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Links to alternative languages and easy read version.

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Formula feeding: How to feed your baby safely

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Guidance on how to safely make up infant formula.

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Links to alternative languages and easy read version.

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Off to a good start: all you need to know about breastfeeding - Publications - Public Health Scotland

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This booklet aims to help pregnant women, new mums and their families make decisions about how they will feed their baby. It gives information and practical advice about developing a close and loving relationship with your baby; preparing for breastfeeding when you’re pregnant; the benefits of breastfeeding; the difference between breast milk and formula; skin-to-skin contact at birth and the first magical hour; how breastfeeding works (including positioning and attachment); breastfeeding when you’re out and about; going back to work; and a troubleshooting guide.

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Safer Sleep for Babies - A guide for parents and carers

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Safer Sleep for Babies - A guide for parents and carers

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Safer Sleep for Babies - A guide for parents and carers

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Safer Sleep for Babies - A guide for parents and carers

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Links to alternative languages

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Safer sleep for babies: guide for parents and carers

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New Scottish Government and NHS Safer Sleep for Babies resources developed in partnership with the Lullaby Trust, UNICEF Baby Friendly Initiative and BASIS the Baby Sleep Information Source based at Durham University.

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Information for New Mothers, Pregnant Women and Families - Information about Feeding a Child in Public and Private Spaces

The Breastfeeding etc. (Scotland) Act 2005

Why is the Act needed?

A key benefit of breastfeeding is that it can happen at any time and in any place, but both you and your baby need to feel relaxed.

We know that any embarrassing interruption during breastfeeding is likely to upset some mothers particularly when they have a crying hungry baby.

However, don't feel that you are expected to feel 100% confident in the early days. It's perfectly normal to prefer to breastfeed only where you feel most comfortable. Hopefully, as you get more used to doing it, you're likely to feel more confident about breastfeeding in front of other people when you're out and about.

What happens if you are stopped from feeding a child in public space?

In Scotland breastfeeding and bottle feeding are both protected by the Breastfeeding etc. (Scotland) Act 2005.

If a person deliberately prevents or stops someone from feeding a child under the age of two in a public place in Scotland they are committing a criminal offence. If a mother is asked to move to another part of the premises, or leave the premises completely this is also an offence. This applies to places that the mother and child has the legal right to be in.

This means that any person should be able to feed a child when required and in the most appropriate place for them, without the fear of interruption or criticism.

Anyone trying to stop a mother breastfeeding or a child's mother or carer from bottle feeding can be prosecuted and, if found guilty, ordered to pay a fine. If the mother or carer wants to report the matter to the police, she may find it helpful to collect information to support the complaint, for example, the name of anyone who witnessed the incident and what they saw and heard happening. They can also complain to the manager of the premises.

Where and when does the act not apply?

The act does not apply to children over the age of two.

Some private spaces are not covered by the act. This mainly applies to spaces where the mother or child would not normally have the right to be such as factories.

However, other forms of protection may apply for the over two's. Under the Equality Act 2010 a court may agree that if you cannot feed your child that you are being unfairly discriminated against.

Here are some ideas to make feeding when you are out and about more comfortable:

You shouldn't ever be made to feel uncomfortable about breastfeeding or bottle feeding in a public space or your home or someone else. Unfortunately many people in Scotland just have not had the opportunity to see breastfeeding as a normal way to feed a baby.

The best approach for dealing with those who may object to you feeding in your own home or when visiting their home is to make it clear before the situation arises that you will need to feed the baby.

Opening up a conversation enables:

Your visitors to choose whether or not to come to your home. It gives visitors the opportunity to be prepared to support you or to choose to leave when you need to feed the baby.

You to be prepared in case anyone raises any objections to you breastfeeding. You can choose not to invite the guests or not to go to their home.

You to have the opportunity to discuss the issue and to change attitudes so that family and friends make you feel welcome and supported.

During the baby's early days, until you feel more confident - you may prefer to breastfeed only where they feel most comfortable. But, as you get more used to doing it, you are likely to feel more confident about breastfeeding in front of other people when you're out and about.

Know your rights - although it is illegal for anyone to ask a person not to feed or to leave a public space to feed a child, if this happens do your best to remain composed and polite. Explain, that you're feeding your baby, and then simply turn away from the complainant. Avoid escalating the situation and try to focus on yourself and your baby.

If the situation does not resolve then ask to speak to the manager and explain the law. However, if the manager is unhelpful or you are upset then ask whoever is with you to deal with it or leave and deal with it later. You need to take down some details including staff names and witnesses details. You will need this information if you are going to take the matter to the police.

Plan ahead - sit in a place where your baby won't be distracted. Before you go out, it can help to think about where you will feel comfortable feeding when your baby gets hungry.

Take a water bottle so you stay hydrated. Enjoy a meal or snack to give you energy.

Take someone with you - it can help to go with a friend who has an older baby and can take you to places that she already knows. You could go with someone else, such as your mum, partner, sister or friend, so that there's always someone to talk to.

Clothing and wraps - Some mothers like to wear loose tops and bras that can be lifted up for breastfeeding. Some baby slings are designed in such a way that you can breastfeed while your baby is still in the sling. Some mums feel more comfortable laying a scarf or muslin cloth over their chest while they're breastfeeding.

Be confident. Be proud of the beautiful baby you have made and what a great parent you are no matter how you have chosen to feed your baby. Don't feel that you should sit in a public toilet or other inappropriate place to breast or bottle feed. You wouldn't eat in there, so don't feel that your baby should be
fed there.

The Scottish National Breastfeeding website offers useful advice and links to other resources for pregnant women and new mothers: www.feedgood.scot

National Breastfeeding Helpline: 0300 100 0212

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Feeding a child in public and private spaces: information for new mothers, pregnant women and families

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Scottish Government information designed to encourage more mums to feel confident and supported when it comes to feeding their babies in public.

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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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Expressing and Storing Breastmilk - The Breastfeeding Network

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Expressing and Storing Breastmilk - The Breastfeeding Network

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Expressing and storing breastmilk - The Breastfeeding Network

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This page gives you some tips on how to hand express and store your breastmilk. It also answers some frequently asked questions on this topic. You might be thinking of returning to work, or study, or planning a night out. It can also help relieve pressure from a blocked duct or mastitis. Expressing small amounts […]

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UNICEF Breastfeeding Resources - for families and healthcare professionals

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UNICEF Breastfeeding Resources - for families and healthcare professionals

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National Breastfeeding Helpline - Helpline

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This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website.

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Breast Buddies Perth & Kinross - Facebook page

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Breast Buddies Perth & Kinross - Facebook page

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Email: bb@homestartpk.org.uk

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email: breastbuddies@voluntaryactionangus.org.uk

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Other mums experiences of returning to work - The Breastfeeding Network

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Other mums experiences of returning to work - The Breastfeeding Network

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Listed below are some useful external resources about returning to work while breastfeeding.

Maternity Action works to end inequality and promote the health and well-being of all pregnant women, their partners and children from before conception through to the child's early years. They have lots of specific information about your rights if you want to continue breastfeeding when you return to work. You can find out more h re.

The Health and Safety Executive (HSE) provides information on breastfeeding and returning to work, for employers and employees.

Working Families is a charity which helps working parents and carers and their employers find a better balance between responsibilities at home and work. It has useful information about returning to work and breastfeeding.

NHS.uk also has some information on breastfeeding and going back to work for employees and employers.

Both Working Families and Maternity Action have helplines you can ring if you wanted to chat to someone about your rights when returning to work. Volunteers on the National Breastfeeding Helpline (0300 100 0212) will also be able to give you information and support about the practical aspect of continuing to breastfeed or providing breastmilk for your baby once you return to work.

If you are an employer, you can find out more about offering a breastfeeding friendly work environment and also sign up to our free Breastfeeding Friendly scheme here.

The Breastfeeding Network is not responsible for the content or reliability of these websites and does not necessarily endorse the view expressed within them. Listings shall not be taken as an endorsement of any kind. We cannot guarantee that these websites will be available all the time and we have no control over availability.
Links checked August 2024
You can read some personal stories about returning to work whilst breastfeeding below:

Barbara returned to her work as a teacher when her baby was six months old. She was suddenly faced with trying work out what to leave for the baby while she was away. Barbara found that her baby led the way by adapting to the nursery routine and breastfeeding more at night and at the weekends. Follow this link Barbara's story, to read what Barbara says about Rebecca who is now 2 ½ and whom she is still breastfeeding.

Further Stories are provided by Kateand .

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Returning to work or study - The Breastfeeding Network

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Listed below are some useful external resources about returning to work while breastfeeding. Maternity Action works to end inequality and promote the health and well-being of all pregnant women, their partners and children from before conception through to the child's early years. They have lots of specific information about your rights if you want to [...]

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What is a lactation room?

A lactation or breastfeeding room should be a clean, comfortable, safe and private space. The main function is for mothers to breastfeed their children, express milk and store it properly.

What should a breastfeeding room include?

To preserve the breastmilk until you take it and feed it to your child, it is necessary to have a cold storage system available which should preferably be a freezer or fridge for the exclusive use of the breastfeeding room.

Ideally, the breastfeeding room should have handwashing facilities and necessary supplies such as drinking water, liquid soap dispenser, hand sanitizer, cleaner for surfaces and paper towels.

The room must have a comfortable chair, preferably an individual seat with adjustable height and good back support rather than a sofa. It must be made of a material that allows it to be easily washed and disinfected.

Location, accessibility and privacy

A breastfeeding room should be located in a physically separate area that is close to your workspace and away from the toilets. The space should be directly accessible and fully available during the workday.

To ensure privacy, entrances must close properly and the facilities designed in a way to ensure that mothers using the room are not visible from the outside. The room should be only accessible to breastfeeding women and cleaning staff.

Lighting, ventilation and hygiene

Natural light is preferred, but if this is not possible due to space constraints, suitable artificial lighting, ventilation and heating must be provided. The use of air-conditioning is recommended to maintain suitable temperatures.

Cleaning should be done with odourless, food-safe products used exclusively in the breastfeeding room.

It is recommended that the walls, floors and furniture in the room have smooth surfaces, so they can be easily washed and disinfected. Any material that cannot be washed (carpets, fabric curtains or other elements that attract dust) should be avoided.

> Learn more: UNICEF's Breastfeeding Support in the Workplace: Global Guide for Employers

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First Steps Nutrition - Eating Well in The First Year, for mum & baby

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First Steps Nutrition - Eating Well in The First Year, for mum & baby

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Infants & new mums — 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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This clip from Best Beginnings shows how ineffective attachment happens and how it can cause sore nipples.

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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Ineffective attachment video - Baby Friendly Initiative

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This clip from Best Beginnings shows how ineffective attachment happens and how it can cause sore nipples. Watch to learn more.

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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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The Breastfeeding Network - if breastfeeding is painful

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The Breastfeeding Network - if breastfeeding is painful

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as a cause of pain. Even if there is another medical basis for the pain, getting positioning and attachment as comfortable as possible will still help.

When you first start breastfeeding, it is common to experience a strong and sometimes uncomfortable sensation for the first few seconds of your baby latching on. However, this should pass quickly, and feeding should become comfortable. If this is not the case, trying some small changes to your positioning and attachment could help make feeding more comfortable for you.

Signs that attachment is not as effective as it could be include:

If the pain is worst at the start of a feed, and continues for more than a few seconds.

If your nipple changes shape after breastfeeding - either lipstick shaped or flattened

If your baby slurps onto nipple rather than attaching with open gape

If your nipple changes colour after the breastfeed - classically a white tip to the nipple, although this may not be visible on all skin tones

If your nipple is damaged, with cracks or bleeding

If the pain is not improved after trying some of the ideas in our guide on positioning and attachment, please seek support from a breastfeeding supporter. They can observe and assess a full feed. You can also find a local support group here or contact the National Breastfeeding Helpline.

If your nipple is damaged, use moist wound healing within the wound (avoid applying cream to whole nipple) to stop a scab forming, which will deepen the wound. You can continue to breastfeed on a damaged nipple as it will still be able to heal, but it is very important to get support with positioning and attachment to prevent further damage occurring.

If a breastfeeding practitioner has helped you adjust your positioning and attachment and you still have pain or nipple damage, your baby may need to be assessed for a tongue tie or other issues that might be making breastfeeding harder.

Other causes of pain in breastfeeding:

Allergy

If your nipples are itchy (which may be triggered by warmth) or changed in colour (which may show as redness on lighter skin tones) but you do not see any change in the shape of your nipples and are not experiencing pain, the problem may be an allergy to something in contact with your nipples, such as nipple cream or breast pads. Try eliminating these to identify the cause. If disposable breast pads are causing irritation, you could try washable ones instead.

The symptoms may be relieved by a non-sedating antihistamine and hydrocortisone 1% cream applied sparingly. See our factsheet on antihistamines for more information on taking these whilst breastfeeding.

Vasospasm

If your nipple turns white at tip after breastfeeds and pain or itchiness, and redness on some skin tones, occurs immediately at end of feed when blood returns, vasospasm could be the cause.

This is due to restricted circulation from compression of the nipple by the baby squashing it between their tongue and the roof of their mouth during a feed. It can be relieved by help with attachment from a specialist breastfeeding practitioner. Vasospasm can occur in one or both breasts. It does not respond to medication which is unnecessary, but can be improved by adjusting positioning and attachment.

Raynaud's Phenomenon

If the pain is worst at the end of or after a feed and your nipples change colour rapidly after breastfeeds from white to purple then red (this might not be visible on all skin tones), you may be experiencing Raynaud's Phenomenon.

If you have a history of circulation problems or migraine and pain is triggered or made worse by cold, Raynaud's Phenomenon is more likely. Pain can be immediately after a feed but may also be delayed or can be triggered by cold even when not feeding.

You may be able to improve your symptoms by avoiding breastfeeding in cold places, covering your nipple as soon as a feed is finished and applying warmth after feeds. If this is not effective, consider asking GP to prescribe nifedipine 10mg three times a day or nifedipine LA 30mg daily. Treatment for two weeks may be sufficient or may be needed long term. You can find more detail in our Raynaud's phenomenon factsheet.

A white spot, bleb or blocked nipple pore.

If pain is worst at the end of or after a feed and you can point to a discrete spot (which may be white, yellow or pale pink) on your nipple as the origin of the pain, this is likely to be due to a white spot, also called a bleb, blocked nipple pore or milk blister. Symptoms may return periodically.

A white spot is thought to be caused by a thin bit of skin growing over a milk duct opening, and milk backing up behind it.

You can continue to feed with a white spot, and feeding may cause it to clear spontaneously. If it does not clear, the skin overgrowth can sometimes be removed by soaking the nipple in warm water and rubbing gently with a clean, moist washcloth. You can also try softening the skin with an oil such as olive oil. If this doesn't work, the skin may require removal by a healthcare professional using a sterile needle. Antibiotic cream may be required if a significant wound results. If you squeeze just behind the blister some toothpaste-like thickened milk may come out through the now opened blister.

Expressing milk

If your nipple is sore or damaged and you are using a breast pump rather than feeding directly, you may need to reduce the strength of the suction on your pump or you may be using a flange that is the wrong size. Speak to your health visitor, midwife or peer supporter to get support with expressing your milk if needed.

Strong let-down

If the pain is strongest at start of feed or just before a feed and there is a sharp intense pain in your breast(s), often described as squeezing pain, this can be due to the let down or milk ejection reflex. Pain can be worse on fuller breast.

If it is associated with leaking milk, you can reduce this by applying firm hand pressure to your breast at the time of leaking.

If your baby also makes a clicking noise during feeds or pulls away choking once the feed has started, the fast flow of milk may mean your baby is struggling to attach well. Further support from a skilled breastfeeding practitioner to improve attachment may be useful.

You may find it helpful to express a small amount of milk just before a feed if your breasts are full, to get past the powerful let-down before starting the feed, or to use a laid-back breastfeeding position, so that the milk flow is less overwhelming for your baby.

Engorgement

If your breasts are painfully hard and full, and feeding or expressing milk relieves this sensation, your breasts may be engorged. This may be worst first thing in the morning, especially if you have not fed frequently through the night. You can avoid engorgement by feeding frequently and responsively, including at night time. Consider offering your baby a feed whenever your breasts start to feel full or uncomfortable. If you are unable to feed at that time, or if your baby refuses a feed, you can express just enough milk to relieve the discomfort. Avoid expressing more milk than necessary, as this could trigger an increase in your milk supply and make the engorgement worse. Allowing your breasts to remain engorged could lead to your breasts becoming inflamed (mastitis), or a reduction in your milk supply, so it is best to avoid this whenever possible.

If you find it hard to latch your baby on when your breasts become very full, you may like to try reverse pressure softening. Reverse pressure softening is a way to soften your areola. It can help make latching and removing milk easier when your areola is very swollen and engorged by temporarily relieving firmness and swelling.

It can be particularly helpful if you have some oedema or swelling due to IV fluids or drugs given during labour and birth, especially if you had a caesarean section. Breast engorgement in the early days can be caused by your milk coming in or by a combination of fluid held in the breast tissue around the milk ducts as well as by milk within the breast.

Reverse pressure softening briefly moves mild or firmer swelling away from under your areola, slightly backward into your breast for a short period of 5-10 minutes. This allows your areola to change shape and makes latching easier as your baby is able to get more of your areola and breast tissue into their mouth.

Reverse pressure softening also causes a 'let-down' reflex, making it easier for your baby to get milk or for you to remove milk by hand expressing or expressing with a breast pump.

Reverse pressure softening should not be used if you have mastitis, plugged ducts or a breast abscess.
How to do reverse pressure softening:
The key is to make your areola very soft right around the base of the nipple. This can make it easier for your baby to get a better latch.

Press gently on the edge of your areola, inward towards your chest wall, counting slowly to 50

Once the areola has softened, you can start to feed your baby or express (by hand or using a breast pump on low to medium pressure)

If you have very swollen breasts, doing reverse pressure softening lying on your back (taking advantage of gravity) will give more relief

Soften your areola right before each feeding (or expressing) until the swelling goes away. This takes two to four days or more

Blocked ducts and Mastitis

If there is a sore, lumpy area on your breast that may also feel hot and can appear red on lighter skin tones, you may have a blocked duct or mastitis. Mastitis is an inflammation of the breast. It may be accompanied by flu-like symptoms. Continue to feed responsively and seek support from a specialist breastfeeding practitioner as soon as possible. Blocked ducts or mastitis may be triggered by feeding infrequently, allowing your breasts to become overfull or other situations that increase pressure on your breast, for example, wearing a bra that is too tight or wearing your baby in a sling for longer than usual. Adjusting the way you hold your baby and bring them to your breast when feeding ( positioning and attachment) may also help.

You can take ibuprofen 400mg as anti-inflammatory if appropriate (i.e. if you have no contra-indications such as asthma or stomach ulcer), and also paracetamol for pain or fever. Antibiotics are not usually required if self-help measures are started quickly, but you should see a doctor if your symptoms persist. You can read our factsheets on pain relief medicines and breastfeeding and our mastitis page for more detailed information.

Abscess

An abscess is a rare complication of mastitis. You might want to consider whether you have an abscess if mastitis has not resolved following frequent, effective feeding and a course of antibiotics and if the skin on your breast looks like orange peel. A milk sample should be taken to ascertain the micro-organism involved in the infection to help decide which antibiotic might be most appropriate. An ultra sound investigation may be required to diagnose an abscess. Drainage of pus by needle aspiration or surgical drainage together with appropriate antibiotic might be offered. Abscess formation is a rare complication of infectious mastitis and may involve MRSA. You may benefit from emotional support from a breastfeeding supporter alongside specialist support from medical staff.

Thrush

Signs of thrush in you

Thrush (Candida albicans) infection can affect your breast while you are breastfeeding. Symptoms of thrush are a sudden start of breast and/or nipple pain in BOTH breasts after some weeks of pain free breastfeeding - pain is severe and can last for an hour after EVERY breastfeed. It should be confirmed by a swab of your nipples.

Thrush should not be diagnosed if:

You have pain in only one breast/nipple (thrush spreads quickly from one breast to the other)

You have never had pain free breastfeeding

If your nipples are shaped oddly after breastfeeds

If your nipple is white at the tip after breastfeeds

If the pain is different at different times of the day

If your baby has a tongue tie which you are waiting to have snipped.

Thrush in the first few weeks of feeding is rare unless the mother had vaginal thrush at delivery or had deep breast thrush at the end of a previous lactation. Less than perfect positioning and attachment with consequent damage are more likely to cause the pain at this stage.

Signs of thrush in your baby

Creamy white patches in your baby's mouth, on the tongue and may be far back or in the cheeks. Patches do not rub off.

Baby's tongue/lips may have a white gloss

It should be confirmed by a swab of the baby's mouth.

If you think you have thrush:

Before treating either you or your baby you should ask the person supporting you with breastfeeding to watch a full breastfeed from the moment the baby goes to the breast to the moment he/she comes away from the breast at the end of the feed. They need to look at your nipples at the end of the feed to look for change in colour and shape

If your baby has a white tongue but you are not experiencing pain, be aware of the risk of thrush but do not treat either of you immediately. Some babies have white tongues in the first few weeks after birth or this may be associated with tongue tie where the milk is not thrown to the back of the mouth.

Diagnosis should be confirmed by nipple swabs cultured for fungal and bacterial infection.

Breastfeeding should be pain free from the point of attachment (the moment the baby goes to the breast) onwards. Pain from thrush begins after a feed. There should be no change in the shape or colour of the nipple after a feed. Even good attachment can often be improved and help to relieve symptoms of pain. Be aware of the other causes of nipple and breast pain described on this page, and exclude them first.

Self-help measures

Thrush can be passed between you and your baby - and also between you, your partner and other children

Anecdotally, some mothers find acidophilus capsules can help to restore bacteria which can keep thrush under control (available from health food stores or chemists)

It is necessary to be very careful with hygiene in order to get rid of thrush completely - be sure to wash your hands well after each nappy change

Use a separate towel for each person in the family

Anecdotally, some mothers find reducing the level of sugar and yeast in their diet helps

If a thrush infection is confirmed, to make sure that you get rid of it, both you and your baby need treatment, prescribed by a doctor. Usually, once treatment begins the pain and other symptoms will begin to improve within 2 or 3 days. It may take longer for full recovery.

If there is no improvement at all after 7 days, consult your breastfeeding helper again as the cause of the pain may not be thrush.

Treatment

Ongoing attention to positioning and attachment is important because even the best latch can slip a little sometimes.

Miconazole cream applied to your nipples after every feed - sparingly and without washing off before the next feed

Miconazole oral gel applied gently to your baby's mouth 4 times a day a small amount at a time

If symptoms persist you may need fluconazole 150-400mg as a loading dose followed by 100-200mg daily for at least ten days. This is rarely necessary if your baby is less than 6 weeks old and could cause vomiting and stomach pains.

For more information, see our detailed factsheet on thrush and our factsheet on miconazole oral gel and the breastfed baby with oral thrush.

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Pain: if breastfeeding hurts - The Breastfeeding Network

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Pain in your nipples or breasts whilst breastfeeding is most often linked to how you are holding your baby and bringing them to your breast (often referred to as positioning and attachment). Before considering any alternative reasons for experiencing pain whilst breastfeeding please use our guide to positioning and attachment to rule this out as [...]

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Is it normal? The first week with a breastfeeding newborn UNICEF

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Is it normal? The first week with a breastfeeding newborn UNICEF

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The first week with a newborn can be a wonderful and exciting time, but adjusting to a new life can also be overwhelming, especially when parents aren't sure what to expect. In this guest blog, lactation consultant Emma Pickett explores what's "normal" in the first few days, and encourages mums to trust their baby and their own instincts of love, affection and responsive feeding.
I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused. The first voice we hear might sometimes be the partner's and a mum is too upset to even come to the phone.

Hundreds of these calls end with a contented calm voice saying, "Thank you. It's such a relief to know that's normal. I feel so much better now". As it happened, breastfeeding was actually going OK; what was interpreted as a breastfeeding 'problem' was actually a new baby's normal and natural response to their new environment. The family just didn't know how babies were 'supposed to behave'.

If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film - but instead of the ability to pilot helicopters or practise high level martial arts, you'd know about cluster feeding and a newborn's desire for closeness, nappies and normal fussiness. The National Breastfeeding Helpline would be quieter overnight but we'd all feel a lot more relaxed and able to enjoy these teeny new people in our lives.

But actually ... you've already had that download. You just may not have realised it. It's deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day three, or how to correct a baby's latch without help, but there's so much you do know. You may not have grown up surrounded by breastfeeding, and for some aspects you will need support and information, but there's a ton you do know about your baby: things that just feel right and things that don't. And your baby had the download too. Sometimes it gets fuzzied with a birth that didn't go to plan but their instincts are in there too.

Two things that are normal:

1.Babies want to be close to you.

Imagine a news story about a baby gorilla just born in London zoo: "ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health" but days later it's reported that staff are concerned. Fumbi's mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She's losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn't feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin- (the hormone that promotes feelings of love) induced bonding that helps the formation of their early relationship. Fumbi is at risk.

Oh dear. Something seems to have happened to Fumbi's mother. We'd be worried.

However, this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We're designed to be close to our babies. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains, and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us 'carry mammals'.

But instead we get the message that babies can be 'spoilt'. We are supposed to encourage them to be independent and sleep apart from us. If we can't put them down, if they want to sleep touching us, if we hold them when they sleep - we've apparently failed some test. Though it's not quite clear who the examiner is.

There are popular books that even use terms like 'accidental parenting' just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of 'advice' has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby's sleep by the clock and leave a baby only a few weeks old to cry if necessary.
What does your baby want?
They don't want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don't want to waste energy keeping warm and crying when they don't need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.

"My baby won't go down in its Moses basket". Yes, it's frustrating when you thought that was what they were 'supposed to do'. But would it feel easier if you knew that wasn't likely to be their first choice and there are good biological and evolutionary reasons for that?

"But I'm not going to get any sleep". According to the Baby Sleep Information Source, "70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart." Research shows that these mums breastfeeding through the night (and mostly bed sharing) will also be getting better quality sleep and be more rested than other parents. Good sleep is possible if we stop battling nature.

The book "Sweet Sleep: night time and naptime strategies for the breastfeeding family" is a great place to start. It talks to you about creating a safe space where everyone gets a better night's sleep.

A lot of your baby's urges are eminently sensible. If they don't want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.

Don't expect to be up and making a moussaka on day five. The feeling that you 'shouldn't' be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren't supposed to change. Our commitment to work isn't supposed to change. Our ability to engage with political life and housework and social media isn't supposed to change. Actually, throughout much of human history, mum isn't going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn't have to be moussaka), sleeping and being with our new baby.

2.They come to the breast for lots of different reasons and they usually have a good reason for doing so.

Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'. I have written elsewhere on the dangerous obsession of the infant feeding interval. It's dangerous for both babies and mothers. But we need to remember breastfeeding isn't just about feeding and it never has been.

Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin (which is the key hormone in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing levels of the stress hormone, cortisol. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotionally secure, growing brain connections and trying to get to sleep (which is one of the purposes of breastfeeding.)

To think breastfeeding is just about food and calories (and "quick, measure the gap between breastfeeds!") is to do nature a huge disservice. Measuring all the different reasons a baby comes to the breast is like trying to measure fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack or has a meal? You wouldn't find an app for that.

Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby's needs in the way they are asking you to. Don't try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are a routine person and you are struggling with a feeling of 'losing control', give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you'll have some options. Try and 'control' too early and you'll find things go out of your influence in ways you can't come back from easily.

Get help if things feel wrong - if breastfeeding hurts, if you're not sure about weight gain or nappies, if you can't work out how to meet your own needs for food and sleep. There are lots of people who will help out and we're at the end of a phone or a Twitter account or Facebook page. But don't confuse your baby behaving unexpectedly for something going 'wrong'. Maybe no one told you what normal would be.
If we let normal happen it will make all of our lives easier in the long term. You're creating a little person who enters this world with their needs being met.
This blog was originally featured on the Growing Families conference website.

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Guest blog: "Is this normal?" The first week with a breastfeeding newborn - Baby Friendly Initiative

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In this guest blog, lactation consultant Emma Pickett explores what's "normal" in the first week with a newborn, and encourages mums to trust their baby and their own instincts.

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Low Supply 101 - Association of Breastfeeding Mothers

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Low Supply 101 - Association of Breastfeeding Mothers

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Every day mothers panic and end breastfeeding or start using formula and there is not an underlying problem with their milk supply.

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A Website to Assist Primary Care Practitioners with Best Practice in Infant Feeding

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Meeting Baby for the First Time - UNICEF

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Meeting Baby for the First Time - UNICEF

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Meeting baby for the first time video - Baby Friendly Initiative

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Baby Friendly’s video on skin-to-skin contact and how it can help mothers and babies get their relationship off to the best start.

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This video looks at both the theory and practice of relationship building and responsive breastfeeding, supporting families to get their relationship with their baby off to the best start.

Hear mothers and professionals give tips and advice on what it can mean to have a close and loving relationship with your new baby.

Find more relationship building resources

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Breastfeeding and relationships in the early days video - Baby Friendly Initiative

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Baby Friendly's video on breastfeeding and relationship building covers views and tips from both mothers and health professionals.

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Medication - The Breastfeeding Network Drugs in Breastmilk

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Medication - The Breastfeeding Network Drugs in Breastmilk

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Drugs in Breastmilk factsheets - The Breastfeeding Network

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

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Wendy Jones - Medication & Breastfeeding

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Wendy Jones - Medication & Breastfeeding

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A list of all the factsheets available on Breastfeeding-and-Medication.co.uk. But happy to answer any other questions if you email me wendy@breastfeeding-and-medication.co.uk

If you search for any word on the title the factsheet page should appear
List of factsheets Breastfeeding and Medication
If you use them a lot maybe you need the books

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A list of all the factsheets available on Breastfeeding-and-Medication.co.uk.

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This policy uses the words 'pregnant woman' and 'mother' to describe the parent who is pregnant or breastfeeding. We acknowledge that there are parents who are pregnant or breastfeeding who may have a

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This information was updated in December 2022. A PDF version is available here.

"I was surprised by how suddenly I felt ill. We went to a wedding and I only missed one feed.
Within a couple of hours I felt fluey and achey. My GP was reluctant to prescribe antibiotics,
saying they were often not needed if I kept feeding. I also took ibuprofen tablets which helped
me cope. I was surprised how well the self-help worked and that I never needed a prescription.
I felt very miserable and depressed when I had the symptoms, wondering whether
breastfeeding was worth all this - but once I felt better I remembered how good it feels."

Mastitis means inflammation of the breast.

The first sign of mastitis is a swollen usually painful area on the breast. On darker skin tones
there might be a darkening of the skin and on lighter skin tones this might be visible as a red
area on the breast. However, it is important to note that there could be no visible change in
skin colour at all. The inflammation and swelling is not always a sign of infection (WHO, 2000).
Harmful bacteria are not always present: antibiotics may not be needed if self-help measures
are started promptly. Very rarely mastitis can develop into a more serious condition which
needs urgent hospital admission and IV antibiotics (RCOG, 2012).

You may get mastitis when milk leaks into breast tissue from a blocked duct. The body reacts
in the same way as it does to an infection - by increasing blood supply. This produces the
inflammation.
NB You may not have all of the above signs during mastitis.
Prevention of Mastitis

A localised area in the breast which is painful to the touch, often in the outer upper
area. Some mums might notice a change of colour or a red area on their breast.

A lumpy breast which feels hot to touch.

The whole breast aches and may appear swollen and skin may be reddened or darker,
depending on skin tone.

Flu like symptoms - aching, increased temperature, shivering, feeling tearful and tired
(Jahanfar et al., 2013). This feeling can sometimes start very suddenly and get worse very quickly.

Signs that the Baby is Well Attached

Try to avoid suddenly going longer between feeds. If you are intending to reduce breastfeeding, cutting down gradually reduces the risk of mastitis.

Make sure your breasts don't become overfull

Avoid pressure on your breast from clothing and fingers

Start self-help measures at the first sign of any lumpy or swollen areas on your breast

Factors which make mastitis more likely:

Difficulty with attaching your baby to the breast - this may mean that the milk is not

being removed effectively and milk may leak into the breast tissue

Pressure from tight fitting clothing, particularly your bra, or a finger pressing into the

breast during feeds

Engorgement or a blocked duct

Sudden changes in how often the baby is feeding, leaving the breasts feeling full

Injuries, such as bumps or knocks from toddlers

Self-Help Measures
Mastitis starts with poor milk drainage. If your baby is not effectively attached to your breast,
or has difficulty feeding, it may be hard for the baby to remove the milk and some parts of
your breast may not be drained during a feed. Improving the way your baby is attached at
the breast will reduce the chance of you getting mastitis again. If in doubt, contact your
midwife, health visitor or breastfeeding peer supporter for help with attaching your baby for
feeding. You can also contact the National Breastfeeding Helpline.

Your baby's chin is firmly touching your breast.

Your baby's mouth is wide open

Your baby has a large mouthful of breast.

If you can see the darker skin around your nipple, you should see more dark skin above your baby's top lip than below your baby's bottom lip.

It doesn't hurt you when your baby feeds (although the first few sucks may feel strong).

No change in shape or colour of the nipple after feeds e.g. it should not be lipstick shaped or have a pressure line across the nipple

Your baby's cheeks stay rounded during sucking.

Your baby rhythmically takes sucks and swallows (it is normal for your baby to pause from time to time).

Your baby finishes the feed and comes off the breast on his or her own.

Your baby produces 6 or more heavy wet nappies every 24 hours (from 7 days old)

Your baby produces at least two yellow poos at least the size of a £2 coin every 24 hours (from 7-28 days old). See UNICEF's breastfeeding checklist for more details.

If your mastitis comes back after you have taken a full course of antibiotics, or is unusually severe, it is good practice to send a sample of milk for bacteria tests. This will help the GP chose the correct antibiotic for your symptoms (Jahanfar et al., 2013). For public health reasons doctors try to avoid antibiotics that are not essential or are unlikely to be effective. It is important that you finish the whole course of antibiotics to make sure that you recover fully and to help prevent the mastitis coming back with resistant bacteria (NICE NG15).
When should I contact my GP or health visitor? If you do not begin to feel better after 24 hours despite using self-help measures, or especially if you start to feel worse, you should speak to your GP or health visitor. You may need to take antibiotics.
These will also help to clear blocked ducts and engorgement. Most cases of mastitis can be improved or resolved with self-help measures.
When should I seek help urgently?

Keep on breastfeeding - you may feel ill, in pain, tearful or discouraged but continuing to breastfeed will help you to get better, and your breastmilk is still the best food for your baby

Feed your baby frequently and responsively (whenever your baby seems like they want to feed), and/or pump to your normal routine (Mitchell et al., 2022; Douglas 2022)

Don't attempt to "empty the breast" by prolonging feeds or expressing extra milk between feeds. You may see this suggested in some places, but the current research suggests you should aim to meet your baby's needs, but avoid increasing your supply beyond that as it could make the inflammation worse. (Mitchell et al., 2022; Douglas 2022)

Try to rest as much as you can, as this will help you recover

Check that your baby is effectively positioned and attached to your breast - if in doubt seek help from your midwife, health visitor or breastfeeding supporter, as even a minor tweak can make a difference.

Try feeding with your baby in different positions.

If necessary, soften your breast, by expressing a little milk or running warm water over it, so that the baby finds it easier to feed well.

Some mothers find warm compresses are soothing, and warmth on the nipple can aid let-down. However, take care using these as compresses that are too hot or used frequently could increase swelling and inflammation. Cool compresses may ease symptoms in between feeds. (Mitchell et al., 2022; Douglas 2022)

Avoid any firm pressure or massage to the breast, or use of items such as an electric toothbrush to massage lumps or sore areas. This could cause tissue damage and increase inflammation (Mitchell et al., 2022; Douglas 2022). Any pressure you apply to your breast should be no firmer than stroking a cat.

Check for clothing or anything else which is pressing into your breast. This includes a bra - some women find it helpful to go without.

Medical Treatment for Mastitis
If you feel these symptoms beginning again, start self-help measures right away.

You should contact your GP if the area becomes round and swollen or, if you can see redness or a change of colour on your skin and the pattern of the colour change/redness changes. Redness may be less visible on darker skin tones. Mastitis can develop into an abscess (a painful collection of pus). There is more information about this here: https://www.nhs.uk/conditions/breast-abscess/.
The World Health Organisation (WHO) recommend Flucloxacillin 500 milligrams four times a day as first line treatment with erythromycin 250-500 milligrams four times a day or cefalexin 250-500 milligrams four times a day if the mother is penicillin allergic. Other options have been suggested by Jahanfar et al., (2013).
If you feel seriously unwell, dizzy, confused, develop nausea, vomiting or diarrhoea or slurred speech along with the symptoms of mastitis you need to seek urgent medical attention. These can be signs that mastitis is developing into sepsis. If severe, this is a medical emergency which needs urgent hospital admission and IV antibiotics. (NHS Choices: Sepsis, RCOG, 2012:6.1)

This information comes from the Drugs in Breastmilk Service.
References

Ibuprofen reduces the inflammation, relieves pain and reduces temperature. Take 400mg three times a day after food. Ibuprofen should not be taken by women who have asthma, stomach ulcers or are allergic to aspirin. The levels of ibuprofen which pass to the baby are small. Ibuprofen is safe to take whilst breastfeeding. See https://www.breastfeedingnetwork.org.uk/analgesics/ for more information.

Paracetamol relieves pain and reduces temperature but has no anti-inflammatory action. Take two 500mg tablets four times a day.

Aspirin should not be taken by breastfeeding mothers.

Antibiotics may be needed if no improvement is seen with self-help measures. Mostantibiotics can be safely taken whilst breastfeeding.

It is essential that breastfeeding is not interrupted during mastitis.

Note: Antibiotics can make the baby produce loose, runny motions and become irritable, colicky and restless. This lasts for a short time and will get better when you finish the antibiotics.

Jahanfar S, Ng CJ, Teng CL. Antibiotics for mastitis in breastfeeding women. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD005458. DOI:10.1002/14651858.CD005458.pub3 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005458.pub3/abstract (accessed 19 November 2020)

Crepinsek MA, Crowe L, Michener K, Smart NA. Interventions for preventing mastitis after childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007239. DOI:10.1002/14651858.CD007239.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007239.pub3/full (December 2022)

Hale T., Medications and Mothers' Milk 2014 (16th Ed),

NICE guideline [NG194] Published: 20 April 2021 https://www.nice.org.uk/guidance/ng194/chapter/Recommendations (accessed December 2022)

World Health Organization. 2000, Mastitis: causes and management, WHO: Geneva http://apps.who.int/iris/bitstream/10665/66230/1/WHO_FCH_CAH_00.13_eng.pdf?ua=1.(accessed December 2022)

NICE guidelines [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use www.nice.org.uk/guidance/ng15 (accessed December 2022)

NHS Choices: Sepsis www.nhs.uk/conditions/Bloodpoisoning/Pages/Introduction.aspx (accessed December 2022)

Royal College of Obstetricians and Gynaecologists (RCOG) (2012) Green-top Guideline No. 64b. Bacterial Sepsis following Pregnancy: 6.1. www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf (accessed December 2022)

Unicef: https://www.unicef.org.uk/babyfriendly/wpcontent/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf (Accessed December 2022)

Mitchell, K. B., Johnson, H. M., Rodríguez, J. M., Eglash, A., Scherzinger, C., Zakarija-Grkovic, I., Cash, K. W., Berens, P., Miller, B., & Academy of Breastfeeding Medicine (2022). Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022 Breastfeeding medicine : the official journal of the Academy of Breastfeeding
Medicine, 17(5), 360-376. https://doi.org/10.1089/bfm.2022.29207.kbm
Please note this information is not yet available in print. The previous print version has now been withdrawn and should no longer be used. A new print version is planned for 2023.
Douglas P. (2022). Re-thinking benign inflammation of the lactating breast: Classification,
prevention, and management. Women's health (London, England), 18, 17455057221091349.
https://doi.org/10.1177/17455057221091349

Original leaflet compiled by Wendy Jones MBE Pharmacist and Phyll Buchanan
Breastfeeding Network Supporter and Tutor, in 2015. With thanks to Magda Sachs who
developed earlier versions

This version revised 22 December 2022.

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Information on mastitis and breastfeeding, updated December 2022 and provided by the Breastfeeding Network

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Fun first foods: An easy guide to introducing solid foods - Publications - Public Health Scotland

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This booklet gives information on the different stages of weaning with tips, advice and recipes.