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Tips and hints from the wonderful Emma Pickett

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Tips and hints from the wonderful Emma Pickett

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If something is not quite right, but you are not sure what, then this list of things to check might be helpful. . . or pick up the phone and call a BFC!

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A dad at my breastfeeding support group this week had a bit of an epiphany. 'It's never felt like this before,' his wife had said. We'd spent just 3 or 4 minutes together. I'd mentioned one or two things about the way she was holding her baby. It was enough to make all the difference.

Just like in golf, he noted, with a tiny change to swing and position the game had been transformed.

As a lactation consultant, you study for hours and hours and pages and pages and pages. You know lots of things you may not talk about from month to month. But there are twenty or so things you say nearly every day.

So many mums have their experience transformed by a tweak. They are sore, dreading each feed, wondering how things will ever change and one comment - that may not even be 20 words long - can make all that go away in an instant.

It's one reason why even a rushed midwife or GP can turn breastfeeding around with the right training, even if they don't always have the time to devote to a long support session.

Here are a few of my favourite tweak considerations:
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1. Get a glass of water. Take a drink. Notice how you tip your head back and your chin comes away from your chest? Now try to take a drink with your chin pointing down towards your chest. Not so easy. Try and do that every time you drink, and I think you'll find you take less, give up sooner that you might otherwise and probably get a bit windy. So, tweak number one is hold your baby in a position where they can lift their chin away from their chest. If you are using a cradle hold or a cross-cradle hold, that means you might need to have them further away from the feeding breast's armpit and slid more across towards the non-feeding breast. We talk about 'nose to nipple' because that's encouraging the baby to reach towards the nipple with their head tilted back. If you are using a rugby hold, super important the baby isn't too far forward so they end up curling around the breast with their chin hunched towards their chest.

2. Don't hold the baby's head too high on the back of their head or push the baby's head towards the breast. Babies are clever at protecting their breathing (why we don't need to press our fingers into the breast near baby's nose). And nature has given them a reflex which means when someone pushes on their head, they'll be very unhappy about attaching in case they can't rescue themselves when breathing becomes restricted. They may even push back and shallow the latch and sometimes even refuse to feed entirely. So, support baby's head by holding around the base of the skull - supporting around their shoulders and chin and ears area - but no higher. Imagine Elvis towards the end of his career in Las Vegas with those diamond encrusted collars. You're holding your baby's Elvis collar and no higher. And even then, as gently as possible. Just enough to support baby's head without being too bossy or firm. You might even be using a position where this isn't a risk at all - you might be lying down or using a reclined position where your hand is nowhere near baby's head.

3. Beware the cushion myth. I am not kidding when I say that most people I meet using breastfeeding cushions are using them in a way that makes their life harder for themselves. The gap between your lap and the natural fall of your breast is probably very different from your mate's. It's going to depend on the length of your torso, the size of your breast, the way your breasts fall, the height of your lap which varies with your chair. It's also going to depend on the shape of your baby. So how on God's green Earth did we all get the message that the same size of breastfeeding pillow fits everyone?

Again and again and again, taller mums are slumping forward and hunching over their baby lying on their cushion. 'This cushion must be right. I just have to contort myself to get to it!'

And shorter women also think that the cushion is surely the answer, so they put baby on the cushion and umm, there's no space between their breast and the cushion for baby to fit. They often end up lifting their breast so baby can fit underneath. They might then have to hold their breast throughout the entire feed, compressing ducts and causing hand pain and usually not holding the breast in the same position the whole way through a feed so things wobble around.

Or folks might put the baby on the cushion and baby is a few centimetres too far away from them with sometimes not even the chin and chest making contact with mum at all.

Cushions can be handy to support mum's arms, but it doesn't normally work that the baby can't be held by mum and is entirely on the cushion.

What often works even better is no pillow at all and mum leaning back a bit. Check out: http://www.mothering.com/articles/natural-breastfeeding/

4. Baby needs to be clooose. If you can see the buttons down the front of baby's sleep suit, they are probably too far away. If baby's arm is trapped between you, they are being pushed too far away. If there's a big blob of your clothing and a breast pad between you, they are probably too far away. I once supported a mum who found night time feeds much more painful. She was sitting in the same chair to feed as she did in the day and was using exactly the same position but at night it was pinchy and uncomfortable. It turns out the difference was that the baby was wearing a sleeping bag at night. Just a few extra millimetres of padding meant that baby's chest and chin was a little bit further away from mum's body and the nipple wasn't going back far enough into baby's mouth. Baby's chin needs to be close into the breast. It's not going to work if the baby's chin isn't touching the breast at all. And the chin can't touch if the chest is too far away.

It's common for a mum to say, "Wow it doesn't hurt anymore!" followed by "I haven't been having them close enough!"

5. Mums are fiddling around and 'checking the latch'. It's completely understandable that when someone tells you the baby's mouth should be a certain way and the bottom lip should be flanged out like a fish lip, you think you are supposed to check! But the minute you push your baby's cheek out of the way and have a bit of a rummage, you've made some adjustments. Better to go with a look at the baby as they approach the breast and the mouthful you saw them take and how it feels. And how the nipple looks when it comes out of baby's mouth (might be elongated but shouldn't be squashed and flattened at the end.) If the baby is close enough, you usually can't see the lips at all. The rounded part of baby's cheek is in contact with the breast and the lips are hidden.

6. And while we are talking about lips, the top lip doesn't need to flange out and do the fish lip thing. It can rest in a neutral position. An excessively flanged top lip can even be the sign of a shallow latch. I've met several mums who have been told that the top lip should stick out and even flip it out themselves to make that happen. Curled in isn't ideal but it doesn't need to flip out.

7. Babies are sinking. Mums might start with baby on a squishy pillow and as the feed goes on, gravity does evil things and the baby starts to sink. The movement might be imperceptible but it's enough to pull the baby away from the breast. That pregnancy pillow filled with beans that the manufacturers claimed was super for breastfeeding? Meh. If it's bean-filled, it's likely to sink. That favourite feather filled bed pillow? Going to sink. Holding all the weight of your baby on your arms and hands and sitting bolt upright? You are going to sink. You are not designed to hold the weight of your baby in that position for minutes and minutes throughout the day. It's a big clue if you finish a feed rubbing your wrist and thinking, 'phew, glad that's over!' Gravity is your enemy. You need to find a position which you can sustain. That might be the right cushion for you (or more than one) or again, it might be about leaning back. Babies also latch better when they are anchored. If they feel themselves slipping, they may even clamp down and things can get even more sore.

8. What's the bottom cheek doing? Not many of us have nipples that come out from our body at precise right angles. So why do so many of us feed a baby as if that's true? The baby is precisely 'tummy to mummy' and lying on a breastfeeding cushion as if our nipples are pointing directly in front of us. In fact, most women have nipples that point slightly down (or off to one side and down). But we put baby into the 'right angle' position anyway. What ends up happening is that the top cheek (which mum can see in a cross-cradle or cradle position) is nice and close to the breast and rounded. However the bottom cheek can be centimetres away from mum's body with an unhelpful gap for air to get in and a shallowed latch. Get someone to check that the bottom cheek is touching the breast too. Look at your natural body shape. Your baby may need to look up towards your shoulder rather than at the back of the chair. You may be able to see both of their eyes.

9. Ear/ Shoulder/ hip in alignment. Get that glass of water again. Twist your neck and try to take a drink. It's rrrreally hard. And if what you were drinking was gradually getting thicker and fattier, again, you're likely to be taking in air and giving up sooner than you might. Baby can't lie on their back and twist their neck towards you to come to the breast. We want the ear and shoulder and hip to all be pointing in the same direction. Even a baby with a twisted torso and the twist is around the hips can run into problems.

10. Look at your body. Look, that mum over there in Costa seems to be able to drink her coffee (yes, you can drink coffee) and is just supporting her baby on one arm! How the heck! Can I do that? You know how hairdressers' clients turn up to their appointments with a celebrity photo and say, 'make me look like that!' That sometimes happens in breastfeeding too. 'Can I hold my baby like that mum I saw?'

Sometimes the answer is yes and sometimes it's no. Your humerus is the bone that goes between your shoulder and your elbow. Sometimes your humerus bone and the height of your breast isn't ideal for particular positions. Long humerus and high firm breast? You may not be able to do the cradle hold. I mean seriously - you may NEVER be able to do the cradle hold. The baby will be too low. Short humerus and long low breast? You may not be able to do the position that that woman in Costa can do and drink coffee. You might always need a hand to support the breast if you want to do the cradle hold.

It's not all about the pictures in that breastfeeding book or what your mates are able to do. It's about the shape of your body and the shape of your baby. Do you need to factor in wheelchair arms? Do you need to think about how your breast texture changes in the day? It's all very individual. Trying to make it work like everyone else does it can be unhelpful - which is why getting face-to-face help tailored to you can be so useful.

11. Give the baby more space for their tongue on the breast. You may have heard people talk about baby getting more of a mouthful of breast below the nipple than above. Or seeing some areola above the top lip and less (or none) below the bottom. If the baby has more space for their tongue on the breast, they have a chance of scooping more breast into their mouth and the latch being deeper. When the nipple is going in, picture it pointing towards the roof of baby's mouth rather than pointing down the back of their throat. Even just a little bit of re-angling can make things easier.

12. Don't make your baby eat cotton. Breastfeeding clothes also assume we're all the same. If you find them a faff - as you pull open a teeny slit to find your nipple hidden in there somewhere - I'm pretty sure your baby does too. If they ping back so the baby's nose and cheek comes back into contact with fabric again, maybe rethink. I've even seen babies with fabric in their mouths with a look of resignation that says, "This is the best I'm going to get". Cheap vest tops you can pull out of the way are very sensible. You can layer more than one so different bits are covered. And a bulldog clip is useful for securing fabric (not your chin holding your clothing and preventing it from flopping down onto baby's face).

As I say, some of that really isn't complicated. It's what we talk through on the breastfeeding helplines and what we point out every day in breastfeeding support groups. While at the same time NOT saying that it's 'normal' to be pain at 10 days or your nipples just need to get used to things. If you feel breastfeeding is just all too hard, remember you could be seconds away from fixing things.

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Category: Breastfeeding Is Just Like Golf! A Tiny Adjustment Makes All The Difference.

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A dad at my breastfeeding support group this week had a bit of an epiphany. 'It's never felt like this before,' his wife had said. We'd spent just 3 or 4 minutes together. I'd mentioned one or two things about the way she was holding her baby.

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Plus notes on common positions

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You'll hear two different messages about positioning and attachment that seem to contradict each other. On the one hand, baby is filled with natural reflexes and you are too and you are both...

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A nice clip showing laid back breastfeeding in action.

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Another example of biological nurturing.

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A detailed article by a bfc

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Laid back feeding positions support babies to use their inborn reflex behaviours to breastfeed. Just in case you want to know more, here’s that nice MedLife Doc Rohan explaining all.

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In the first few days, sometimes the breasts can get very hard and full. This makes it difficult for the baby to latch on. Reverse pressure softening is a useful way of softening the area around the nipple, making attachment easier.

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How To Relieve Engorgement - RPS By Mother

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A useful technique for getting a deeper latch. sometimes helpful with a baby with compromised tongue function

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*More information on this topic can be found in my NEW BOOK on breastfeeding and tongue ties, "All Tied Up! How To Keep On Boobin' Through A Tongue Tie". Available here.
Most babies will latch on the best when they are supported to self-attach on their own, with the mother in the "laid-back" breastfeeding position, or self-attachment in the "koala" hold. Here is a video to show what this process looks like. It's an amazing thing to see (and experience yourself!)...

But what about the babies who cannot latch on well by themselves? What about the babies with tongue ties or other physical issues going on that inhibit their ability to keep enough of the areola in their mouth while breastfeeding? This is where the "flipple" technique can really help. In the following video I discuss how this little breastfeeding trick can work even better if the mother does this while her baby is in the "koala" position which looks like this:

Step 1. Try to get your knees lower than your hips as this can make it easier for some mothers.

Step 2. Put your baby's mouth right at your nipple.

Step 3. Use the "flipple" technique to get as much of your breast tissue into your baby's mouth as possible. Point your nipple very high towards their nose, try to get as much of the bottom part of your areola into your baby's mouth and use your finger to flip their top lip up after they have latched on.

*You may need to use this "flipple" technique before AND after you get a laser or scissor tongue/lip tie revision done. Some mothers find that they need to use this for quite some time as their baby get's the hang of using their new tongue!

Step 4: Watch this video to see it in action!

And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm...

Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions about tongue ties please CLICK HERE.

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How to get a better latch! The exaggerated latch or "flipple" breastfeeding technique... - The Milk Meg

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And here is another video demonstrating the flipple in an upright position but baby is supported from behind by both a pillow and their mother's arm... Have you used the flipple and/or the koala hold? Share your experiences below! If you need some help getting your baby to latch on or have questions [...]

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Scratch mittens and integral scratch mittens on sleep suits are marketed to prevent babies scratching their face or eyes with their finger nails. Are scratch mittens really needed or could they have any negative effects for baby? After all, babies manage perfectly well without mittens in utero and covering up a baby's hands removes his sense of touch. Preventing a baby from sucking his thumb, fist or fingers also prevents a baby from comforting himself or showing feeding cues (signs that he is hungry). This article discusses the trend to cover a new baby's hands with scratch mittens and how it could affect breastfeeding.

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What are scratch mittens?

Scratch mittens (or mitts) are tiny gloves without separate finger openings that are made to cover babies' hands. They are often integrated into the sleeves of newborn sleep suits so that a pocket of extra material can be pulled over a baby's fingers. They prevent a baby accidentally scratching himself or his mother's breast with their finger nails. They might also stop a baby touching a wound on his hands or face or spreading infection.

Are there any disadvantages of scratch mittens?

There are a number of potential disadvantages of using scratch mittens:

Mittens mask a baby's sense of touch via his hands just as covering his eyes would mask his sight or ear defenders would prevent hearing.

Covering hands creates a barrier for skin-to-skin contact and all the breastfeeding benefits that are associated.

Wearing mittens could lead to missed feeding cues if a baby is unable tosuck his fist or fingers to indicate he is hungry.

A baby cannot comfort himself by sucking his thumb or fingers when wearing mittens.

A baby will find it very difficult to use his hands to help him find, feel or shape the breast to help him breastfeed if he is wearing scratch mittens

Tiny separate mittens could be a choking hazard.

Why are scratch mittens popular?

Although there are quite a few disadvantages to covering babies' hands, scratch mittens remain popular. It is likely that parents do not realise that there can be a downside to using scratch mittens, and where hospitals and government initiatives endorse them as necessary, parents are led to believe they are needed. For example, some hospitals recommend parents bring scratch mittens to the labour ward and Scotland's Baby Boxes (a government initiative giving free baby items to parents) contain free scratch mittens.

Why do babies scratch themselves?

Babies occasionally scratch their faces accidentally due to uncoordinated movements of their arms and hands when they:

Have long finger nails that need trimming

Bring their hands to their mouths when they are hungry or use their arms to search for the breast

Have dry or sensitive skin that causes itching.

Preventing scratches

Parents can minimise opportunities for babies to scratch themselves by:

Trimming their finger nails regularly using a nail file, emery board or blunt ended baby scissors.

Responding promptly to feeding cues such as rooting (searching for the breast with an open mouth), waving their arms, sucking their fist, thumb or fingers, or crying. Crying is a very late hunger cue and by the time a baby is crying for attention, he is likely to be even more uncoordinated and frantic to find his mother or father and more prone to scratching himself.

Babies use their hands to breastfeed

A baby uses all his senses to breastfeed and a baby's hands are also involved in each of the senses of touch, sight, smell and taste. Because hands are so important during breastfeeding, covering them with scratch mittens could interfere with breastfeeding. In the first excerpt below authors Watson-Genna and Barak explain how babies are not completely helpless, they have instinctive latching instincts which are triggered when they are held in certain breastfeeding positions and they can use their hands to help them:

Infant ability to find and attach to the breast has only been recently appreciated. When mothers are in reclined, laid-back or biological nurturing positions, the mothers' bodies provide optimal support for their infants, which releases infant instinctive feeding behaviors. One type of instinctive behavior that infants reveal is their deliberate use of their hands to locate, move and shape the nipple area.

In the next quote, Breastcrawl.org explain some of the ways babies use their hands to help them breastfeed...

Horizontal motion is achieved by using small push ups and lowering one arm first in the direction they wish to go. The ability to move its hand in a reaching motion enables the baby to claim the nipple. This helps to stimulate, elongate and protract the nipple and facilitates attachment. When the baby massages the breast and subsequently suckles, a large oxytocin surge is induced from the mother's pituitary gland into her bloodstream. This also helps in the manufacture of prolactin.

The five senses and breastfeeding

Touch

Skin-to-skin contact has many benefits for mother, baby and breastfeeding and is the subject of another article: Why Skin-to-Skin? Covering a baby's hands reduces skin-to-skin contact.

Milk supply. The touch of a baby's hands and face against the breast helps to stimulate the hormones involved in milk production (oxytocin and prolactin). Babies also push and massage the breast to stimulate a let-down (milk release).

Sucking hands. Sucking their hands or fingers prior to attaching to the breast is part of the sequence of events for babies' successful self-latching.

Finding the nipple. Babies use their hands to stabilise and orientate themselves to find the nipple .

Latching. When a baby runs his hand across a nipple or grabs at the breast it helps to make the nipple more erect and so easier to find and grasp with his mouth (latch)-this won't normally be painful unless the mother already has sore nipples. Babies can also deliberately shape the breast with their hands to help them breastfeed and pull the breast into their mouth .

Swallowing. Babies have been observed touching their mouths before swallowing.

Bonding. Touch positively influences the mother/infant relationship leading to more interaction, intimate touching of the face and head and bonding.

Smell

Babies can smell the amniotic fluid (birth fluids) on their hands after birth and this can help them find the nipple which smells similarly and helps them make a connection with the nipple. The natural smells of the baby and the mother are also calming to each other and babies prefer these smells. Natural smells stimulate their sucking and feeding cues and a mother's breast odour in particular is said to encourage eye opening and reduce crying.

Sight

Baby's use their sight to guide themselves towards the darker nipple and areolar and sight also helps to control their hand movements . They may push away from the breast with their hands in order to look for the nipple.

Taste

The mother's colostrum has the same flavour as her amniotic fluid which is familiar to the baby from the womb. The pleasurable and familiar taste of colostrum may encourage suckling.

Hearing

A baby responds positively to his mother's voice which can calm him and help him organise himself for breastfeeding.

Baby scratching mum's breast or nipple

If a baby is not feeling safe or stable in certain positions or can't use his hands to guide himself, he may start thrashing or bobbing around and accidentally scratch the breast. If you already have sore nipples any touch to the nipple by a baby's thrashing hand or grasping fingers will be very painful. It can help to find positions that help baby use his hands creatively. And see Causes of Sore Nipples and Treatments for Sore Nipples.

What can you do?

Try breastfeeding positions that let baby use his hands to orientate himself to the breast and use his instinctive feeding reflexes. Reclining positions that allow baby to feel safely supported on your body and allows their arms to cradle the breast can cut down on hands thrashing across the breast and nipple. An IBCLC lactation consultant can help with positioning.

Try to ensure baby's face is in contact with the breast to allow him to search for the nipple with his mouth instead of using his hands. Watson-Genna and Barak explain:

Excerpt from

If the face is touching the breast, infants may use their hands to push or pull the breast to make the nipple accessible to the mouth, or to shape a better-defined teat. If the face is not touching the breast, infants may use their arms to push away, perhaps to get a look at the nipple location, or may search with the hands for the nipple and close on it or just below it. Once the hand finds the nipple, the baby mouths the hand, calms, and then often moves the hand away and latches on to the same spot.

Summary

Scratch mittens are designed to prevent babies scratching themselves with their fingernails. However they also prevent a baby from using their hands to breastfeed, comfort themselves, give feeding cues and prevent a baby using his sense of touch with his hands. Babies do occasionally scratch themselves as their movements are uncoordinated and they will try to raise their hands to their mouths when they are hungry, prior to swallowing and for comfort. By keeping little finger nails short and responding quickly to a baby's feeding cues, a baby is much less likely to scratch himself. If breastfeeding is painful then any touch from the baby's hands is likely to be painful to sore nipples even without sharp nails. Certain breastfeeding positions can help a baby use his hands meaningfully while he breastfeeds. Seek help from an IBCLC lactation consultant to find the cause of your sore nipples or see Causes of Sore Nipples and Treatments for Sore Nipples. Preventing a baby from using his hands and covering them with scratch mittens can hinder successful breastfeeding.

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Scratch mittens and integral scratch mittens on sleep suits are marketed to prevent babies scratching their face or eyes with their finger nails. Are scratch mittens really needed or could they have any negative effects for baby? After all, babies manage perfectly well without mittens in utero and covering up a baby's hands removes his sense of touch.

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It can be a shock when your baby is born early. Small Wonders have videos about all aspects of caring for a prem baby, including feeding

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This information is available in verified by experts in our Editorial Board including representatives from Royal College of Midwives, Royal College of Paediatrics and Child Health and Royal College of Psychiatrists as well as other key health organisations in the UK. To download Baby Buddy, visit the relevant app store of your choice:

Introduction

The first video from the Small Wonders DVD explains the different levels of care your baby might need, and who might give it. We meet some of the families and hospital staff, and guide you as to how to use this DVD to get support, wherever you are on your journey.

In the second video from the Small Wonders DVD, we meet three families, two who had time to prepare for life in a neonatal unit and one who had very little warning. We see three births, one of which is the birth of triplets, and we follow the babies being prepared for transfer to the neonatal unit.

First hours

The third video from the Small Wonders DVD provides a look into the first hours and days in the neonatal unit and shows you how you, as a parent, can play a very important role in your baby's care.

Expressing breast milk

The fourth video from the Small Wonders DVD shows how mothers can express breast milk for their baby within a few hours of giving birth (if at all possible mothers should express milk within the first 6 hours after giving birth). Starting to express breast milk early and expressing milk often will help your body produce plenty of milk for the weeks and months to come.

Holding your baby

The fifth video from the Small Wonders DVD shows how skin-to-skin contact (also known as 'kangaroo care') can help both you and your baby. You will see families move from being nervous to being able to hold their babies with confidence.

Your time in hospital

The sixth video from the Small Wonders DVD follows families as they begin to feel more confident in caring for their babies on the neonatal unit. You will also see how some of our families cope with their baby's condition getting worse.

Feeding independently

The seventh video from the Small Wonders DVD follows four families as they learn to help their babies feed independently of tubes. Although some babies may go home being fed by tube, most will be feeding independently before they are discharged from hospital, whether they are breastfeeding or formula-feeding.

Preparing for home

The eighth video from the Small Wonders DVD covers what to expect when your baby is ready to leave hospital. We follow five families as they prepare to go home.

First months at home

The ninth video from the Small Wonders DVD follows nine families enjoying the early weeks and months at home with their pre-term baby. They all have different experiences and challenges.

Twins and triplets

The tenth video from the Small Wonders DVD follows four families who had twins or triplets and discovers some some of the joys and challenges that come with having more than one baby.

Bereavement

This video from the Small Wonders DVD is only for families who have to deal with bereavement. We have included it because parents asked us to. Only watch this video if you feel it will be helpful to you and please be aware that everyone's experience of bereavement is different and may not reflect your own. This film follows the journeys of families who lost babies during filming and chose to carry on sharing their experiences to help others.

The twelfth and final video from the Small Wonders DVD shows the families whose journeys we have been following in films 1 to 10 looking back on their experiences and sharing their thoughts and feelings.

Latest

The Impact Lead will focus on developing Best Beginnings' frameworks for monitoring and evaluating our national and international work ensuring that learning continues to be captured in ways that can be shared and used for effective advocacy and influencing. The successful candidate will also play a pivotal role influencing policy and its implementation within the maternity, early years, digital health and public health context.

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The Small Wonders videos have been designed to help you on your journey with your sick or premature baby.

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How to know if your baby is getting enough milk

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How to know if your baby is getting enough milk

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And how to improve attachment if he or she isn't

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'Is Your Baby Getting Enough Milk - Breastfeeding Series' on ViewPure

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By Global Health Media Project. Download link: http://globalhealthmedia.org/videos/\n\nA common concern of a new mother is whether her baby is getting enough milk.

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is crucial to effective and pain-free breastfeeding.

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Watch safe YouTube videos without comments, related videos, or any other distractions. It’s great for teachers, parents, and organizations alike - or really, anybody.

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Breasts and nipples vary enormously in shape and size and that’s just fine. There isn’t a ‘wrong’ shape or size! But this article has some handy tips for the more well endowed.

Scroll down for the section on nipples, and further on the article looks at common worries that larger breasted women have.

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Breastfeeding can run smoothly with all sizes of breast. However, large breasts may make it more challenging to position baby comfortably, or to find nursing bras, pump flanges or nipple shields in larger sizes. This article shares tips for breastfeeding with large breasts and looks at common concerns larger breasted women can have when breastfeeding.

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Again this week, I read a comment by a leading breastfeeding expert tutting over the use of nipple shields.

Of course, this person has decades of experience.

Of course, there are plenty of times when nipple shields are used incorrectly and over-enthusiastically .

Of course, when they are used without seeking access to other breastfeeding support they can mean supply issues, continued nipple pain and damage and a situation that can be challenging to unpick.

But can I please just take one moment to say that sometimes they can be bloody marvellous.

I'm not 'supposed' to say that. I've heard lactation consultant colleagues say, "Oooh, I hate nipple shields." I'm meant to be down on them and focus on all the disadvantages.

But sometimes I just feel they need a little bit of defending.

I don't know what's going on with tongue tie at the moment. It seems like every breastfeeding drop-in group I visit has at least a third of babies who are post-frenotomy (tongue tie 'snipping') or they have been diagnosed and are waiting to be seen. Obviously the proportion of babies who come to get breastfeeding support will inevitably include more struggling with tongue dysfunction - however the numbers still seem ludicrous.

I've seen mums who are breastfeeding several months after an initial nightmare month living with tongue-tie and a nipple shield has made all the difference. Tongue tie is often accompanied by a high-arched palate or 'bubble' palate as when a baby is in utero the tongue hasn't been pressing up against the soft bone of the palate due to its restriction and the palate doesn't end up being smoothed into the typical gentle arch. And although babies can feed just fine on flatter nipples and even inverted nipples, they often do like to feel something touching their palate and triggering their sucking reflex. And if that palate is an extra centimetre away, that can be tough. A baby may struggle to get purchase. They may appear to be searching for something and become frustrated. Finding a way to get baby to latch on and stay on may not always be easy.

Babies with tongue tie and high palates can latch on effectively but it's not easy for everyone to find those ways on their own.

There are ways to get babies to latch on beautifully to flat nipples but it's not easy for everyone to find those ways on their own.

In some cases, nipple shields can be a useful tool. The baby receives that palate stimulation and settles into a fabulous rhythm of deep swallows and great chin movements, milk is transferred and it's hard to see what's so evil about that.

Those who demonise nipple shields might have talked about the need to 'work harder' to find a latch that works. That's fine - but when it's 2am and mum is exhausted and baby is exhausted a bottle of formula may well be an appealing choice when your nipples are already sore and feeding has never been easy.

If we make nipple shields the 'bad guy', you may find that less feeding happens at the breast. Not everyone has a breastfeeding specialist sitting in the corner of their bedroom behind the nightlight. Or even access to good quality breastfeeding support throughout the week in the day time.

This morning I worked with a mum who had nipples that looked naturally quite different. One had a wide barrel shape and a length of about 15mm. The other was a slight dome rising no more than 3mm above her areola. She had been feeding successfully on one breast but when it came to the flatter side, baby was confused and frustrated. He had never really latched on for more than a few moments. Several weeks on, she was feeling desperate. She had been supported to try many positions by several breastfeeding counsellors and lactation consultants. She had visited a cranial osteopath. But the reality was that her son was used to the sensation of the longer nipple and the other side was less straight forward and he was struggling to move between the two. Perhaps she could only feed from one side and express the other? Perhaps she could just lactate on one side?

She tried a shield today and, for the first time ever, he moved immediately to deep chin movements, audible swallowing and mum said, "Yay!".

She actually said "Yay!" quite a few times.

I would defy someone who had spent time with that mum and heard her history and worked with her to then say, "I hate nipple shields".

There are certainly times when they don't work well. I've also been to a group and a mum has shown up using shields to help her cope with sore nipples. The low point came a couple of nights ago and she couldn't continue feeding just on the breast. Even in that moment, it's hard to argue it would've been better for her to stop breastfeeding and use a bottle in order to 'rest' completely. The shields allowed her to keep going and avoid the complication of using a bottle. However the shields were not her solution. Thankfully she sensed that and knew to come to a group and get support but I wonder how many women don't. Her positioning and attachment could certainly have done with some improvement. She was leaning forward and 'offering the breast' and then pushing it in baby's mouth without really waiting for a gape or bringing the baby to her. Her nipple was coming out after a feed flattened and compressed and was visibly damaged along the ridge where it was flattened. There were lots of things that could be improved. And the shield didn't help with any of that. But it helped with her psychology and she came to the group. It kept her going.

Shields don't help with sore nipples. They can exacerbate issues where babies have insufficient gapes and the baby just then transfers their insufficient gape onto the shield. But if the shield means that mum can cope with breastfeeding until she does manage to get the right support, if they stop her giving up, then that surely is a positive.

Shields are connected to a lower milk supply. Possibly because hormones aren't being stimulated in quite the same way even through the modern thin silicone shields. Possibly because the people who resort to using the shields have issues that are the true cause of milk supply reduction. It can be wise to stimulate your supply using some additional expression if you are using shields and keep a closer on on baby's weight gain. However I've also seen shields get a mum through a difficult couple of days when she had too MUCH milk. After struggling with oversupply and overactive letdown, her baby choking and spluttering with every feed, she found using the shields tided her over until she was able to get proper support and information. The baby was able to come to the breast without being flooded and her alternative would've been expressing and bottlefeeding.

If we demonise nipple shields, we reduce options. Options that actually might help when the next breastfeeding group is in two days time and the breastfeeding helpline isn't open for the next 10 hours. And when the temptation is to pick up a bottle when it's really not want you want to do.

You can use a shield and practice good body positioning and nose to nipple and head tilting and gaping. The baby works at the breast and is held close and does lots and lots of useful and valuable things and transfers milk as it gradually thickens and this is all still breastfeeding.

If you've been a breastfeeding supporter for a gazillion years and you've always managed to get babies to latch on superbly and you've never needed to use a shield - that's dandy. But I will hold my hand up and say that sometimes I've worked with mothers who did use a shield and it made them happy and they felt great and the baby felt great. They went on to reach their breastfeeding goals, often weaning off the use of the shield with very little difficulty.

I think sometimes nipple shields deserve a teeny little 'yay!' They aren't right in MOST situations and good quality breastfeeding information usually means that they are not needed. If they are going to be used, they should be used with support from someone who is qualified in breastfeeding. But in a minority of cases, they can be bloody marvellous.

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Again this week, I read a comment by a leading breastfeeding expert tutting over the use of nipple shields. Of course, this person has decades of experience. Of course, there are plenty of times when nipple shields are used incorrectly and over-enthusiastically .