long term build up a pre-expressing ritual that 'prompts' their breasts to release milk.

Use your hands
When hand expressing, the skin-to-skin contact helps stimulate the let-down reflex. And your hands can remove milk from parts of your breast which the pump can't. It's also perfect for the first few days after birth when the small droplets of precious colostrum you make can be collected on a clean teaspoon.

Combine hand expression with pumping
This can help you remove milk more thoroughly than with pumping alone.
Each time you express start with hand expression to stimulate a let-down. Then alternate pumping (double pumping if possible) and massage/hand expression until the flow slows. Finish by hand expressing into the pump flange, or single pumping with intensive breast compressions, switching between breasts until you feel that no more milk can be removed.

Suction and cycling speed
When using a pump, set its suction strength so it feels comfortable. Aim for the lowest suction strength which effectively produces milk for you; higher settings can hurt and won't necessarily produce more milk. Encourage multiple milk releases by mimicking a baby's natural sucking pattern. Increase the cycling speed when milk flow slows and use a slower speed as flow increases again. Aim for at least 3-5 milk releases during the session. If single pumping, switching between breasts several times can help trigger milk releases.

How often?

If you need to establish milk production without breastfeeding your newborn baby, aim to express 8-12 times per 24 hours including at least once during the night to mimic a baby's natural breastfeeding pattern. It might help to plan when to express during the day (e.g. on waking, after breakfast, mid-morning, after lunch, mid afternoon, early evening, twice during the evening and once at night).

Once your milk supply is well established, you may find that you can maintain your milk production with fewer expressing sessions.

You don't need to express at evenly spaced intervals-little and often can be more effective than long sessions.

Express until milk flow stops, then have a short break and come back to it-even a few extra drops of milk or expressing for a few minutes here and there make a difference.

Expressing several times (cluster pumping) during the evening can help you increase the number of times you remove milk per day, so increasing your milk production.

If you're expressing to increase milk production, or because your baby isn't yet feeding well at the breast, do it after or between feeds to ensure your breasts stay well drained. This will stimulate them to make milk faster.

If you are expressing at work or for a short term separation from your baby see our page Workday Practicalities for useful suggestions.

Expressing when out and about

You can breastfeed your baby very discreetly but you may feel much more exposed when expressing. In a public place you can use a lockable baby change facility or ask to use a changing room in a clothes shop. A battery or hand pump can be useful in these situations. Some mothers express in the car, creating privacy with shades on the windows and/ or with a cardigan or scarf. When visiting people you may feel more comfortable and relaxed in a separate room. At home it helps if you can get used to expressing with family around, as retreating to a separate room may reduce how often you do it. But some women just find it easier in a private place.

Support and encouragement

Expressing milk is sometimes challenging but it's always worthwhile, whether you are establishing breastfeeding, producing milk for a baby who is unable to breastfeed, increasing your milk or returning to work. Seek support from people who understand and value what you are doing and ignore comments from those who don't. Your local LLL Leader and Group will be able to give you encouragement and support. To find them take a look at our website.

Feeding your baby your milk

See Further Reading and resources below for information on ways to feed your baby your expressed milk.

Written by mothers of LLLGB. Photos courtesy of Lois Rowlands and Rae Vacher Lowe.

Further Reading

How to increase your milk supply
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won't Breastfeed
When Mum Can't Be There
Comfortable Breastfeeding
Sleepy Baby - Why and What to Do
Storing Your Milk
Bottles and other tools

Other websites
Hand expressing:

Maximizing milk production when expressing:

Books
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Breastfeeding Solutions. Mohrbacher, N. New Harbinger Publications, Inc. 2013.
Exclusively Pumping Breastmilk, Second edition. Casemore, S. Gray Lion Publishing, 2014

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

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

Copyright LLLGB 2016

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Expressing Your Milk - La Leche League GB

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Expressing your milk by hand or with a pump helps you establish and maintain your milk production if you're separated from your baby or if he isn't breastfeeding well. And if your milk production is low, expressing can help increase it whilst also providing extra milk to give to your baby.

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Responsive bottle feeding/paced bottle feeding

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Responsive bottle feeding/paced bottle feeding

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Baby Led Bottle Feeding - Wendy Lever IBCLC

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How to help your baby attach and breastfeed | Baby & toddler, Feeding articles & support | NCT

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Many people assume breastfeeding just comes ‘naturally’ but it’s a learning process for many mums and babies. Here are our tips on getting the hang of it…

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NCT Breastfeeding support Northern Ireland 

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NCT Breastfeeding support Northern Ireland 

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Log into Facebook to start sharing and connecting with your friends, family, and people you know.

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Safer sleep overview - The Lullaby Trust

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An easy guide to practicing safer sleep for your baby and reducing the risk of sudden infant death syndrome (SIDS, or cot death).

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by Dr. Amy Brown

Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development ¹. When babies feel secure in the care of a primary caregiver, they go on to have better outcomes socially, educationally and emotionally ².

There are many elements to responsive parenting but one of the central aspects within this relationship is the importance of responsive feeding. Responding to a baby's feeding cues (both of hunger and satiation), whether they are breast or bottle fed is an important step to helping a baby develop not only a secure attachment relationship, but in establishing longer term positive eating behaviours. Responsive feeding takes advantage of a young baby's natural ability to regulate their intake of calories - something that can disappear when a baby gets older ³. Feeding when they are hungry and being able to stop when they are full helps them to retain this ability ⁴.

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However, the notion of responsive feeding can lead to significant concerns for new parents, particularly in relation to how often breastfed babies feed. One concern is whether feeding frequently is a sign that the baby isn't getting enough milk, exacerbated by not being able to see how much milk the baby is consuming. Others may worry about whether babies need to learn to feed less frequently in a set pattern. However, responding to a baby's natural cues is a critical step in establishing milk supply and encouraging healthy weight gain and development in babies.
How often do babies breastfeed?
As with everything, how often a baby naturally wants to feed will vary amongst individuals. However studies that explore how often babies breastfeed find that most do so between 8 - 12 times per 24 hours, although some feed much more than that (up to around 18 times in some studies). Most tend to feed towards the latter part of that range, with around 11 - 12 feeds per 24 hours ⁵.

Notably, babies calorie needs do not change vastly after the first few weeks, but they become able to take bigger feeds. This means that from around 8 - 12 weeks some babies start feeding in longer intervals. However, this pattern doesn't necessarily remain. Studies that have tracked this longitudinally find that many babies do start to feed less often but then start feeding again more frequently (akin to a newborn) around 4 months of age, before dropping down again. This fits with the commonly observed 'four month growth spurt', which is often seen as a mistaken need for solid foods ⁶. However, as with everything, some babies will continue to take smaller feeds more often until they move to solid foods (and, still even then). Just as with adults, some of us prefer set meals a day whereas others prefer to graze.

As well as being little and often, most babies don't naturally breastfeed to a set pattern e.g. every three hours. If allowed to feed whenever they want to, many breastfed babies are good at feeding according to hunger, which doesn't fit into a set pattern (how many adults truly eat or drink at precise set intervals?). Things like growth spurts and cluster feeding (where babies feed numerous times over a period of up to a few hours) are common and are thought to stimulate the body to produce more ⁷.

Variations will also occur according to the content of the mothers milk. Research has shown that fat content can vary between mothers. Mothers who produce milk with a higher fat content are more likely to have babies that have shorter feeds e.g. they take in a similar energy density to those with lower fat content in their milk who take a little longer to consume it ⁸.

Breastmilk also changes in content, particularly in terms of calories and fat. During a feed, milk becomes denser in fat as the feed progresses. Fat content and energy density are also higher during the day than the night. In hot weather breastmilk can also be less energy dense, encouraging infants to consume more of a higher water content milk ⁹. Again, this can affect the amount or frequency of how often babies feed. Generally, the less energy dense the milk, the more they take in.

Feeding frequency is also context dependent. In Western culture our norm is to separate from our babies to some extent. Baby wearing for most of the day and co-sleeping are normal from an evolutionary perspective but not common in our society today. Put simply, this means that babies do not always have easy and unfettered access to the breast. However, in cultures where co-sleeping and carrying infants in a sling are common, and babies therefore have free access to the breast, they feed far more frequently than this. An observational stud of the rural hunter- gatherer tribe known as the !Kung, found that babies breastfed on average four times an hour, with an average feed being two minutes or less ¹⁰. Other studies show less frequent feeds, but sill significantly more than in Western cultures. For example one study in rural Thailand found babies averaged 15 feeds over 24 hours ¹¹. In the UK, when babies do co-sleep, they feed more per night ¹².
Why do babies need to breastfeed so often?
Firstly, breastmilk is low in fat and protein but high in carbohydrates and lactose, which makes it easy - and quick - to digest. It is more easily digested than formula milk, which means that breastfed babies often feed more frequently than formula fed babies (approximately every two hours compared to three hour for formula fed babies) ¹³. Breastfed babies reach a fasting state quicker than formula fed infants, with 75% of breastfed infants reached a fasting state within 3 hours from the last feed compared to 17% of formula fed babies ¹⁴.

Breastfed babies also tend to consume less milk than formula fed babies at each feed, preferring to feed little and often compared to many formula fed babies. A baby's tummy has a maximum capacity of 90ml. Breastfed babies tend to take smaller feeds, not completely filling their stomach. In the first six months babies need around 750ml of milk a day meaning that even at maximum capacity that equates to feeding around every three hours ¹⁴. Research has shown that formula fed babies take in more milk from the first day of life (about twice as much on day one and three times as much by day two) ¹⁵.
Why is responsive feeding so important?
Meeting the frequent and unpredictable feeding needs of a breastfed baby can feel challenging and is a common reason why mothers stop breastfeeding - either through anxiety that something is wrong, or a belief that formula will offer a more convenient feeding schedule ¹⁶. However, responsive feeding is not only normal but important for a number of reasons.

Feeding responsively is particularly important when a baby is breastfed because it is intrinsically linked to establishing and maintaining a good supply of breastmilk. Breastmilk starts to be produced in small amounts during pregnancy. Once the placenta is removed after birth this production shoots up, supported by rises in the hormones prolactin and oxytocin ¹⁷.

However, once this initial surge has occurred, one of the most important things for breast milk supply is frequent feeding. Simply, the more milk is removed from the breast (either by a baby or by expressing), the more milk is produced. The human body is very clever at matching how much milk is removed (e.g. how much the body believes the baby needs) to how much it produce ¹⁸. One study that asked mothers to either feed their newborn baby responsively or to feed to a set 3 - 4 schedule found that babies who were fed responsively consumed a third more milk ¹⁹.

Because responsive feeding is linked to a better milk supply, it has a knock on effect onto outcomes for babies. Responsive feeding is associated with mature milk coming in quicker after the birth ²⁰, regaining birth weight faster ¹⁹, and a lower risk of jaundice ²¹. Conversely, supplementing with formula milk, particularly in the early days and weeks, can lead to a drop in supply, or difficulties with latch ²². Using a pacifier can also reduce milk intake as it can lead to a delay in how often babies are fed. Babies who use a pacifier feed on average for half an hour less each day which equates to one fewer feed< ²³.

Based on this, it is not surprising that babies who are fed responsively are more likely to continue being breastfeed ²⁴. Meanwhile, trying to breastfeed to a parent led routine is associated with stopping breastfeeding ²⁵. This can apply to wider parenting style; mothers who adopt a routine for feeding, sleep and day to day care of their infant are more likely to stop breastfeeding in the early days ²⁶. Notably, those who stop breastfeeding after using a routine are more likely to report breastfeeding difficulties e.g. low milk supply, pain on latch and a fussy baby - likely a knock on impact of lower milk supply from less frequent feeding ¹⁶.
What about night time feeding?
Babies' needs do not cease to exist simply because it is dark outside. One of the main needs infants have at night is to feed. A baby's stomach is still the same size and breast milk still easily digested at night as it is in the day. Research suggests that it is not until around two months that a baby's natural day and night circadian rhythm kicks in. Until that point, the concept of sleeping for an extended period of time is not something that babies are physiologically designed to do - and even then it can take a while to get into the habit ²⁷.

However, society continues to sell us the myth that babies should start sleeping through the night after the first few weeks, and that getting them to this stage is an achievement. Aside from evidence to the contrary, given that around a third of adults report at least mild insomnia, should we really believe that babies who cannot meet their own needs if they wake should be able to sleep all night? How many adults when they wake have a drink of water?

Waking at night is also thought to be protective. Babies want to be close to their mother at night and sleeping close to them helps babies maintain their temperature ²⁸, heart rate ²⁹ and have steadier breathing ³⁰. Sleeping too deeply may be a risk factor for SIDS. Babies who have died of SIDS are more likely to have longer periods of uninterrupted sleep and moved about less in their sleep ³¹.

Research exploring night waking in the first year brings estimates of between 30 - 80% of babies still waking at least once with a number of studies saying most babies continue to wake once or twice a night throughout the first year ³². Although sleep problems in older children can be an issue, waking at night as a baby has no link with later sleep problems or development ³³.

Feeding at night is also common - and important - in supporting breastfeeding. Firstly, the body takes into account feeds at night when establishing milk supply. Babies take in around a third of their milk supply at night (although in toddlers in cultures where co-sleeping is the norm, this can rise to 50% as many are busy and distracted during the day) ¹¹. Feeding at night is an important step in developing a good milk supply. Although it may be dark outside, the body still considers frequency of feeds at night when establishing milk supply.

Feeding at night is also an essential part of providing a high level of contraceptive cover through the Lactational Amenorrhea Method. This method offers 98% security of contraception as long as babies are fed responsively (and are under 6 months and receiving no formula milk or solid foods). Feeding at night is an important part of this ³⁴.

Additionally, feeding at night is important from a hormonal perspective. Prolactin is linked to milk supply; generally the higher prolactin levels you have, the more milk is made. Prolactin levels are already higher at night but also rise further when your baby feeds, so feeding at night is a great opportunity to really drive those levels higher and help your milk supply ³⁵.

Sometimes parents worry about their baby continuing to breastfeed at night based on the myths that a) babies should sleep through the night and b) breastfeeding stops babies sleeping through the night. However, rather than being something breastfed babies do more, breastfeeding at night should be recognised as something that is very normal. In countries where night-time infant care and co-sleeping is the norm, babies breastfeed around four times a night ³⁶.

Some studies do show that very young babies who are formula fed start sleeping for longer at an earlier age more, suggesting that breastfeeding was likely used as a tool to encourage the baby back to sleep quickly ³⁷ and have longer periods of deep sleep ³⁸. However once babies get a little older, this difference disappears. One study found that for babies aged 6 - 12 months, babies who were breastfed did more at night than babies who were formula fed. However they did not ³². Indeed, two studies exploring the sleep patterns of mothers who breast or formula fed found that breastfeeding mothers got more hours of sleep overall, alongside feeling in better health< ³⁹ whilst another found that mothers who were breastfeeding actually had more rest per night that those who formula fed because it took less time to resettle the baby ⁴⁰.

When parents are thinking about a routine for feeds, one of the most common places they start is by trying to reduce night feeds, and more generally encourage 'sleeping through the night'. However, sleep training can have a negative impact on breastfeeding success. One intervention to reduce night waking in babies aged 6 - 12 months found that although babies started sleeping for longer, breastfeeding rates dropped far more rapidly than expected during the course of the study ⁴¹.

Feeding responsively is therefore a critical element of establishing and maintaining milk supply, supporting weight gain and promoting positive longer term eating behaviour in children. More importantly, it is the norm and biological expectation of young babies, and a central element of a responsive parenting relationship however a baby is fed. Feeding responsively can be demanding for mothers though and as a society, rather than trying to normalise routines and scheduled feeding, we should be looking towards how we can value and support our new families better. Mothering the mother so she can breastfeed her baby, and more widely, supporting the new family and a unit makes the new responsibility of caring for a young baby that little bit easier.
References and links http://psycnet.apa.org/journals/dev/42/4/627 https://www.ncbi.nlm.nih.gov/pubmed/19112517
3. Fomon, S.J., Filmer, L.J., Thomas, L.N., Anderson, T.A., & Nelson, S.E. (1975). Influence of formula concentration on caloric intake and growth of normal infants. Acta Paediatrica Scandinavia , 64/2, 172 - 81.
https://www.ncbi.nlm.nih.gov/pubmed/1168981 http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2012.00071.x/abstract https://www.ncbi.nlm.nih.gov/pubmed/16510619 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1999.tb01083.x/abstract http://europepmc.org/abstract/med/1476844
8. Tyson, J., Burchfield, J., Sentence, F., et al. (1992). Adaptation of feeding to a low fat yield in breast milk. Pediatrics , 89/2, 215-220.
http://pediatrics.aappublications.org/content/89/2/215.short https://www.ncbi.nlm.nih.gov/pubmed/22797414
https://www.ncbi.nlm.nih.gov/pubmed/7352291
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442252 http://adc.bmj.com/content/89/12/1106 http://www.nature.com/ejcn/journal/v58/n9/full/1601964a.html http://pediatrics.aappublications.org/content/80/3/434.short http://www.tandfonline.com/doi/abs/10.1080/07315724.2001.10719033 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2010.01145.x/abstract http://europepmc.org/abstract/med/7818388 http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1986.tb10313.x/abstract http://www.sciencedirect.com/science/article/pii/S0140673652904509 http://jamanetwork.com/journals/jamapediatrics/article-abstract/510586 http://www.academia.edu/1603964/The_initiation_of_lactation_the_effect_of_early_versus_delayed_contact_for_suckling_on_milk_intake_in_the_first_week_post-partum._A_study_in_Chiang_Mai_Northern_Thailand https://www.ncbi.nlm.nih.gov/pubmed/24529621
https://www.ncbi.nlm.nih.gov/pubmed/10506275
http://pediatrics.aappublications.org/content/107/3/e38.short http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054229 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0083893 https://www.ncbi.nlm.nih.gov/pubmed/12897290 http://adc.bmj.com/content/75/3/249.info https://pdfs.semanticscholar.org/68c7/5209655dd68925115082acd8730ca1aaea06.pdf https://journals.physiology.org/doi/full/10.1152/jappl.1998.84.4.1374 http://europepmc.org/abstract/med/2740699 http://online.liebertpub.com/doi/abs/10.1089/bfm.2014.0153 https://www.nationalelfservice.net/cms/wp-content/uploads/2013/01/Price-2012-Sleep-Med.pdf
34. Labbok, M.H. et al. Multicenter study of the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception 1997; 55(6):327-36

https://www.ncbi.nlm.nih.gov/pubmed/9262927

35. Riordan, J. & Wambach, K. (2010) Breastfeeding and Human Lactation 4th ed. Jones and Bartlett, p. 89
https://books.google.co.uk/books?hl=en&lr=&id=lDb3BQAAQBAJ&oi=fnd&pg=PR1&dq=Riordan,+J.+%26+Wambach,+K.+(2010)++Breastfeeding+and+Human+Lactation+4th+ed.+Jones+and+Bartlett,+p.+89&ots=NrFUzunn3I&sig=OMVyHApWEzVmFRKVEXYY4dynQeQ#v=onepage&q&f=false http://journals.sagepub.com/doi/abs/10.1177/089033440101700307 http://onlinelibrary.wiley.com/doi/10.1046/j.1523-536X.2003.00243.x/full https://www.researchgate.net/profile/Jon_Moon3/publication/21676170_Sleep_Organization_and_Energy_Expenditure_of_Breast-Fed_and_Formula-Fed_Infants/links/5543d6230cf24107d396377b/Sleep-Organization-and-Energy-Expenditure-of-Breast-Fed-and-Formula-Fed-Infants.pdf http://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007
http://onlinelibrary.wiley.com/doi/10.1111/jpc.12089/full

41. Hall, W.A., Saunders, R.A., Clauson, M., Carty, E.M. and Janssen, P.A., 2006. Effects of an intervention aimed at reducing night waking and signaling in 6-to 12-month-old infants. Behavioral Sleep Medicine, 4(4), pp.242-261.
http://www.tandfonline.com/doi/abs/10.1207/s15402010bsm0404_4 About Amy Brown:

Dr. Amy Brown is an Associate professor in Child Public Health in the Department of Public Health, Policy and Social Sciences at Swansea University, UK. Her research explores the psychology of maternal and infant health and wellbeing, particularly during the first 1001 days of pregnancy and the first two years of life. She has a particular expertise in infant nutrition, but her research also explores the wider yet inter related issues of normal baby behaviour, sleep, parenting and postnatal depression.

As part of her role, Dr Brown leads the MSc in Child Public Health - an interdisciplinary programme which explores the evidence base behind child public health policy in the UK and internationally. This programme is particularly popular amongst health professionals and graduate students alike and has attracted students from South Korea, Nigeria, Canada, Guatemala and Ghana to name a few.

Check out her book Breastfeeding Uncovered at:

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Importance of Responsive Feeding * KellyMom.com

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The importance of responsive feeding in establishing a good breastmilk supply by Dr. Amy Brown Responsive parenting e.g. responding promptly and appropriately to a baby's needs is widely recognised as an important protective element for infant health, wellbeing and development1. When babies feel secure in the care of a primary caregiver, they go on to [...]

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Cluster feeding usually happens during the first 3 to 4 months. It's when your baby wants to feed even more frequently (sometimes constantly) over a period of time.

It's very normal and nothing to be concerned about. Your baby may want to cluster feed during the day or night (or a bit of both). Your baby may cluster feed for a few days when they are going through a growth spurt.

You can cluster feed formula milk, but it's important not to overfeed your baby.

Watch your baby and follow the cues for when they need a break - these signs will be different from one baby to the next. They may splay their fingers and toes, spill milk out of their mouth, stop sucking, turn their head away or push the bottle away.

You should be able to tell when they're full as they will not want the bottle any more or may just fall asleep at the end of the feed.

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Cluster feeding - Bottle feeding - Start for Life

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Cluster feeding is when your baby feeds more frequently. Find out why your baby may want to feed more than usual.

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

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Find out more here about our infant feeding support line and the help available if you have any questions or concerns about feeding your baby.

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Is your milk supply really low?

New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds. There are many reasons for babies to be unsettled and breasts usually get softer after the first few weeks - these are not proof of low milk supply. If your baby is growing as expected (at least 20-30g a day, on average, during the first three months) just on your milk, then your milk supply is fine. If your baby does not grow well on your milk alone, then you may be making less milk than your baby needs.

The most common reason for genuine low milk supply is a slow start with breastfeeding, when not enough milk was removed from your breasts in the early days after birth. It may be possible to turn this around, with prompt action. Some other causes of low milk supply, such as previous breast surgery and some hormonal conditions, may mean that there is a limit to how much milk you can produce. Many nursing parents can make more milk than they are making, and you never know what you can do until you try!

Increasing low milk supply is hard work. It takes time, energy and commitment. It is important to be realistic from the start about your goal and how much time and energy you are able to invest. It works best when you have lots of practical and emotional support, so you can concentrate on your baby and your milk supply. Remember that this won't be forever - it is a short-term investment for long-term gain. Set yourself short-term goals, e.g. 48-72 hours, then review your progress. If you are not able to increase your milk supply as much as you would like, or decide that it is not realistic to try, you can still have a close, happy feeding relationship with your baby.

While you are working on your milk supply:

Find skilled feeding support. LLL is here to help! You can find information about ways we can support you here. We can also help you connect with other women who have experienced low milk supply.

Track how you are doing. Keep a record of how much milk you express and the amount of formula or donated breastmilk your baby takes (if relevant) and how many wet and dirty nappies your baby produces. Tracking changes over time is useful to show how well your plan is working and can help you decide what to do next.

Monitor your baby's health and growth. Your baby needs to be weighed regularly while you are working on your milk supply. Your midwifery or health visiting team will usually do this. For more complex feeding issues, you may be referred to a local specialist infant feeding team or clinic. Any baby who is not growing as expected should be under the care of a doctor. This is because occasionally, slow growth can be caused by underlying health issues in the baby, rather than low milk supply.

How milk production works

Milk production starts in the middle trimester of pregnancy. After birth, milk continues to be made in the breasts in response to milk being removed. The most common reason for low milk production is a slow start with breastfeeding - not enough milk being removed from the breasts in the early days after birth.

Milk supply usually reaches its peak around four weeks after birth, with most of the increase happening in the first two weeks. If not enough milk is removed during this time, your breasts may end up making less milk than your baby needs. It may be possible to increase milk production, by removing more milk from your breasts. The earlier you start this, and the more energy you put into it, the higher your chances of making more milk. Even if more time has passed, it may still be possible to increase your milk production to some extent, but unfortunately there is no guarantee of being able to make a full milk supply.
Any amount of milk you are able to produce is valuable to your baby. Breastfeeding is about much more than just milk and you can enjoy nurturing your baby at the breast, however much milk you are making.
For more detailed information about how milk production works see How Milk Production Works.

Risk factors for low milk supply

These include:

Previous breast surgery (especially reduction) or radiation

Retained placenta

Unusually small/thin/unequally sized/widely spaced breasts

A history of infertility with hormonal cause

Hormonal conditions like thyroid problems or polycystic ovary syndrome (PCOS).

If you have any risk factors for low milk supply, you may be referred to an infant feeding specialist. Some of these conditions are treatable. Even if you have underlying factors that can't be treated, you may still be able to make more milk than you are currently making.

Effective attachment

A baby who isn't deeply attached at the breast may not be able to get enough milk, and feeding may also be uncomfortable for you. Squashed ("new lipstick") nipples after a feed, skin damage and pain that lasts throughout feeds are all signs of shallow attachment. You can read more about positioning and attachment here.

Face to face help (including via video call) is usually best when working on attachment. If feeding doesn't become more comfortable and/or effective even with skilled help, your baby may be referred for an oral assessment (a thorough examination of their mouth) to check for tongue tie, which is a problem for a small number of babies and can be treated. You can read more about this here and here.

Hold your baby skin to skin

This helps your milk-making hormones to work well, keeps your baby calm and happy, helps you and your baby feel connected and encourages interest in feeding. You can read more about holding your baby skin to skin here.

How often and when to feed

While you are working to increase your milk supply, you will want to encourage your baby to feed as often as possible. Signs of interest in feeding include your baby turning their head and opening their mouth (rooting), licking lips, mouthing hands, restlessness and making small sounds. Try to offer a feed when your baby is first interested, before they become upset. If your breasts are feeling full or you just feel like feeding your baby, you can offer your baby a feed, even if they are not asking.

You may want to avoid using a dummy, a baby swing, or swaddling your baby, as these can make it difficult to tell if your baby is interested in feeding.

Don't give your baby water, tea or any other non-milk drinks.

Breastfeeds don't have to be regular (e.g. every 2-3 hours). Your baby just needs to have enough feeds in 24 hours, whenever they are awake enough and interested. Most young babies need at least 8-12 feeds in 24 hours. Don't watch the clock - watch your baby and count feeds.

Keep your baby feeding actively when they are at the breast

Knowing when your baby is feeding actively at the breast, with deep sucks and swallowing after every one-two sucks, can be very helpful. While you are working to increase your milk supply, you will want to make sure that milk is removed from your breasts as effectively as possible. If your baby is mostly doing light, fluttery sucks with very little swallowing (three or more sucks per swallow), they are not removing much milk. If your goal is to increase the amount of milk removed from your breasts, you may want to end the feed and use a breast pump instead to maximise efficient milk removal.

Breast compressions and switching sides can help to keep your baby actively feeding for longer. Start compressing your breast as soon as your baby stops actively feeding. You can read about how to do compressions here. When your baby is no longer actively feeding even with compressions, repeat on the other side. Offer as many breasts as your baby will take - it can be more than two!

Some babies seem to want to feed all the time and protest when you take them off the breast. If they are not growing well, it may be because they are not yet breastfeeding effectively. To increase your milk supply, you may temporarily need to limit their time at the breast, to give you more time to express your milk.

Increasing breast stimulation by expressing your milk

If the steps above do not result in increased milk supply, the next step is to increase stimulation of your breasts by expressing your milk:

An LLL Leader and/or your local infant feeding specialist will agree with you how many times in 24 hours to aim for at first. For more impact, you can increase the number of sessions. For maximum effect, you would aim to express 8-12 times in 24 hours (this is the number of times most babies need to feed).

A double electric breast pump, preferably a large "hospital grade" pump, is usually the best tool for this job. Smaller single electric and manual pumps are designed for occasional expressing, not the big task of increasing milk supply.

You don't need to pump after set intervals (most babies don't feed after set intervals either), just as often as you can. The important thing is how many times you express in 24 hours - it's up to you when you do it. It's fine to take a break for a few hours to go out or to sleep! More, shorter expressions often work better than fewer, longer ones and it's fine to stop in the middle of pumping, if you need to do something. Even if you only have a few minutes, it's worth pumping. Notice the times of day or night when you can express most and aim to pump more often then. First thing in the morning and in the quiet hours of the night can work well. Experiment to see what works best.

Use your hands as well as your pump. Try massaging your breasts before and during pumping. You might want to buy or make a "hands-free pumping bra" to hold your pump in place. Some women find that they can express lots of milk by hand after they have finished pumping. You can see how to use your hands to express more milk in this video.

Try covering the collection bottle with a sock so you can't see it. Frustration about how slowly it is filling with milk can make it even slower!

Try visualisation, e.g. a flowing fountain, or milk pouring into a bottle.

Many women find that they get most milk in the first few minutes of pumping. To make the most of this, it can work well to pump very frequently for short periods, stopping and starting as many times as possible. This is sometimes called 'power pumping'.

Try pumping with a piece of your baby's clothing near enough to smell, or while looking at your baby, or holding your baby skin to skin.

You can find more tips on how to express milk here.

Balancing breastfeeding and expressing

The priority at this stage is to increase your baby's milk intake and your milk supply. This may mean limiting your baby's time at the breast, for now, to free up enough time to express. Your baby has lots of time to learn to breastfeed. Your milk supply will become more difficult to increase as time goes on, so it is important to act quickly. This might feel all wrong - you want to breastfeed, not pump! Remember that it is an investment of your time now to help your baby breastfeed later. As your milk supply increases, breastfeeding will get easier and more rewarding for your baby. When breastfeeding is going well, you will be able to let your baby feed as much as they want.

How to feed expressed milk to your baby

There are lots of options - an LLL Leader can help you choose some to try, including paced bottle feeding and more, , and at-breast supplementers (lactation aid).

Keeping the breast a happy place for your baby

If your baby is upset, try offering some extra milk before offering the breast. This helps your baby to associate the breast with feeling full and happy, rather than hungry and frustrated.

Babies enjoy ending a feed by falling asleep at the breast. You can offer expressed or formula milk between breasts, allowing your baby to finish with the second breast.

You can give milk by bottle or cup with your baby's cheek against your breast.

If a supplementer is used, your baby can drink expressed milk while breastfeeding.

Domperidone

This is a prescription medication that can help to increase milk supply in some women, whilst they are taking the tablets. It is not suitable for everyone, e.g. it is not safe for those with certain heart conditions. Because of this, doctors are currently discouraged from prescribing domperidone to anyone. However, the NHS states that domperidone may be appropriate in some cases, so if you would like to try it, it's worth discussing with your GP, and taking along some information for them to read.

The most important thing to do to increase milk supply is to remove more milk from your breasts, so don't worry if you can't or prefer not to take domperidone.

Formula milk

Some babies need extra milk for a short time or longer term if their mother is not making a full milk supply. If donated human milk is not available, the only safe alternative is infant formula milk. You can find LLLGB's information on milk sharing here.

It is never safe to suddenly stop or reduce supplements of formula or donor breastmilk. This needs to be done gradually, to allow your own milk supply time to increase. and it is very important that your baby is weighed regularly, to make sure that they continue to get enough milk. It would usually be appropriate to weigh your baby every 1-2 weeks while working on reducing supplements. You can read about how to use donor milk or formula to support breastfeeding here.

Whether or not you are producing all the milk your baby needs, you can still have a great feeding relationship with your baby. The breast can still work beautifully to calm, comfort and soothe your baby, even if your milk supply remains low. Any amount of your milk that your baby gets will be beneficial to them. Some of the immune components of milk become concentrated so that babies get the same amount, no matter how much of your milk they get each day. Whatever feeding looks like for you and your baby, we are here to support you.

Summary
Stage 1 - make sure your baby is feeding as effectively as possible

1. Consider risk factors for low milk supply.

2. Make sure that your baby is well positioned and attached at the breast. This will include checking for any reason the baby might not be able to attach and feed well (e.g. tongue tie).

3. Hold your baby skin to skin as much as possible.

4. Offer the breast as soon as your baby shows any signs of interest in feeding, at least 8-12 times in 24 hours, waking baby if necessary.

5. Switch sides and use breast compressions to increase milk flow.

Stage 2 - if milk supply has not increased enough

1. Express your milk at a frequency agreed with an LLL Leader and/or infant feeding specialist.If your baby is still not growing well, increase the number of expressions. For maximum effect, aim for at least 8 times in 24 hours. This may mean temporarily limiting your baby's time at the breast, to give you enough time to express.

2. Feed as much expressed milk as your baby wants to drink by cup, paced bottle-feeding, finger feeding or nursing supplementer.

3. Aim to keep your baby's time at the breast happy and relaxed, and to end feeds with your baby at the breast (if necessary, after giving your baby extra milk at the start or in the middle of the feed) as often as you can.

4. Consider using the medication domperidone, which may help increase your milk supply.

5. If necessary, use enough formula milk to make sure your baby grows as expected and seems satisfied.

Further reading

Getting breastfeeding back on track after a difficult start
How milk production works
My baby needs more milk
Expressing your milk
Relactation and induced lactation - bringing back milk supply after a break or bringing in a milk supply when you haven't been pregnant.

Books
Making More Milk, by Diana West & Lisa Marasco (2019)
Defining Your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West (2001)
Breastfeeding Without Birthing by Alyssa Schnell - for non-gestational parents who are inducing lactation.

Written by Jayne Joyce and Emily Tammam, LLL Oxfordshire, February 2021

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How to increase your milk supply - La Leche League GB

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Is your milk supply really low? New mothers who are learning to breastfeed often worry that they might not be making enough milk for their baby. Their breasts might stop feeling full and their baby might sometimes be unsettled, or not want to be put down between feeds.

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Sore nipples when breastfeeding | Baby & toddler, Feeding articles & support | NCT

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Sore nipples can be a problem in the early days of breastfeeding and beyond. This article discusses causes of sore nipples and how to ease the pain.

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply.

Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive. Oversupply can also make feeding uncomfortable and increase the risk of mastitis.

Symptoms of oversupply
How does oversupply happen?
How is your milk supply established?
A note about foremilk and hindmilk
What can I do about the symptoms of oversupply?
Reducing your milk supply
If you still have problems
Breast compression
Adjusting to the new normal

Symptoms of oversupply

The main symptoms of oversupply for a baby are:

Very fast weight gain, moving upwards through centile lines

Explosive green frothy poos

Struggling to control milk flow

Pain and excessive wind or 'gas'

You may also notice the following:

Choking, coughing, and pulling on and off the breast

Clamping down and biting to slow the flow of milk

Frequent spitting up

Always appearing hungry and unsatisfied despite large weight gain

Unwillingness to nurse to sleep

Breast refusal

Faltering weight gain due to breast refusal

Lots of wet and dirty nappies

General 'colicky' behaviour

A mother with oversupply may have the following symptoms:

Some of these symptoms may have other causes; allergies and reflux, for example, can have similar symptoms to oversupply. They may also fall within the normal range. Therefore, it is important to rule out other possibilities before taking steps to reduce your milk supply, as this can have longer term consequences.

How does oversupply happen?

Some mothers naturally produce large quantities of milk, and we tend to produce more milk with each baby. Occasionally, there are medical reasons for having much more milk than your baby needs. Oversupply can also occur as a result of breastfeeding management, for example, when a baby's feeds are scheduled, or if a mother is told to feed from each breast for a certain amount of time. It can happen if a pump is used too often, or used in a way that overstimulates the breast.

Milk production is best regulated by your baby's appetite. When you breastfeed responsively, rather than by following a schedule, your milk production adapts to their needs. Occasionally, a poor latch can contribute to oversupply as a baby might feed very frequently to get the volume they need. However, this tends to reduce milk supply over time.

How is your milk supply established?

After your baby is born, milk production is regulated on a supply and demand basis. Put simply, the more milk you remove, the more milk you are likely to make. How quickly or slowly milk is made depends on the fullness of the breast - an 'empty' breast makes milk more quickly, a full breast makes milk more slowly.

It takes a few weeks for your supply to settle down to what your baby actually needs. It is not unusual in the early weeks to feel as if you have too much milk, and to have times when the breasts feel full or even engorged. This is not the same as oversupply.

Feeding frequently and removing milk from the breasts is essential to resolving engorgement - it won't make the engorgement worse or result in too much milk.

Babies usually nurse more during developmental leaps and growth spurts, and many mothers find there are changes to their baby's nursing pattern during holidays and family get-togethers, or during periods of stress. Milk supply is very adaptable - if you follow your baby and your body, your supply will most likely regulate itself.

Read more about how milk production works.

A note about foremilk and hindmilk

One of the symptoms of oversupply in a baby is green frothy poos, gas, and pain. This is sometimes called lactose overload or a foremilk-hindmilk imbalance.

You may be given confusing information about foremilk and hindmilk, and how long a feed 'should' last. Or think that there are two different kinds of milk - lower-fat and fat-rich - and that one is better than the other.

Typically, the fat content does increase during a feed, as the fat globules tend to be drawn down towards the end of a feed. However, it is not the length of a feed that is important, but the length of time between feeds. Fat content is determined mostly by the fullness of the breast. If there is a long gap between feeds and the breast is full, the baby may get a large quantity of lower-fat milk before much of the fat starts getting pulled down. The same may be true if a mother naturally produces very large quantities of milk. In the absence of fat-rich milk, the lower-fat milk moves through the gut faster than it can be digested, causing green poos, gas, and pain.

All breastmilk is good! What matters most to weight gain is overall milk volume.

What can I do about the symptoms of oversupply?

To start with, you might like to:

adjust your position and your baby's attachment to help them manage a fast letdown

feed responsively (as often as your baby wants) and/or offer more frequent feeds

use breast massage

avoid overpumping

Managing a Fast letdown
A fast letdown can be one symptom of oversupply. It is possible to have a fast letdown with an 'average' milk production. When your baby nurses, a hormonal reflex causes milk to release, (what is known as 'letdown'). When this happens, it is not unusual for milk to spray out quickly. Some babies like this fast flow, but others are upset by it and struggle to coordinate sucking, swallowing, and breathing. You may find it helpful to:

Ensure that your baby is deeply attached at the breast. This will make it easier for them to manage a fast flow.

Try different positions. Some parents use gravity to help them by feeding in a 'laid-back' (reclined) position. Others find it helps to feed in a more upright position such as a 'koala hold', or to feed while using a sling or baby carrier. Side-lying may also be helpful as excess milk can easily leak out.

Allow your baby to come off the breast when they need to catch their breath, and use a muslin to catch the spray.

Some mothers hand express a little to slow the flow before bringing the baby to the breast (however, if this is done frequently, it may make oversupply worse).

If your breast is very full and engorged, you might try 'reverse pressure softening' to move fluids away from the nipple area as this can help your baby to latch more deeply.

Feed frequently so that the milk spray doesn't have quite so much volume and force behind it.

Try breastfeeding before your baby is really hungry, or while they are slightly sleepy.

Responsive feeding
How do you know how often or how long to feed your baby for? Let your baby tell you! We all have different milk storage capacities and this may determine how frequently your baby feeds, and whether they feed from one side or two. Allow your baby to feed from the first breast for as long as they want to before offering the second breast - they may or may not take it.

Sometimes babies will only take one breast, and sometimes two (or three or four!). Most babies will take both breasts, at least some of the time. Babies are very good at letting us know how often they want to feed, and if in doubt, it is always fine to offer.
Breast massage
You could do what is sometimes called the 'breast milkshake'. This involves massaging each breast very gently for half a minute or so before feeding, then using a combination of massage and breast compression (see below) during a feed to help dislodge some of the fat. Any massage should use a light fingertip pressure such as you would use to apply body lotion.
Expressing
Overuse of pumps - or using a pump in a way that unintentionally stimulates milk production (such as a silicone pump to collect dripping milk) - can make oversupply worse. If you've been expressing regularly, reduce this gradually to avoid further problems.

Reducing your milk supply

If your baby is gaining more weight than average and you and your baby are happy, then you don't need to change anything. It is not possible to overfeed a breastfed baby.

If you or your baby are struggling with some of the above symptoms, you have ruled out other causes and changes to breastfeeding management do not help, then you may want to consider taking steps to gradually slow milk production.

Consult an LLL Leader before using these approaches. This is especially important if your baby is under one month old, or you are experiencing other problems such as sore nipples or mastitis.

Monitor your baby's weight gain to ensure it doesn't drop below expected levels, and keep a close eye on nappy output.

One side per feed
Limit your baby to one breast per feed. If your baby wants to have a short rest during a feed, then offer the same breast again. When a mother has a generous milk storage capacity, their baby may only need to feed on one side. This approach may help milk production to reduce in line with their baby's demand.

Block feeding
Block feeding involves feeding on the same side for a set period of time (block), e.g. for two or three hours. If your baby wants to feed again within that time block, offer the same side. As a starting point, you might like to:

Limit your baby to one breast for about two hours, allowing them to nurse as often and for as long as they like, but only on that one side.

Continue in this way, switching breasts every two hours. If your baby is asleep, switch breasts when they wake.

It is important not to have a rigid approach to block feeding: read your breasts and your baby, not just the clock. By doing this, you will find the time block that works best for both of you. If the unused breast feels uncomfortably full before the next feed then 'express to comfort' only.

It is possible to experience oversupply in just one breast, in which case you could nurse for longer periods on the unaffected side.

Full drainage and block feeding method
For more severe oversupply - for example, if you are suffering from recurrent blocked ducts or mastitis and your breasts never feel soft and comfortable even after a breastfeed - you will need to keep your breasts well drained while you take steps to reduce milk production.

You could try the following, in consultation with an infant feeding specialist, in addition to block feeding:

Express from both sides thoroughly to 'empty' your breasts as fully as possible.

After expressing, immediately offer both 'empty' breasts to your baby.

Next, limit your baby to one breast changing sides every two or three hours (see block feeding above).

Some mothers will need to use this approach only once. However, if your breasts feel uncomfortably full, you may need to repeat it, increasing the interval between each pump for your breasts to readjust.

Medications and herbs to reduce milk production
There are herbs and medications that can help dry up your milk production. Talk with your health care provider or a lactation consultant.

If you still have problems

After 4-7 days, your breasts may be more comfortable. If you and your baby still have trouble coping with the supply of milk, you can gradually increase the time block you keep your baby to one breast. Some women with extreme oversupply have gone as long as six or more hours before switching breasts to adjust milk production. A hormonal imbalance may cause overproduction of milk, but this is rare. A visit to your doctor may be helpful if the suggestions offered here aren't enough.

Block feeding should be a temporary measure. In practice, it is suggested that it is done for no more than one week, and only when babies are gaining double (or more) the average weight for their age. Once supply has settled, you can return to a more normal feeding pattern, following and trusting your baby and your body.

Breast compression

Babies used to a generous milk flow can become fussy at the breast when milk flow slows. They may have to work harder at the breast and deepen their latch to remove milk effectively. Breast compression will increase milk flow and encourage your baby to keep feeding actively:

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

2. Wait while your baby breastfeeds actively (slow, rhythmic sucking, lots of swallowing). When their swallowing slows, compress your breast gently to increase milk flow and encourage swallowing. Hold it squeezed while they continue nursing actively, then release your hand.

3. Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Be gentle - this shouldn't hurt.

Adjusting to the new normal

Always monitor your baby's weight gain, wet and dirty nappies, and overall well-being while following these strategies. Monitor their weight over a period of several weeks to see a trend. If your baby had been gaining weight very quickly, you may see 'catch-down' growth. Your baby will gain weight steadily, but may gradually drop against the percentile lines as your milk production adjusts. Their weight should then settle into following a new percentile line on the chart.

As your supply reduces, your breasts will feel softer and more comfortable, and leaking will be reduced. Soft comfortable breasts between feeds during the early weeks are normal and a sign that your milk production is in tune with your baby's needs.

Written by Charlotte Allam

Last updated May 2023

Kimberly Seals Allers' photos on this site are used under a creative commons license of Black Breastfeeding 360° http://mochamanual.com/bb/

Further Reading
Mastitis
Engorged Breasts - Avoiding & Treating
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk
Comfortable Breastfeeding
Rhythms & Routines
The Unhappy Breastfed Baby
Reflux
Allergies and Intolerances
Fat Content of Breastmilk - FAQs
Positioning and Attachment

Other websites
UK-WHO Growth Charts: www.rcpch.ac.uk/growthcharts
Block Feeding Dos and Don'ts: http://www.nancymohrbacher.com/articles/2013/10/9/block-feeding-dos-donts.html?rq=oversupply

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

Copyright LLLGB 2023

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While it's good to have plenty of milk, some mothers produce more milk than their babies need. This is usually called oversupply. Some babies cope very well with a generous milk supply; however, others will be unhappy and uncomfortable even though they are gaining weight and appearing to thrive.

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference.

Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it? And if she does decide to breastfeed, she's much more likely to have a good experience and manage any difficulties if her partner supports her decision (Tohotoa, 2009; Rempel, 2011). A partner's emotional support is so important for helping mums to breastfeed for longer too (Tohatoa et al, 2009; Su, 2016).

Why is breastfeeding important?

If your partner is breastfeeding your baby - or planning to - that's fantastic because breastmilk has so many benefits for babies. For instance, breastmilk can help to reduce the risk of your baby getting infections and diseases (NHS, 2017). It also contains hormones that help your baby's development (Victora et al, 2016).

Overall, breastfeeding will have a positive impact on your baby's health. What's more, it can influence their health as an adult too (Victora et al, 2016).

Is breastfeeding hard or will my partner just know what to do?

Many parents see breastfeeding as a natural process but it can take time for mum and baby to learn this new skill together. It might take around six weeks to get the hang of it fully (NHS, 2016).

The good news is that with the right support, your partner can overcome any challenges and continue breastfeeding if she wants to. If you think your partner needs more information, support or just someone to talk to, why not give one of our trained breastfeeding counsellors a call on our support line: 0300 330 0700. The line is open every day from 8am to midnight, including bank holidays.

You might find it helpful to read up about breastfeeding and attend a breastfeeding session before your baby is born. This can help you know what to expect and perhaps give you a little more confidence. It can also help you both talk about feeding your baby and raise any questions or worries you might have.

What do I need to know about breastfeeding?

You might find it helpful to know how breastfeeding works and what normal behaviour is for breastfed babies. Here are a few quick and handy facts:

Babies are happier if they're fed as soon as they show signs of being hungry.

Babies usually feed frequently (anything from eight to 12 times or more in 24 hours) in the early weeks, especially during the evenings.

Some babies are slow feeders at first, but they get quicker as they get older.

The more a baby feeds, the more milk their mum makes because it's the removal of milk that drives the production of it.

The Department of Health recommends exclusive breastfeeding for at least your baby's first six months. Breastfeeding is also beneficial for toddlers because it gives them a health boost every time they feed. So your partner can breastfeed your baby for as long as they both want to.

Nipple soreness or pain during feeding might be a sign that a baby needs some adjustment to their attachment at the breast. If there is soreness or pain when breastfeeding, talking to a healthcare professional or breastfeeding counsellor can help.

Women enjoy feeding more when they are comfortable and relaxed.

(Department of Health, 2011; La Leche League, 2016; NHS, 2016)

What can I do to help support my partner with breastfeeding?

There are lots of things you can do to support and encourage breastfeeding.

Here are 10 tips:

1. Boost your partner's confidence by encouraging her and being positive about her progress. As with learning any new skill, reassurance and praise are a massive help.

2. Listen and talk honestly about how you each feel about finding your way with your new baby.

3. Be involved with your baby in other ways so that the caring is shared (see below).

4. Help to reduce the household chores so your partner can feed your baby for as long and as often as they need.

5. Try to help your partner to relax by giving them a massage.

6. Women don't need to eat anything special while breastfeeding, but it's a good idea to encourage your partner to eat and drink regularly.

7. Help her get specialist support if she's struggling with breastfeeding. As mentioned above, you can both talk to one of our breastfeeding counsellors on 0300 330 0700.

8. Help out by bottle feeding your baby expressed milk once your partner and baby have got the hang of breastfeeding (see below).

9. Accept your partner's decision on when to stop breastfeeding.

10. Try to remember that with your support, breastfeeding can quickly become just another part of your family life.

(Rempel et al, 2010)

What practical support can I give to my baby if my partner is breastfeeding?

You might expect to feel like a bit of a spare part with feeding but it's good to remember that each parent plays a different and vital role. The decision on how you feed your baby is certainly a joint one (deMontigny et al, 2018). It might take a while to get used to the different parts you play though.

Whatever you decide to do, you might actually find feeding is less important to you than you expected anyway. Especially if you're hands-on with your baby in different and rewarding ways.

Tips for being a hands-on partner with your baby

Changing nappies and generally caring for your baby - it's great if you can spend time with your baby and interact (see below) with them while you're looking after them.

Bathing your baby - you could bath your baby or even have a bath with your baby. You'll both enjoy the bonding benefits of skin-to-skin contact and one-to-one time together (NHS, 2018).

Talking and playing - babies enjoy hearing gentle sounds. They even recognise the muffled tones of people talking from their time in the womb and they'll be aware of familiar voices like yours (Lee and Kisilevsky, 2013). So a chat with your baby might be a little one-sided but rest assured, they know it's you. Socially interacting with your baby through their senses helps to stimulate their brain development; for example, you could pull some different expressions (Boucenna et al, 2010).

Baby carrying - this means taking your baby out and about in a sling. It can be a rewarding and comforting experience for both you and your baby (Miller, 2019).

For more ideas on being a hands-on parent, see our article about bonding with and getting to know your baby.

How can I share feeding our baby?

If you're keen to feed your baby, you could give them expressed breastmilk from a spoon, syringe, cup or a bottle. But only introduce your baby to a bottle once breastfeeding is going well. For more on expressing, see our 10 bottle feeding tips for breastfed babies article.

And once your baby's moved on to solid food, there are so many ways you can get involved with that...chopping, mashing, cleaning up all the food that ends up on the floor...

I want to support breastfeeding but will it affect our sex life?

Possibly, but tiredness - and your partner's birth experience and recovery - is more likely to affect their sex drive rather than breastfeeding (Rowland et al, 2005). See our article about breastfeeding and sex for more details.

What if I feel uncomfortable about my partner breastfeeding in public?

If you're feeling uncomfortable or nervous about your partner breastfeeding in public, have a chat with her so you can talk it through. Maybe you're worried about your partner showing her breasts in public? Yet in reality, very little breast actually shows when a baby is feeding. You might have even seen a mum breastfeeding before without realising it.

It might also help to talk to other families where the mum is breastfeeding and find out about both partners' experiences of it. The chances are, you'll change your mind as you get used to seeing breastfeeding.

It's good to know that breastfeeding in public is protected by the law under the Equality Act 2010. That means providers of any services or facilities open for the public are not allowed to discriminate against women who are breastfeeding (Maternity Action, 2019).

Many places now welcome breastfeeding and have special facilities for mums if they'd prefer to feed in private.

Some mums might feel uncertain themselves about feeding in public at first and may appreciate the reassurance of having their partner with them.

At the end of the day...

Don't underestimate the huge difference you can make if your partner is breastfeeding. With you both on board, breastfeeding can quickly become an everyday part of your lives (Rempel, 2011).
This page was last reviewed in October 2017.
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.

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.

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

Health Talk has some interesting videos about different people's experiences of breastfeeding, click here to view them.

Boucenna S, Gaussier P, Andry P, Hafemeister L. (2010) Imitation as a communication tool for online facial expression learning and recognition. 2010 IEEE/RSJ International Conference on Intelligent Robots and Systems, Taipei: 5323-5328. Available at: https://ieeexplore.ieee.org/abstract/document/5650357 (Accessed 1st July 2018)

deMontigny F, Gervais C, Larivière-Bastien D, St-Arneault K. (2018) The role of fathers during breastfeeding. Midwifery. 58:6-12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29272696 (Accessed 1st July 2018)

Department of Health. (2011) Breastfeeding. Available at: http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publichealth/Nutrition/Nutritionpregnancyearlyyears/DH_127625 (Accessed 1st July 2018)

La Leche League. (2016) Still nursing? Available at: https://www.laleche.org.uk/still-nursing/ (Accessed 1st July 2018)

Lee GY, Kisilevsky BS. (2013) Fetuses respond to father's voice but prefer mother's voice after birth. Dev Psychobiol. 2014 Jan;56(1):1-11. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23817883 (Accessed 1st July 2018)

Miller R. (2019). Babywearing education in the neonatal intensive care unit. The International journal of childbirth education: the official publication of the International Childbirth Education Association. 34. 43-47. Available at: https://www.researchgate.net/publication/334151320_Babywearing_Education_in_the_Neonatal_Intensive_Care_Unit (Accessed 1st July 2018)

NHS. (2016) How to combine breast and bottle feeding. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/combining-breast-and-bottle/ (Accessed 1st July 2018)

NHS. (2017) Benefits of breastfeeding. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/benefits-breastfeeding.aspx (Accessed 1st July 2018)

NHS. (2018) Washing and bathing your baby. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/washing-your-baby/ (Accessed 1st July 2018)

Rempel LA, Rempel JK. (2010) The breastfeeding team: the role of involved fathers in the breastfeeding family. J Hum Lact. (2):115-21. Available at: http://journals.sagepub.com/doi/abs/10.1177/0890334410390045 (Accessed 1st July 2018)

Rowland M, Foxcroft L, Hopman WM, Patel R. (2005) Breastfeeding and sexuality immediately post partum. Can Fam Physician. 2005 Oct;51:1366-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1479788/ (Accessed 1st July 2018)

Su M, Ouyang YQ. (2016) Father's role in breastfeeding promotion: lessons from a quasi-experimental trial in China. Breastfeed Med. 11:144-9. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26836960 (Accessed 1st July 2018)

Tohotoa J, Maycock B, Hauck Y, Howat P, Burns S, Binns C. (2009) Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia. Int Breastfeed J. 4:15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788531/ (Accessed 1st July 2018)

Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC; Lancet Breastfeeding Series Group. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 387(10017):475-90. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26869575 (Accessed 1st July 2018)

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How can dads and partners support breastfeeding? | Baby & toddler, Feeding articles & support | NCT

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This article looks at how dads and partners can help support a new mum who is breastfeeding in the early days.

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This page is about young babies who have never breastfed or who get very upset when offered the breast. If your baby was breastfeeding well but is now refusing, see our page on "nursing strikes". Sometimes, a new difficulty with feeding is the first sign that the baby is becoming unwell. If you are not sure that your baby is well, please contact your doctor.
When a baby doesn't breastfeed after birth, it can be upsetting, confusing and frustrating. You might wonder whether you're doing something wrong, or even whether your baby likes you. It's hard not to take it personally!

Babies are 'hardwired' to breastfeed - it is an essential survival behaviour. When a baby doesn't breastfeed, it's never because they don't want to. Something is making it hard for them. Babies are never "lazy" or "difficult" - they always do the best they can. So do their mothers!
When it's taking time for breastfeeding to get going:
If you do this, your baby is very likely to breastfeed when they are ready. Time, patience, and good feeding support are usually all you need.
This useful summary of the "3 Keeps" can be downloaded as a free A4 poster
You can read more about getting breastfeeding on track after a difficult start here.

Why isn't my baby breastfeeding?

After a straightforward birth, most well, full-term babies will start feeding within an hour or so. Not all babies have such an easy start, though. Babies can take longer to start breastfeeding if:

They had a more complicated birth. Babies born with the aid of forceps, for example, often take a few days to recover and feed well. If you had pain medication in labour, your baby may be sleepy and uncoordinated at first.

Your baby was born early, or small for their gestational age. See also breastfeeding premature babies and late preterm babies (those born between 34 and 37 weeks). Even being born one or two weeks early can mean that your baby takes longer to start breastfeeding. It might take until around your baby's due date, or a little longer, before they are ready to feed well.

You and your baby were separated after birth because one or both of you needed medical care.

Your baby is very sleepy and doesn't yet have enough energy to breastfeed. See also sleepy baby and newborn jaundice.

Your baby is unwell.

Your baby is uncomfortable, e.g., some babies have a sore head or sore shoulder after birth.

Your baby has low muscle tone (hypotonia).

Your baby has a physical challenge such as tongue-tie.

You have plenty of time

Parents sometimes worry that if their baby isn't breastfeeding well, or at all, in the first few hours, days or weeks after birth, it will never happen. While breastfeeding in the first hour after birth is ideal, the window of opportunity for babies to start breastfeeding is much longer than this. The feeding reflexes, which keep babies seeking and attaching to the breast, last for at least two to three months after birth. We have seen many babies start breastfeeding older than three months, too! There are even reports of children over a year old starting to breastfeed, when placed for adoption with a lactating mother. Where there is milk, there is always the possibility of breastfeeding.

First things first

Sorting out breastfeeding problems can feel overwhelming. There seems to be so much to do, and you might feel you have to do it all at the same time! It is helpful to know what is urgent and what can wait. This can help you to work out what to do in what order, and how best to use your time and energy. Feeding at the breast is the least urgent thing, at this stage.

If your goal is to have a full milk supply (enough milk to meet all your baby's needs) but you need to use donated breastmilk or formula at the moment, or if your baby is not growing well just on your milk, then making more milk is the top priority. This is more urgent than your baby starting to feed at the breast.

If your baby is not breastfeeding at all yet, or is not breastfeeding effectively, you can express your milk. This gives you milk to feed your baby now and encourages your breasts to make plenty of milk for the weeks and months to come.

Your breasts may temporarily become swollen and uncomfortable, starting around 2-4 days after birth. This is called "engorgement" and is a sign that your breasts are becoming more active (though not all mothers feel it). It is important to treat engorgement, to keep your breasts comfortable and your milk flowing well. Read more here: Engorged breasts - avoiding and treating.

Read here about how milk production works and how to increase your milk supply.

You can find information here on how to use bottles and other feeding tools.

Exclusive Expressing

Expressing all the milk your baby needs is known as "exclusive pumping" or "EP". You can read more here. Some mothers choose to do this; many do it because their babies are not able to breastfeed. You might find it helpful to join an online support group for "EP mums".
If you need to express your milk for a baby who is not breastfeeding yet, it is important to work with a skilled breastfeeding supporter. You might also want to connect with other mothers who have needed to express milk - they can be your best cheerleaders while you do this important job! Your local La Leche League group would love to support you.
Setting the scene for breastfeeding - happy time at (or near) the breast

Most babies need only time, patience, and gentle encouragement to help them start breastfeeding. Babies are born expecting to breastfeed, with a set of reflexes to help them do it. We need to keep them well fed (with expressed or formula milk), give them lots of relaxed time near the breast, and.... give the baby time.

Here are some ideas to try:

Hold your baby skin-to-skin. Babies use their whole bodies to feed. The more of their skin they feel against yours, the more likely they are to find the breast and start feeding. Undress your baby down to their nappy and move your clothes out of the way. If you are cold, you can put a blanket round both of you. Even if your baby doesn't breastfeed yet, it feels lovely, and helps your baby get used to being at or near the breast. Holding your baby against your skin helps you make more milk, too! If your baby can't tolerate being held in a feeding position, try holding them against your shoulder.

Avoid holding your baby in a feeding position during medical procedures, especially if your baby will be having lots. Offer the breast afterwards instead, if it calms them.

Try "laid-back" breastfeeding. Try putting your baby tummy-down, on the slope of your body as you recline comfortably (as if you are lying on a sun lounger). Placed like this, they can use their arms and legs to help themselves find the breast and attach well for feeding. This can work better than trying to "put" the baby to the breast, especially if they have already had difficult experiences of this. This video shows you how. The safest place to do this is in a bed that has been set up following safe sleep guidance. See our article on safer sleep.

Turn up the smell! Newborn babies don't recognise the breast well by sight, though they do recognise your face, and love looking at it. They find the breast mostly by feel and smell. The little bumps around your nipple (Montgomery's glands) make a scented oil which helps your baby find the breast and encourages them to feed. You can give your baby extra help by expressing a bit of milk and rubbing it on and around your nipples. This can encourage your baby to feed by increasing the smell and giving them something to lick as they approach the breast!

Try "drip-drop feeding". Your partner or supporter uses a cup and spoon to drip milk (expressed milk or formula) onto the breast as you hold your baby. This can encourage babies to attach and feed. You can watch a video here.

Take a bath with your baby. When placed skin-to-skin with their mother in a warm bath, some babies find the breast and feed for the first time. Some mothers even describe it as "a second chance at giving birth". You could set the scene with low lighting, a candle or soft music. Whether or not your baby is ready to breastfeed yet, sharing a bath can help you and your baby relax together and enjoy each other. Have another adult with you to help you get in and out safely, put the baby on you and wrap them in a warm towel when they are ready to get out.

"Wear" your baby. Babies who are kept close in a sling or soft carrier cry less, are calmer and warmer than babies who are put down by themselves. Being carried is good for babies' physical & emotional development and helps parents and babies make strong connections. If your baby is not breastfeeding yet, carrying them close, as much as you want, is an excellent way to help them feel comfortable near the breast. Always follow the instructions for your sling or carrier and the rules for safe babywearing. You can read more about babywearing in this book.

Feed your baby at or near the breast. If your baby will go to the breast at all, consider using a nursing supplementer so your baby can have extra milk while they breastfeed. This can be helpful when milk supply is low and/or your baby is frustrated by the speed of milk flow at the breast. If your baby is fed by cup or bottle, try feeding them skin-to-skin with their cheek against your breast. Let your baby end the feed by sleeping with their cheek pillowed on the breast.

Consider sleeping with your baby. Some babies will attach and feed in their sleep if the breast is near enough to smell and feel. Always consider sleep safety before sleeping with your baby in your bed. It is never safe to sleep with a baby on a sofa. You can read more about sleep safety and normal baby sleep in LLL's book Sweet Sleep.

Babies with low muscle tone (hypotonia)

A baby who has been diagnosed with a condition that makes them hypotonic, or 'floppy', may show little interest in breastfeeding. To make feeding easier:

Support your breast. Tuck a rolled-up cloth under your breast close to your chest wall, or support your breast with your thumb on one side of the areola, fingers on the other side.

Support your baby's chin. If your thumb is parallel to your baby's upper lip, you can use your index finger to put gentle pressure just behind the bony part of the chin while your baby feeds.

Try upright positions. A hypotonic baby often feeds better held with their head higher than their bottom.

Breast compression can also be helpful, but you may also need to give some expressed milk until your baby's muscle tone improves. Breast compressions are explained in more detail in "My baby needs more milk".

If your baby suddenly becomes floppy and you don't know why, seek medical advice.

Baby steps

When you are keen to breastfeed, but your baby isn't yet ready, it can be frustrating. Don't forget to celebrate how far you have already come! Every time your baby enjoys being held close to your body, or falls asleep near your breast, they are taking another "baby step" towards breastfeeding. Your baby is doing the best they can for now, and so are you.

When breastfeeding is stressful

When breastfeeding is difficult for your baby, it may become stressful for both of you. Babies who have had unhappy experiences at the breast can develop negative associations with breastfeeding. This might happen, for example, when:

A baby is in pain or discomfort e.g. from birth injury or allergy.

A sensitive baby is handled at the breast in a way they don't like, e.g., if a helper tries hard to "put" the baby to the breast when they aren't ready.

Milk supply is low.

A baby has a physical restriction (e.g., tongue tie) that makes attaching and sucking difficult.

A baby who is finding feeding difficult may become upset:

A short time into the feed, when milk flow slows down.

At the start of the feed, when milk doesn't come straight away.

When offered the breast.

When put in a breastfeeding position.

When they see the breast.

When feeding isn't going well, babies may come to associate the breast with hunger and frustration. They may develop a preference for another feeding method, such as a bottle, if they associate it with feeling full and satisfied. You can find some ideas on how to keep your baby's relationship with the breast positive here: using donor milk & formula milk to support breastfeeding

The ideas in the previous section ("Setting the scene for breastfeeding - happy time at (or near) the breast") can help your baby learn that the breast is a lovely place to be, and to associate it with calm, relaxation, comfort, and satisfaction rather than hunger and frustration.

Take a break

If breastfeeding has become very stressful for you and your baby, you might need a "breastfeeding break". You could stop trying for a few days, whilst expressing your milk to keep your baby fed and keep your milk flowing. When you're both ready, you can try again. There is no rush! Dr Christina Smillie, an American doctor who specialises in breastfeeding medicine, calls this " rebooting the baby ".

What if my baby is still not breastfeeding?

When you are eager to breastfeed, it is hard to wait. It is not uncommon for babies to need time to begin breastfeeding well. You might be encouraged by hearing the stories of other parents whose babies took time to get going.

If your baby is still not breastfeeding even with time, patience and some of the tips in this article, there will be a reason why. A skilled breastfeeding supporter can help you find out, and work towards breastfeeding. Some babies need medical care, some benefit from feeding tools such as nipple shields and a few need treatment for tongue tie. Many just need a little more time.

A few babies never do breastfeed. Some have a medical condition that makes it impossible. Very rarely, we never find out why. You don't have to feed your baby directly from the breast to give them the many benefits of your milk or to nurture them at your breast. We can support you to have a close, happy feeding relationship with your baby, whatever form that takes.

La Leche League Leaders (breastfeeding counsellors) can help. You can find your local group, and LLL Zoom Meetings all over the country, at https://www.laleche.org.uk/find-lll-support-group/

Jayne Joyce, LLL Oxfordshire & Karla Napier, LLL Edinburgh, April 2022

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My Baby Won't Breastfeed - La Leche League GB

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Breastfeeding is normal and nature but some babies struggle to get started. This page explores ideas for helping babies won't breastfeed

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The baby sleep
info source

For parents who wish to make informed
choices about infant sleep and night-time care.

About us

Welcome to Baby Sleep Info

This website presents research evidence about biologically normal sleep for human babies.

We discuss how infant sleep may vary due to cultural behaviours and expectations such as what babies are fed, where they sleep, and how we interpret their needs. This information is for:

parents who wish to make informed choices about infant sleep and night-time care

health practitioners who wish to share evidence-based information with parents about infant sleep.

Basis does not address clinical sleep problems or provide individual sleep advice and parents should contact a health practitioner with any concerns about their baby's health. For information about the organisations and funding that support Basis please see ' About Us '

Get the App

The Infant Sleep Info App provides key information from the Basis website in a handy format for mobile devices. Covering normal sleep development, sleep location and sleep safety the familiar info from the website is delivered in smaller chunks. Two features are exclusive to the app.

Get it Now

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Research-based information on baby sleep for parents and practitioners, covering normal infant sleep, sleep safety, where and how babies sleep, SIDS and SUDI, parental sleep and free resources.

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A nipple shield is a thin, silicone teat that can be placed over a mother's nipple and may help a baby who is having difficulty learning to breastfeed. Holes in the tip allow milk to flow into the baby's mouth. A nipple shield can be used temporarily to help establish breastfeeding or in some cases to help ensure that breastfeeding continues. A shield provides a firm stimulus at the roof of a baby's mouth where the soft and hard palate meet. This can help him suckle more effectively.

If your baby is not nursing at all, or is nursing ineffectively despite improving attachment and increasing milk flow, a nipple shield may help by providing a firmer stimulus in your baby's mouth. A nipple shield may be a useful tool in some situations. When nothing else works, it can be a temporary way to establish and maintain breastfeeding.

A nipple shield may be helpful if

Your baby is struggling to learn how to breastfeed

You have flat or inverted nipples, or very soft breasts as it can help maintain nipple shape

Your baby thrusts his tongue, has a retracted tongue or has neurological problems

Your baby was born prematurely

Your baby needs extra stimulus to prompt sucking

In these situations, a nipple shield can

Give a baby the opportunity to learn to breastfeed

Allow a baby who breastfeeds ineffectively to take more milk directly at the breast. This can be particularly helpful for premature babies

Avoid or reduce the need to express milk and use cups or bottles

Help keep breastfeeding going

Not a magic solution

It is very important to seek skilled help with positioning, attachment and any other problems if you are planning to use nipple shields or are already using them. Helping your baby get a deep latch at the breast is the key to effective and comfortable nursing with or without a nipple shield. A shield cannot correct underlying problems, especially those of sore and damaged nipples or low milk production. And if your baby is not attached well he may compress your nipple, causing damage and intense pain. When your baby latches on deeply at the breast he gets plenty of milk. Also, as you wean from the shield he will be able to adapt to breastfeeding effectively and comfortably without it.

Even with a nipple shield, your baby may still need help to learn to breastfeed well. Sometimes just a small adjustment to the way you hold your baby makes a big difference. You may find the suggestions and pictures in Comfortable Breastfeeding helpful. If you cannot get comfortable or breastfeeds are taking an hour or more, seek help from an LLL Leader who can give you personalised suggestions.

Holding your baby in skin-to-skin contact can make a big difference too. With or without a shield, laid back or 'natural' breastfeeding positions (see above) can be a great help in encouraging your baby to latch on effectively, as well as being comfortable for you. You can either lie down or recline with your baby on top of you and with his whole front against you and his body completely supported by yours. Such positions also leave both your hands free to shape your breast and help him latch.

If your baby won't breastfeed

Don't panic! Some babies take time to learn. However, babies will often latch on and suckle spontaneously if they can snuggle up close to their mother's bare chest for periods of time. Try letting your baby lie on your body as you recline so that both his chest and tummy are against you. This kind of contact, known as Biological Nurturing ™, or laid back breastfeeding usually stimulates a baby's instinct to attach and suckle well at the breast. In such positions, babies can also latch on when sleepy or even asleep. Watch for signs your baby is stirring and gently encourage feeding. If he is not breastfeeding effectively or at all you will need to express your milk for him. This will help maintain your milk production while he learns to breastfeed. An LLL Leader can give you tips for effective milk expression.

Is he getting enough milk?

Offer frequent feeds and monitor wet and dirty nappies for evidence your baby is getting plenty of milk. His weight will need checking regularly-as often as every three days for premature babies. For more information see Is My Baby Getting Enough Milk?

Check your breasts

Areas that aren't being drained well may appear swollen, sore or red. Treat early signs of localised engorgement to avoid a blocked duct or mastitis.

Practicaliti es
Type and fit
Modern nipple shields are made of clear ultra thin silicone. Different makes vary in flexibility. Some shields have a cut out section, but these may not stay in place as well as a full nipple shield. Full nipple shields do not bother babies or affect their breathing. Nipple shields come in different sizes but choice is limited. Both the width of the tip section and the shape of the flat part vary and you may need to experiment to find which size and shape you prefer. A comfortable fit is very important and some mothers need more than one size of nipple shield due to differences between their breasts.

Applying
Stretching the shield onto the breast can help it stay in place. You can also moisten the shield's edges or warm it with hot water to help prevent it moving. Turn the nipple shield almost inside out before applying it. Smooth it onto the breast, starting well away from the nipple in the area where your baby's lower jaw will latch on. Stretch the shield over your breast, with the tip centred over your nipple. The nipple shield should be tight against your breast with your nipple extending into the tip. If necessary, you can express milk into the tip or drip expressed milk onto the outside to encourage your baby to latch on.

Cleaning
If you and/or your baby are in hospital, wash the nipple shield thoroughly in hot soapy water and sterilise it before each use. If you have a healthy, full-term baby and are at home, cleaning with hot soapy water or washing in a dishwasher on a hot cycle will be sufficient. Shields should be dried thoroughly before use and stored in a clean, sealed container or bag.

A faster flow
Swallowing encourages sucking, which will help keep milk flowing. A baby who has become used to a continuous fast flow from a bottle may need help to persist with breastfeeding. Hand expressing for a few minutes can encourage a good flow of milk before your baby latches on. You can even hand express milk into your baby's mouth to encourage him to latch on or keep him nursing when your milk flows more slowly.

Try breast compression

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

2. Wait while your baby breastfeeds actively, his jaw moving all the way to his ear. When he stops swallowing, compress your breast firmly. Hold it squeezed until he stops nursing actively and then release your hand.

3. Rotate your hand around your breast and repeat step 2 on different areas of the breast as needed. Go gently-this should not hurt.

Use a shield with a nursing supplementer

If your baby needs extra milk, a nursing supplementer can be used to deliver this through a tube as your baby breastfeeds. This avoids the need to bottle feed. The end of the supplementer tube can be placed either inside or outside the shield. Consult an LLL Leader if you think a nursing supplementer may be helpful.

Giving up the shields

Nipple shields are intended to be a temporary solution until your baby learns to breastfeed without them. When using a shield, help your baby to latch on by himself with a wide open mouth. This will help him to learn to breastfeed without a shield. Offer your baby some time in skin-to-skin contact every day without a nipple shield so he has the opportunity to latch on if he is able. It can take time to wean from shields but do keep gently trying. Try at times when you and your baby are most comfortable and relaxed and there are fewest distractions. You can try different methods to see what suits your baby.

Start with skin-to-skin next to breast without the nipple shield before nursing with the shield.

Start a feed with a shield, removing it part way through nursing from one breast or when switching breasts.

Gradually offer the breast without the shield.

DO NOT CUT a silicone shield as this could leave sharp edges that would hurt you and your baby.

Seek support

Whilst you may be relieved that a nipple shield is enabling your baby to breastfeed, it can be frustrating if he will not feed without it. However, given time and patience, it is usually possible for a baby to learn to breastfeed without the shield. An LLL Leader can be a useful source of support if you need to choose, use and wean from nipple shields.

Written by Karen Butler, Sue Upstone and mothers of La Leche League GB.

Further Reading

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

Positioning & attachment
Comfortable breastfeeding
Engorged breasts - avoiding and treating
Hand expression of breastmilk
Inverted nipples?
Is my baby getting enough milk?
My baby needs more milk
My baby won't breastfeed
Nipple confusion?
Nipple pain - why and what to do

References
The Breastfeeding Answer Book. Third edition. Schaumburg IL: LLLI, 2003.
Breastfeeding and Human Lactation. Fourth Edition. Sudbury, MA: Jones and Bartlett, 2010.
Supporting Sucking Skills in Breastfeeding Infants. Watson Genna, C. Sudbury, MA: Jones and Bartlett, 2008.
This information is available in printed form from the LLLGB Shop
Copyright LLLGB 2016

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how an when to use nipple shields to support successful breastfeeding

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BHSCT video - benefits of breastfeeding premature babies

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BHSCT video - benefits of breastfeeding premature babies

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The Public Health Agency (PHA) and colleagues from the Neonatal Network Northern Ireland (NNNI) have launched a new video highlighting the benefits of breastfeeding and showcasing the support that is available to mums and families of premature babies and babies in neonatal units to encourage them to breastfeed in those early days.

Dr Joanne McClean, Director of Public Health at the PHA, said : "Breast milk is important for all babies and is particularly beneficial for premature babies and those who need extra support in the neonatal unit. There are significant clinical benefits to giving breast milk to your premature or neonatal baby.

"Breast milk helps protect babies from infections, especially of their gut - which is particularly important for premature babies who are more likely to get infections. It contains hormones, nutrients and growth factors that will help babies grow and develop, and breast milk is also easier for babies to digest than formula milk. This is because breast milk is specially designed by your body for your baby.

"This video has been developed to showcase the benefits of breast milk for both mum and baby at a neonatal stage, which can be very challenging for families. It highlights a range of support services available to help mums and families on their breastfeeding journey and will be on computer tablets in neonatal units across Northern Ireland."

Dr McClean continued: "If your baby is very small or sick, they may not be able to breastfeed from your breast at first, but you can start regularly collecting your breast milk - called expressing - as soon as possible after your baby is born. This will help get your milk supply going and it can be provided to your baby in other ways. If there is any extra milk expressed it can also be frozen so you can give it to your baby at another time, once you and your baby are ready. Even if you were not planning to breastfeed, you could express your breast milk for a while to help boost your baby's immune system in the early weeks after birth."

Whether you need information on the benefits of breastfeeding, support with breastfeeding or you want to know how you can help support a friend or family member on their breastfeeding journey, the first step is simple, visit the PHA's website, www.breastfedbabies.org for information on all types of support available.

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New video launched to showcase benefits of breastfeeding for premature and neonatal babies | HSC Public Health Agency

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The Public Health Agency (PHA) and colleagues from the Neonatal Network Northern Ireland (NNNI) have launched a new video highlighting the benefits of breastfeeding and showcasing the support that is available to mums and families of premature babies and babies in neonatal units to encourage them to…

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Providing breast milk for your baby is a very practical way in which you can contribute to their development and growth in the crucially important early days and weeks of life.