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This is a short (!) video looking at making laid back feeding work for you? The channel had about 20 short videos on laid back feeding so you can pick and mix what's more relevant to you?

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Can I see Natural Breastfeeding positions in action?

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UNICEF guidelines on infant feeding during the Covid-19 crisis

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UNICEF guidelines on infant feeding during the Covid-19 crisis

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These are the most up to date guidelines and I will be updating them as they are issued.

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Breastfeeding safely during the COVID-19 pandemic

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How to nourish your child following the latest expert guidance

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

Why do you need to express?

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

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

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

Not all breast pumps are the same

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

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

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

Hospital grade pumps

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

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

Personal use double electric pumps

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

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

Single electric pumps

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

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

Hands free wearable pumping

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

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

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

Manual and silicone pumps

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

Flange fit

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

Spare parts

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

Portability

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

Quality

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

Second hand pumps

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

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

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

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Choosing a breast pump - Sarah Oakley Lactation

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

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a guide to what fast flow and/or oversupply look like and some ideas on how to manage it?

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What is an oversupply and what are the symptoms?

An oversupply of breast milk is when you have too much milk. You might also hear people call it hyperlactation or hypergalactia.

Around three to five days after you give birth, you may notice that your breasts are uncomfortable and your milk supply is more than your baby needs. This is known as engorgement and it can be a very a common experience.

For more information on how your breasts might change after birth and what to expect, see here.

When might I experience breast engorgement?

It can happen around day three to five after birth when your milk 'comes in'.

During the first 14 days following your baby's birth you may have times when you experience engorgement, followed by times when your breasts feel soft.

Whenever you have gone longer between feeds than what's normal for you and your baby.

(Hill and Humenick, 1994; Berens and Brodribb, 2016)

What is the difference between oversupply and engorgement?

While engorgement can be normal, it's unusual for this to last beyond the first six to eight weeks. That is, unless there's been a longer gap between feeds.

Mums who experience oversupply can feel engorged the majority of the time and find that their milk supply always seems to exceed their baby's needs.

What are the signs of having too much breast milk?

You might notice the following if you have an oversupply of breast milk:

Your baby might struggle to maintain their latch - they might keep slipping off, letting go or slip to the end of the nipple (sometimes called 'disordered' feeding). If your baby comes off like this you may notice your milk spurting or flowing out of your nipples.

Your baby might be unsettled, fussy, have gas and bring up a feed.

You might hear your baby struggling with a strong flow of milk.

There may be problems with your baby's weight gain (either too much or too little).

Frothy and plentiful poos.

Your breasts always feel full and you're troubled by frequent leaking.

(Trimeloni and Spencer, 2016)

Would it help to get some breastfeeding support?

The signs mentioned above can also be symptoms of other breastfeeding issues. So asking for support from your midwife, health visitor, NCT Breastfeeding Counsellor or other breastfeeding supporters can be a good idea if you're worried about any of these issues.

Having an oversupply of breast milk can feel isolating and frustrating, and some mums say it makes social interactions more difficult (Trimeloni and Spencer, 2016). So getting breastfeeding support could help with this too.

It's also worth checking out our information about how to protect yourself against mastitis.

How do I reduce my oversupply of breast milk?

An oversupply normally settles down in time as your supply regulates. But if it persists beyond six to eight weeks, the following might be helpful:

Check your baby is latching well at the breast.

Leaning back when feeding can help to slow the flow down if your baby finds it hard to latch (Trimeloni and Spencer, 2016).

Consider asking for support from a trained breastfeeding supporter, such as an NCT Breastfeeding Counsellor or peer supporter.

Cut down on or stop expressing your milk - the more milk you take, the more you make.

You could try block feeding

It can be helpful to get breastfeeding support first before trying block feeding. But some mums find block feeding helpful in reducing their supply (Caroline and van Veldhuizen-Staas, 2007).

Block feeding is when you only offer your baby one breast at a feed or the same breast for a certain amount of time if your baby feeds very frequently. Although block feeding is an effective way to reduce supply, the changes can happen quickly.

When you've tried everything...

For a very small number of women, the oversupply is due to medical conditions. If you think this could be the case, or your oversupply is continuing despite trying the above, you may need support from a healthcare professional (Trimeloni and Spencer, 2016).

If you would like to explore any of these options, you can call an NCT Breastfeeding Counsellor on 0300 330 0700 and they can help you to find out more.
This page was last reviewed in December 2021.
Further information

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

National Breastfeeding Line (government funded): 0300 100 0212.

Berens P, Brodribb W. (2016) ABM Clinical Protocol #20: Engorgement, revised 2016. Breastfeed Med. 11:159-63. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860650/ (accessed 3rd December 2021).

Caroline GA, van Veldhuizen-Staas CG. (2007) Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeeding J. 2:11. Available at: http://www.nancymohrbacher.com/articles/2013/10/9/block-feeding-dos-donts.html (accessed 3rd December 2021).

Hill PD, Humenick SS. (1994) The occurrence of breast engorgement. J Hum Lact. 10(2):79-86. Available at: https://www.researchgate.net/publication/15580406_The_Occurrence_of_Breast_Engorgement (accessed 3rd December 2021).

Trimeloni L, Spencer J. (2016) Diagnosis and management of breast milk oversupply. J Am Board Fam Med. 29(1):139-42. Available at: https://www.jabfm.org/content/jabfp/29/1/139.full.pdf (accessed 3rd December 2021).

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Oversupply of breast milk and how to reduce it | Baby & toddler, Feeding articles & support | NCT

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Having too much breast milk - an oversupply - can be uncomfortable and can mean your baby struggles with feeding. Here are the signs and what to do...

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Common breastfeeding positions

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Breastfeeding and vitamin D supplements

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This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
In 2012 the Chief Medical Officer in the UK made recommendations about supplementing all pregnant and breastfeeding mothers and children with Vitamin D. There seems to remain a lot of confusion as to who should take these supplements, why this is necessary and how to obtain them. The recommendations were updated in July 2016 in line with the SACN recommendations on vitamin D and health.

Breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D as a precaution (SACN 2016)

Breastfeeding Mothers should also take a daily Vitamin D supplement of 10 µg per day

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live.

Breastmilk is perfect for babies

Vitamin D drops should be given to babies on a teaspoon as droppers are hard to sterilise

Healthy Start Vitamins remain an excellent, economic source of vitamin D and are provided free of charge in many areas. The daily dose of 5 drops contains 10µg www.healthystart.nhs.uk/for-health-professionals/vitamins/

Babies born to mothers with low vitamin D status are at risk of developing rickets. Taking into account that MOST of us are deficient between October and April at best and MANY of us will have low levels throughout the year, the recommendation that ALL pregnant women should take a supplement of 10 µg Vitamin D per day throughout pregnancy is sensible and cost effective (Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation).

Babies born to mothers who have not taken a vitamin D supplement in pregnancy are likely to be born with low vitamin D status. Levels of vitamin D in that mother are also likely to be low and even if she begins to take a supplement herself at that time, cannot redress the baby's deficiency by breastfeeding. So the recommendation is that the baby should receive its own oral vitamin D drops containing 7-8.5µg per day from 4 weeks of birth until the age of 5 years. Waiting until the baby is 6 months may be too late to prevent development of symptoms. Mothers may also develop symptoms of deficiency themselves.

Although it was thought that levels of vitamin D stores laid down in pregnancy by a mother who has taken vitamin D supplements in pregnancy would be sufficient for a few months,
new recommendations (July 2016) are that breastfed babies from birth to one year of age should be given a daily supplement containing 8.5 to 10mcg of vitamin D, to make sure they get enough ( www.nhs.uk/Conditions/vitamins-minerals/Pages/Vitamin-D.aspx). In addition breastfeeding mothers should take a daily Vitamin D supplement of 10 µg per day - in fact as more and more conditions are linked with lack of vitamin D most of us would benefit from taking it regularly.

In children; rickets, delayed tooth eruption, increased risk of infection, decreased bone mass, hypocalcaemic seizures, delay in walking.

In adults; osteomalacia, muscle weakness, bone pain plus possible association in many other conditions.

Mothers who are diagnosed with vitamin D deficiency may be prescribed very high dose supplements. Papers looking at these doses are scarce. Hollis and Wagner (2004) concluded that "Maternal vitamin D intakes of 4000 IU/d appear to be safe and to provide sufficient vitamin D to ensure adequate nutritional vitamin D status for both mothers and nursing infants. Hollis et al 2015 that "Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant's requirement and offers an alternate strategy to direct infant supplementation.

For information on high dose vitamin D prescribed for breastfeeding women see https://breastfeeding-and-medication.co.uk/fact-sheet/high-dose-vitamin-d-supplements-and-breastfeeding

Oily fish including trout, salmon, mackerel, herring, sardines, anchovies, pilchards, and fresh tuna

Cod liver oil and other fish oils

Egg yolk; 0.5 micrograms (20 IU) per yolk)

Mushrooms

Supplemented breakfast cereals typically contain between 2 and 8 micrograms (80-320 IU) per 100 g

Margarine

The average dietary vitamin D intake of young women in the UK approximates 3 micrograms per day and fewer than 1% consume more than the 10 micrograms (Williams 2007). The National Diet and Nutrition Survey of British adults suggest that if such a threshold were investigated in the UK population data, some 80-90% would be deficient (Henderson 2003).

The main source is Ultraviolet B sunlight exposure; more than 90% of mankind's vitamin D supply is derived from exposure UVB in sunlight. Deficiency of vitamin D in the UK is predominantly caused by poor weather, increasing use of high factor sunscreen (more than factor 8), and latitude: those born north of approximately Birmingham (40°N) are unlikely to be able to reach sufficient exposure.

Sunlight exposure needed is 2 hours per day (if only the face exposed), 20-30 minutes a day if the face, arms and neck are exposed without sunscreen. Sun protection factor in excess of 8 prevents absorption of the UVB sufficient to make vitamin D. Need increases for those with darker skins. In all cases it is important to avoid sunburn, particularly in babies.

Those who are eligible for Healthy Start vouchers receive free vitamin tablets and drops containing the correct dose of vitamin D for mothers and children.

Those not eligible for Healthy Start may purchase vitamin supplements form pharmacies and Health Food Stores - please check that they contain 10µg for adults and at least 7-8.5µg for children (usually 10 µg).

Vitamin D deficiency in the UK is a consequence of our weather and the latitude at which we live. The addition of vitamin D to formula milk does not make it better than breastmilk - it does not contain all the immunological properties that make breastmilk specific to cater for each baby's needs.

Some mother and infant groups have been shown to be at increased risk, including:

Babies of mothers with darker skin types

Pregnant and breastfeeding women.

Babies born in the winter months and not exposed to the sun

Babies and mothers who wear concealing clothing, preventing skin exposure to sunlight

Babies and mothers who spend a lot of time indoors or use sun creams, reducing exposure to sunlight

Babies of obese mothers (BMI >30)

Babies of mothers with gestational diabetes.

Ahmed SF et al. Recent trends and clinical features of childhood vitamin D deficiency presenting to a children's hospital in Glasgow. Arch Dis Child 2011;96:694-6 http://adc.bmj.com/content/96/7/694.full.pdf+html

American Academy of Paediatrics Prevention of Rickets and Vitamin D deficiency in infants, children and adolescents 2008 http://pediatrics.aappublications.org/content/122/5/1142.full.pdf+html

CMO Vitamin D supplements for at risk groups. dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_132508.pdf

Department of Health. Vitamin D an essential nutrient for all, but who is at risk of vitamin D deficiency? http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_111302.pdf

Henderson L, Irving K, Gregory J, et al. The National Diet and Nutrition Survey: adults aged 19 to 64 years. Vol 3. Vitamin and mineral intake and urinary analytes . London: Stationery Office, 2003: 1-160.

Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004;80(Suppl 6):1752S-1758S

Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG,Taylor SN, Morella K, Lawrence RA,Hulsey TC, Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics 2015;136 (4):

Jones W. Breastfeeding and Medication Routledge 2018

Michie C. Managing vitamin D deficiency in children. London Journal of primary care July 2010 londonjournalofprimarycare.org.uk/articles/3186685.pdf

NHS Choices. nhs.uk/news/2012/01January/Pages/vitamin-d-medical-advice-and-supplements.aspx

Prevention of rickets and vitamin D deficiency in Birmingham: the case for universal supplementation. infantfeedingwm.org.uk/documents/Website_VitD.pdf

SACN Update on Vitamin D 2007. sacn.gov.uk/pdfs/sacn_position_vitamin_d_2007_05_07.pdf

SACN Vitamin D and Health 2016 www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network June 2020

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Vitamin D and Breastfeeding - The Breastfeeding Network

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

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Buying a breast pump can be daunting if you’re a new mum with a hungry baby to feed. How to buy the best breast pump takes you through essential need to know before you buy an electric breast pump, or a manual pump

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is a way of describing the period after birth when both parents and baby are adjusting to their new lives.

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Kathryn Kelly, NCT antenatal teacher, explains: 'The Fourth Trimester is a way of describing the period after birth when both parents and baby are adjusting to their new lives.

'We think of other trimesters as being three months long, and we can think in terms of roughly another three months after the birth to make the adjustments to being a new family.'

What's the fourth trimester like for babies?

Having been in your warm womb for nine months, your baby has now got to get used to a sensory overload of sights, sounds and smells, as well as a frequently colder environment where they're not constantly supported by your protective amniotic fluid.

Kathryn says: 'Babies have been used to being fed continuously, sleeping when they want to, and being rocked in the cosy embrace of their mum's tummy. When babies are born we introduce gaps between feeds, and put them in a different place to sleep. It's no wonder that they can find this scary, and it's natural that they cry to express their fears.'

Understandably, babies are likely to cry more in this three-month period than any other time in their life. But however logical it might be, it doesn't make this period any easier for new parents. Knowing that other parents are going through the same experience, and thinking of this period as the fourth trimester, might help.

'Parents describe it as a very useful concept, which reminds them that it is OK to find the early days with a baby hard. It is a period of transition, where women become mums, men become dads, and babies adjust to life outside the womb,' Kathryn says.

What can you do to help your baby in the fourth trimester?

Fundamentally, the closer your baby feels to you, the happier they will be. According to Kathryn: 'Anything that mum, dad or other carers can do to replicate the womb-like world will help their baby feel safe. And when we feel safe, we thrive. For your baby, this means holding them close, perhaps in a sling, so they feel the warmth of your body, hear your heartbeat, and are gently rocked as you go about your day (or night).

'Feeding for babies, just like for adults, is about more than just nutrition, it's also social - a way of sharing and being with those we care for. Feeding your baby whenever they they want to will support their emotional development, as well as their physical and intellectual development.

'Your baby will sleep when they're tired, and you will both feel safer if they're close to you. Many parents tell me that in the early days their baby won't sleep in their Moses basket or crib, but only when they're held by a parent. This is perfectly normal and understandable when you think about the baby's point of view. It's important that parents find out about the safer sleep guidelines, and work out a way of sleeping that suits them as a family.'

Can you 'spoil' your baby in the fourth trimester?

No. Despite some people saying that babies need to 'learn' that you won't rush to pick them up every time they cry, in this crucial Fourth Trimester period you can't care for them too much. In fact, the more you look after them when they're upset, the more reassured and confident they'll be.

How might you be feeling?

Even if you're not an international tennis champion, parents who have gone from living busy, independent lives, can find the sudden change to around-the-clock care for a completely dependable infant hard.

Add to that the need to recover from a traumatic or difficult birth, and you can understandably feel like you're the one in need of a little TLC. Kathryn says: 'With the emotional changes in a woman's body, plus the realisation of the enormous responsibility of having a baby, new mums can feel overwhelmed and tearful at times.

'Partners can be dealing with their own response to the birth, their changing identity, and strong feelings about protecting and providing for the family. All of these feelings can also be affected by the way both mum and her partner were parented themselves.'

As with all stages of early parenthood, it's worth remembering that this stage will pass. In what seems no time at all, you might be looking back at the period with fondness at how tiny and attached to you your baby was when they were first born.

However, that is not to downplay how challenging the Fourth Trimester can be for parents. When you're in it, it's all-consuming. You can feel like you don't know what you're doing and you're constantly one step behind.

So, what should I do?

If you think in terms of the first three months of your baby's life being a Fourth Trimester, it can be easier to take the pressure off getting back to 'normal'. You wouldn't have been trying to rush around tidying the house and welcoming endless visitors when you were heavily pregnant, so don't put pressure on yourself to do it now.

'When women are discharged from healthcare some people might think that means they should be able to return to normal life, but there is a long period of adjustment and care needed at home,' says Kathryn. 'Friends and family can support new parents with food, help around the house, and reassurance that they are doing a great job of looking after their baby.'

This is especially important for mums who are raising their baby alone, in which case asking for help from friends and family in advance can help ensure you get the support you need.

Kathryn adds: 'Having very modest aims in the early days - getting outside most days (perhaps a short walk around the block), eating well, resting as much as possible - will change over time to meeting up with friends regularly, getting some exercise every day, and doing the most necessary housework.'

When will the crying settle down?

'As babies grow and change, things that seemed easy one day might feel very difficult another,' Kathryn says. 'A baby's crying tends to peak at around week six, which can mean that parents feel they must be doing something wrong, or that there is a problem with their baby. However, this is normal, and has usually reduced by three months.

'Parents report the excitement and happiness that comes when they see their baby is starting to interact with them, including smiling for the first time.'

Where can I get more help?

'Part of the challenge of this early period is the feeling that there is so much to learn, and to worry about,' explains Kathryn. 'Using safe sources when looking for information about caring for yourself or your baby will reduce anxiety.

'Reputable sources such as NCT practitioners and the website, or NHS health professionals and are a good place to start. Avoid sources of information (including people or media) who make you feel bad about your parenting, and stick with people who you trust and who support you.

'Although things can feel like they're getting harder in the early weeks, most people are feeling much better by around three months after the birth, and some will feel fine before that. If parents are still finding life a real struggle at that point they might consider talking to a health professional, or seeking more support from friends and family, to help them until they are feeling more in control.'

Further information

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

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby. To find out when an NCT nearly new sale is happening near you, search here.

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

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What is the fourth trimester? | Baby & toddler articles & support | NCT

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Everyone knows that pregnancies last three trimesters - so what exactly is the Fourth Trimester? We explain what this crucial stage is, and what it means for you and baby

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An informative article from Kellymom talking about engorgement of breasts and some self help information

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By Kelly Bonyata, BS, IBCLC

What is Normal?

It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity (" comes in ") 2-5 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

How to prevent or minimize engorgement

Nurse early and often - at least 10 times per 24 hours. Don't skip feedings (even at night).

Nurse on baby's cues ("on demand"). If baby is very sleepy: wake baby to nurse every 2-3 hours, allowing one longer stretch of 4-5 hours at night.

Allow baby to finish the first breast before offering the other side. Switch sides when baby pulls off or falls asleep. Don't limit baby's time at the breast.

Ensure correct latch and positioning so that baby is nursing well and sufficiently softening the breasts.

If baby is not nursing well, express your milk regularly and frequently to maintain milk supply and minimize engorgement.

Signs & Symptoms of Engorgement

When? Engorgement typically begins on the 3rd to 5th day after birth, and subsides within 12-48 hours if properly treated (7-10 days without proper treatment).

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How does the breast feel? The breast will typically feel hard, with tightly stretched skin that may appear shiny, and you may experience warmth, tenderness, and/or throbbing. Engorgement may extend up into the armpit.

How does the areola feel? The areola will typically feel hard (like the tip of your nose or your forehead) rather than soft (like your earlobe), with tight skin that may appear shiny. The nipple may increase in diameter and become flat and taut, making latch-on challenging.

You may also have a low-grade fever.

Moms' experiences of engorgement differ. Engorgement:

May occur in the areola and/or body of the breast;

May occur in one or both breasts;

May build to a peak and then decrease, stay at the same level for a period of time (anywhere from minimal to intense), or peak several times.

Tips for treating engorgement

Before nursing

Gentle breast massage from the chest wall toward the nipple area before nursing.

Cool compresses for up to 20 minutes before nursing.

Moist warmth for a few minutes before nursing may help the milk begin to flow (but will not help with the edema/swelling of engorgement). Some suggest standing in a warm shower right before nursing (with shower hitting back rather than breasts) and hand expressing some milk, or immersing the breasts in a bowl or sink filled with warm water. Avoid using warmth for more than a few minutes as the warmth can increase swelling and inflammation.

If baby is having difficulty latching due to engorgement, the following things can soften the areola to aid latching:

While nursing

Gentle breast compressions and massage during the nursing session can reduce engorgement.

After nursing for a few minutes to soften the breast, it may be possible to obtain a better latch by removing baby from the breast and re-latching.

Between feedings

If your breast is uncomfortably full at the end of a feeding or between feedings, then express milk to comfort so that the breasts do not become overfull.

Hand expression may be most helpful (though obviously second to breastfeeding) as this drains the milk ducts better.

Mom might also use a hand pump or a quality electric pump on a low setting for no more than 10 minutes (engorged breast tissue is more susceptible to damage). A "juice-jar" pump may also be used.

Massaging the breast (from the chest wall toward the nipple area) is helpful prior to and during milk expression.

It's not good to let the breasts get too full, but you also don't want to overdo the pumping, as too much pumping will encourage overproduction. If you do need to express milk for comfort, your need to express will likely decrease gradually over time; if it does not, then try gradually decreasing the amount you express.

Use cold compresses (ice packs over a layer of cloth) between feedings; 20 minutes on, 20 minutes off; repeat as needed.

Cabbage leaf compresses can also be helpful.

Many moms are most comfortable wearing a well fitting, supportive bra. Avoid tight/ill-fitting bras, as they can lead to plugged ducts and mastitis.

Talk to your health care provider about using a non-steroidal anti-inflammatory such as ibuprofen (approved by the American Academy of Pediatrics for use in breastfeeding mothers) to relieve pain and inflammation.

AVOID:

Excess stimulation (for example, don't direct a shower spray directly on the breasts).

Application of heat to the breasts between feedings. This can increase swelling and inflammation. If you must use heat to help with milk flow, limit to a few minutes only.

Restricting fluids. This does not reduce engorgement. Drink to thirst.

Contact your lactation consultant or health care provider if:

Engorgement is not relieved by these measures.

Baby is unable to latch or is not having enough wet/dirty diapers.

You have mastitis symptoms: red/painful breast, temperature greater
than 100.6 degrees F, chills, body aches, flu-like symptoms.

You have any questions.

Other treatments for engorgement

Cabbage

Applying cabbage leaf compresses to the breast can be helpful for moderate to severe engorgement. There is little research on this treatment thus far, but there is some evidence that cabbage may work more quickly than ice packs or other treatments, and moms tend to prefer cabbage to ice packs.

What are cabbage compresses used for?

Engorgement.

Extreme cases of oversupply, when the usual measures for decreasing supply (adjusting nursing pattern, nursing "uphill," etc.) are not working

During weaning, to reduce mom's discomfort and decrease milk supply.

Sprains or broken bones, to reduce swelling.

To use cabbage leaves:

Green cabbage leaves may be used chilled or at room temperature.

Wash cabbage leaves and apply to breasts between feedings.

For engorgement or oversupply: Limit use as cabbage can decrease milk supply. Leave on for 20 minutes, no more than 3 times per day; discontinue use as soon as engorgement/oversupply begins to subside.

During the weaning process: Leave the leaves on the breast until they wilt, then apply new leaves as often as needed for comfort.

For further information on how to use cabbage leaves:

"Juice Jar" breast pump

This simple pump can be useful to help with engorgement, and to draw the nipple out when baby is having a difficult time latching on.

Find an empty glass jar or bottle at least 1 liter in size with a 5 cm or larger opening. The type of bottle that cranberry juice comes in is often a good size.

Fill the jar nearly full with very hot water. The glass will get very hot and you will need to hold it with a towel.

Pour all the water out of the jar.

Use a cool washcloth to cool down the rim and upper part of the jar so you can touch it without burning yourself (test it with your inner arm).

Place your breast gently into the mouth of the jar so that it makes an airtight seal. Some moms lean over a table to do this, others put the jar in their lap on a pillow and lean forward. Expect this to take a few minutes, so make yourself comfortable.

As the air slowly cools inside the jar, it creates a vacuum inside the jar and this gentle suction expresses milk from the breast. Break the suction immediately if you feel discomfort - if the jar cools too quickly it may create excessive suction which can damage breast tissue.

Repeat for the other breast.

Some moms need to repeat this, others find it works sufficiently with only one try.

Fenugreek seed poultice

This is a traditional treatment for engorgement or mastitis. Steep several ounces of fenugreek seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots. For more information, see Fenugreek.

Additional Resources

@

Reverse Pressure Softening ... aids latching when mom is engorged

@ other websites

Prevention and Treatment of Engorgement by Becky Flora, BS, IBCLC

References:

Veldhuizen-Staas C. Overabundant milk supply: an alternative way to intervene by full drainage and block feeding. Int Breastfeed J. 2007; 2: 11. doi: 10.1186/1746-4358-2-11

Cotterman KJ. Too Swollen to Latch On? Try Reverse Pressure Softening First. Leaven, April-May 2003;39(2):38-40.

Hill PD, Humenick SS. The occurrence of breast engorgement. J Hum Lact. 1994 Jun;10(2):79-86.

Humenick SS, Hill PD, Anderson MA. Breast engorgement: patterns and selected outcomes. J Hum Lact. 1994 Jun;10(2):87-93.

Lawrence R and Lawrence R. Breastfeeding: A Guide for the Medical Profession, 6th ed. St. Louis: Mosby, 2005, p. 278-281.

Moon JL, Humenick SS. Breast engorgement: contributing variables and variables amenable to nursing intervention. J Obstet Gynecol Neonatal Nurs. 1989 Jul-Aug;18(4):309-15.

Mohrbacher N. Breastfeeding Answers Made Simple. Amarillo, Texas: Hale Publishing, 2010, p. 679-683.

Riordan J and Auerbach K. Breastfeeding and Human Lactation, 3rd ed. Boston and London: Jones and Bartlett, 2004, p. 205-207, 228.

Roberts KL, Reiter M, Schuster D. A comparison of chilled and room temperature cabbage leaves in treating breast engorgement. J Hum Lact. 1995 Sep;11(3):191-4.

Roberts KL. A comparison of chilled cabbage leaves and chilled gelpaks in reducing breast engorgement. J Hum Lact. 1995 Mar;11(1):17-20.

Smith A, Heads J. Breast Pathology. In: Walker M, ed. Core Curriculum for Lactation Consultant Practice. Boston: Jones and Bartlett, 2002, p. 175-180.

Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. Cochrane Database Syst Rev. 2001;(2):CD000046.

Walker M. Breastfeeding and Engorgement. Breastfeeding Abstracts, November 2000;20(2):11-12.

Wilson-Clay B, Hoover K. The Breastfeeding Atlas, Third Edition. Austin, Texas: LactNews Press, 2005, p. 109-111.

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It is normal for your breasts to become larger and feel heavy, warmer and uncomfortable when your milk increases in quantity ("comes in") 2-6 days after birth. This rarely lasts more than 24 hours. With normal fullness, the breast and areola (the darker area around the nipple) remain soft and elastic, milk flow is normal and latch-on is not affected.

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below is a link to the activity covered in the session on what to expect in the first days, weeks and at anytime when breastfeeding

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Some additional information from the NHS on some common breastfeeding positions.

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Rugby hold (or the 'clutch')

The rugby hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there's no pressure on the tummy and scar area.

Positioning

1. Sit in a chair with a cushion or pillow along your side.

2. Position your baby at your side (the side you want to feed from), under your arm, with their hips close to your hips.

3. Your baby's nose should be level with your nipple.

4. Support your baby's neck with the palm of your hand.

5. Gently guide them to your nipple.

Further help

For help with latching on (positioning your baby on your breast), watch our breastfeeding animation video:

Tip: If your baby finds latching on tricky, this position is good as you can guide your baby's head towards your nipple - and it's easier to see what's going on.

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Start4Life - How to Breastfeed | Breastfeeding Guide | Start4Life

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The rugby hold is a good position for twins as you can feed them at the same time, as well as caesarean babies as there's no pressure on the tummy and scar area. Positioning Sit in a chair with a cushion or pillow along your side.

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Mixed feeding

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When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

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Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

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Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding

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An interesting article on what cluster feeding is and some strategies to cope with it

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Maternity action's guide to feeding in public.

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This information sheet gives a brief guide to the law and what to do if you are treated unfavourably because you are breastfeeding while out and about with your baby in public places.
For more information on your rights to continue to breastfeed on return to work, see the information sheet: Continuing to breastfeed when you return to work.

What does the law say?

The Equality Act 2010 says that it is discrimination to treat a woman unfavourably because she is breastfeeding. It applies to anyone providing services, benefits, facilities and premises to the public, public bodies, further and higher education bodies and association. Service providers include most organisations that deal directly with the public. Service providers must not discriminate, harass or victimise a woman because she is breastfeeding.

Discrimination includes refusing to provide a service, providing a lower standard of service or providing a service on different terms. Therefore, a cafe owner cannot ask you to stop breastfeeding, ask you to move or cover up or refuse to serve you.

How long does protection apply for?

There is no age restriction, the law protects you for as long as you wish to breastfeed your baby.

Where can a woman breastfeed?

You are protected in public places such as parks, sports and leisure facilities, public buildings and when using public transport such as buses, trains and planes. You are protected in shops, public, restaurants and hotels regardless of how big of small. You are also protected in places like hospitals, theatres, cinemas and petrol stations.

Am I protected if I am asked to stop breastfeeding at work?

If your employer provides services to the public, your employer is also responsible for the actions of its employees.

The law does not currently provide a right to time off at work to breastfeed but you have health and safety rights at work as an employee and the right to ask for flexible work. For more information, see: Continuing to breastfeed when you return to work. Employers are not obliged to provide facilities for expressing and storing milk but they may wish to as a matter of good practice and they must take steps to protect the health and safety of an employee who is breastfeeding on return to work.

What protection is there for students?

Further and higher education bodies must not discriminate, harass or victimise a student who is breastfeeding in terms of admission or provision of education or by excluding the student or subjecting her to any detriment. This includes access to benefits, facilities or services.

Which associations are included?

An association must not discriminate, harass or victimise a person because she is breastfeeding by refusing membership or discriminating in provision of benefits, facilities or services.

An association includes clubs, such as golf clubs, that have rules of membership, with at least 25 members, where members have to apply to join. Private clubs, with less than 25 members, that have no formal rules of membership, such as a book club, would not be counted as an association. Clubs where you simply pay a membership fee to join are not counted as an association but would be considered to be providing public services.

Are there some places where I cannot breastfeed in public?

Yes, it is not against the law to prevent a woman breastfeeding in a service which is a single sex service for men. This single sex service must be justified, for example, where only one sex needs it or one sex needs the service more than the other. Voluntary groups or charities set up specifically to benefit one sex may be acting lawfully if they exclude women. Religious organisations may offer services to one sex if it is in line with the doctrines of that religion. In some cases, where single sex services are justified, it would be reasonable to object to members of the opposite sex being there.

It is not against the law to prevent a woman breastfeeding where there are legitimate health and safety risks, for example, near to certain chemicals or radiation.

What can I do if I am discriminated against because I am breastfeeding?

If you have been asked to stop breastfeeding or to cover up or you have been refused services while you are out and about, you can make a complaint to the company or organisation. This includes complaints about how you were treated by other customers as well as members of staff.

Ask the company or organisation, e.g. restaurant, sports complex, cinema, if they have a complaints policy. This will tell you who to write to. Alternatively, you can look on their web page for their complaints policy or find the address of their Head Office.

You can make a complaint by email or by sending a letter, outlining what happened and when and who was involved. Think about what you would like to ask for to remedy the situation, for example, an apology and a commitment to providing staff training in breastfeeding rights. You can use the model letter below if you wish.

You could also send the company a tweet or post a comment on their Facebook page. This may be effective in raising awareness of their treatment of mothers who are breastfeeding but businesses are unlikely to treat tweets and Facebook comments as formal complaints so they may not investigate your complaint.
What can I do if I'm not happy with the response?
If you have made a complaint and you are unhappy about the service providers' response you can take a case in a county court in England or Wales or a Sheriff court in Scotland. You should seek advice as these can be expensive cases to bring. You must start the case within 6 months of the day that it happened. This time limit will only be extended in very exceptional circumstances.

If you win your case, the court can order compensation which can include an amount for injury to feelings. The court can also issue an injunction or make a declaration that you have been discriminated against. If you lose, you may be ordered to pay the other side's legal costs so it is very important to get expert advice.

Additional protection in Scotland

In Scotland a person has a right to breastfeed or bottle feed a child under two and it is a criminal offence to try to stop or to prevent a woman from feeding a child under two in any place in which the public has access and in which a child under two is entitled to be. Anyone who tries to stop or prevent a person feeding milk to a child under the age of two can be prosecuted and can face a claim under the Equality Act.

Employers are responsible for ensuring that their staff are fully aware of the law. If an employee tries to stop or prevent a woman from breastfeeding in the course of their employment, the employer may also be liable even if they were unaware of the incident. You should complain to the employer in the first instance and, if necessary, you can report the matter to the police.

Model letter

Dear [add name]

This information sheet was produced in April 2024. It is very important to get up-to-date advice as law and guidance changes.
This guide is for information purposes only and should not be treated as legal advice. You are strongly advised to get personal legal advice about the individual circumstances of your case.
Where to go for more help
Maternity Action
For information on maternity and parental rights at work and benefits, see: www.maternityaction.org.uk.

Maternity Rights Advice Line - 0808 802 0029

For opening hours see: https://maternityaction.org.uk/advice-line.
ACAS
For advice on employment rights or for Early Conciliation if you are thinking of making a tribunal claim

Helpline: 0300 123 11 00 (offers telephone interpreting service)
Citizens Advice
For information about your rights see: www.citizensadvice.org.uk

You can telephone the national Citizens Advice phone service on 03444 111 444

You can get help with Universal Credit claims through the free national Help to Claim service: England: 0800 144 8444, Wales: 0800 024 1220, Scotland: 0800 023 2581

For more information on how to find your local Citizens Advice Bureau, see:
https://www.citizensadvice.org.uk/about-us/contact-us/contact-us/contact-us/ Civil Legal Advice
If you are eligible for legal aid you can get free legal advice on 0345 345 4 345 (offers translation service). To check your eligibility see www.gov.uk/civil-legal-advice

To search for specialist legal advisers or solicitors in your area see: https://find-legal-advice.justice.gov.uk/
Equality Advisory Support Service
Help and advice on discrimination and human rights www.equalityadvisoryservice.com

Helpline: 0808 800 0082 Mon - Fri 9am - 7pm, Sat 10am - 2pm

Textphone: 0808 800 0084
Equalities and Human Rights Commission (EHRC)
For information and advice about discrimination law www.equalityhumanrights.com

For information for employees and employers about pregnancy and maternity rights in the workplace see: www.equalityhumanrights.com/about-us/our-work/key-projects/managing-pregnancy-and-maternity-workplace
GOV.UK
The government's online information service
Jobcentre Plus
To make new telephone benefit claims or request claim forms, including Maternity Allowance and Sure Start Maternity Grant: 0800 055 6688 Mon - Fri 8am - 6pm

For ESA/JSA/Income Support claims: 0800 169 0310 Mon - Fri 8am - 6pm

For Maternity Allowance claims: 0800 169 0283 Mon - Fri 8am - 6pm

For Sure Start Maternity Grant claims: 0800 169 0140 Mon - Fri 8am - 6pm/For Best Start Grant claims in Scotland: 0800 182 2222

Universal Credit helpline - for new claims and existing online claims: 0800 328 5644. Mon - Fri 8am - 6pm

For help with claiming Universal Credit see: www.gov.uk/universal-credit
HM Revenue & Customs (HMRC)
Tax Credit Helpline: 0345 300 3900 Mon - Fri 8am-8pm, Sat 8am-4pm, Sun 9am -5pm

Child Benefit: 0300 200 3100 Mon - Fri 8am-8pm, Sat 8am- 4pm

For queries about Statutory Maternity Pay, Adoption Pay, Paternity Pay and Shared Parental Pay:

Employees helpline 0300 200 3500

Employers helpline 0300 200 3200
HMRC Statutory Payments Disputes Team
If you cannot resolve a dispute about your SMP, you can ask HMRC for a formal decision on your entitlement. You can also ask HMRC to pay your SMP if your employer has refused to pay, has dismissed you to avoid paying SMP or has gone into liquidation. This includes disputes about Statutory Maternity Pay/Adoption Pay/Paternity Pay/Shared Parental Pay/Parental Bereavement Pay or Statutory Sick Pay

See: https://www.gov.uk/guidance/statutory-pay-entitlement-how-to-deal-with-disagreements

Telephone: 0300 322 9422

You can also write to the Statutory Payments Disputes Team at HM Revenue and Customs, PT Operations, Statutory Payments Dispute Team, BX9 1AN.
Insolvency Service Helpline
You can currently only contact the Insolvency Service online.

For what you can claim if your employer goes out of business, see: https://www.gov.uk/your-rights-if-your-employer-is-insolvent
Law Centres Network
To find out if there is a Law Centre in your area telephone 020 3637 1330 or see: www.lawcentres.org.uk/
Turn2us
Online benefits calculator and grant search www.turn2us.org.uk

More Maternity Action information sheets
Rights during pregnancy Pregnant at work 2021 Pregnancy Discrimination Time off for antenatal care Health and safety during pregnancy and return to work Resigning from your job during pregnancy and maternity leave Changing jobs or more than one job
Pregnant during maternity leave (when you are expecting again)
Premature births - rights to maternity leave and pay Miscarriage stillbirth and neonatal death - rights to time off and pay Maternity pay and benefits Maternity Pay Questions Money for Parents and Babies Maternity and parental leave Rights during maternity leave and return to work Keeping in touch during leave Shared Parental Leave and Pay Time off for Working Parents Asking to change your working hours or go part-time Child friendly working hours Redundancy, dismissal and discrimination Pregnancy Discrimination Rights during maternity leave and return to work Redundancy during pregnancy, maternity and parental leave Dealing with problems at work Health and safety, breastfeeding and sickness Sickness during pregnancy maternity leave and return to work Health and safety during pregnancy and return to work Postnatal depression and depression during pregnancy Childbirth injuries - rights at work and benefits for new mothers Breastfeeding on return to work Breastfeeding while out and about Self-employed, agency and zero hours work Maternity and parental rights for agency workers Maternity and parental rights if you are self-employed Changing jobs or more than one job Zero hours contracts - maternity and parental rights Apprentices - maternity and parental rights at work Fathers and partners, including same sex partners Rights at work for fathers and partners Shared Parental Leave and Pay Child friendly working hours Time off for Working Parents Dealing with problems at work Adoption or surrogacy Time off and pay for parents-surrogacy Shared parental leave and pay - adoption Money for Parents and Babies
Available at www.maternityaction.org.uk

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Breastfeeding while out and about - Maternity Action

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This page contains information on:What does the law say?How long does protection apply for?Where can a woman breastfeed? Am I protected if I am asked to stop breastfeeding at work? What protection is there for students? Which associations are included? Are there some places where I cannot breastfeed in public?

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Contact numbers and websites of national breastfeeding organisations.

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My contact number is at the top of this padlet, but this link has information on the support available in the Stockport area.

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Stockport Breastfeeding - Stockport NHS Foundation Trust

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This booklet by the NHS presents basic information of feeding in a easy to digest format.

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images to help recognise when your baby wants to feed.

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A link to the la Leche League page on colostrum harvesting. Different hospital have different protocols so check with your health professional.

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Antenatal Expression of Colostrum - La Leche League GB

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

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A UNICEF video guide on hand expressing milk

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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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Information on how to express and store your milk safely

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First Steps nutrition is a very useful resource for unbiased information on any area of infant feeding. This guide contains information on all types of formula milk.

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Infant milks for parents & carers — First Steps Nutrition Trust

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

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A diagram to show how a baby's suck/swallow pattern changes throughout a feed.

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A lovely short video showing a newborn baby's first feed.

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NCT have a few branches in the Cheshire East area. They run bumps and babies sessions and various events throughout the year, Search for your local branch below.

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To search for branches, events or courses, please use the dedicated searches in these sections.

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A video guide showing examples of how to effectively attach your baby at the breast.

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

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

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

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How dads and partners can support breastfeeding.

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How dads and partners can support breastfeeding.

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How everyone can get involved in different ways!

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

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

Why is breastfeeding important?

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

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

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

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

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

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

What do I need to know about breastfeeding?

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

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

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

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

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

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

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

Women enjoy feeding more when they are comfortable and relaxed.

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

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

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

Here are 10 tips:

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

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

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

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

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

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

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

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

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

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

(Rempel et al, 2010)

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

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

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

Tips for being a hands-on partner with your baby

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

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

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

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

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

How can I share feeding our baby?

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

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

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

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

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

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

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

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

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

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

At the end of the day...

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

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

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

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

Visit our breastfeeding support contacts page.

NHS Choices breastfeeding information.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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How can dads and partners support breastfeeding?

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When it comes to breastfeeding, you might wonder what you can do to support your partner and baby. The truth is you can make a huge difference. Did you know that a mum is more likely to choose to breastfeed if she's sure her partner is positive about it?

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A set of videos from best beginnings looking at a variety of topics from the first feed, skin to skin, attachment, overcoming challenges and others.

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This information and videos are 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:

Meet four prospective mums, Melissa, Maria, Teresa and Angela. Melissa has never been through labour - she had a caesarian-section with her previous child. For medical reasons Maria has to have a c-section; Teresa wants to give birth at home; and Angela is expecting her third child. We follow them as they prepare for their births.

All our mums have different birth experiences. Find out why skin-to-skin contact is so important and about breastfeeding for the first time. "It's a great feeling to be able to provide for him without anything else, just me myself," Angela says. Melissa's partner Andy says breastfeeding is healthy, cheaper and much less effort than making up bottles.

Angela is back home with baby Cameron and breastfeeding is going well. "It's a great feeling to be able to sit there and watch him feeding away. It's a really special bond," she says. Teresa is making sure she has plenty of contact with Rufus, ensuring her body is supplying enough milk for him. Breastfeeding can protect you against ovarian cancer and give you stronger bones in later life.

How to make sure your baby is attaching well at the breast.

Meet four mums whose babies have been breastfeeding for a little while and hear their experiences. Linda was troubled by breastfeeding outside the home - until she tried it. "I thought, 'nobody breastfeeds in public,'" she says. "What I realised is, loads of women breastfeed in public, you just don't realise it's happening."

Find out about overcoming challenges like uncomfortably full breasts and mastitis, and how to position your baby so he or she feeds properly.

Linda and Heidi have fed their babies breast milk for six months. Now their babies are ready to try their first solids.

Join a class with specialist midwife Bella Dale, who explains how breastfeeding works and how mums' bodies start preparing to feed their babies before birth.

Three mums tell us how they overcame hurdles with breastfeeding. Thomasina overcame sore nipples, while Lowri encountered mastitis, both of which were caused because their babies weren't attaching properly at the breast.

We meet three mothers who express their milk for different reasons and learnt how to do it in different ways. Find out techniques for expressing, different pumps and ways to store breast milk. We also discover how mothers fit breastfeeding into their return to work.

In their first few weeks, pre-term babies may be fed using a nasogastric tube. But as they progress they will begin to take milk feeds, usually through a tube into the baby's mouth or nose. Breast milk is best for many reasons. Find out why and how as we follow four mothers and their premature babies.

Follow three mothers as they share their tips on the joys and challenges of feeding twins.

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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Your guide to breastfeeding and how to do it successfully.

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A visual guide from NCT about what to expect from your baby's nappy in the first few weeks.

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A picture guide showing effective attachment from NCT

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A really interesting NCT link discussing baby feeding patterns and how varied they can be!

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When should I feed my baby?

As a rough guide, babies need to feed at least eight to 12 times (sometimes more) over 24 hours during the first few weeks (NHS, 2019a; UNICEF, 2010). That means they'll probably need to feed every two to three hours.

Watch our video for tips on how often and how long to breastfeed your baby for.

It's best to feed babies responsively or in a baby-led way rather than sticking to a feeding schedule (WHO, 2009; Entwistle, 2013; Fallon et al, 2016). Letting your baby feed when they want will help them get the milk they need. It will also stimulate your milk supply (Infant and Young Child Feeding, 2009).

What if I'm struggling or worried about the number of feeds?

We know from the experiences of new mums that breastfeeding responsively can feel emotionally and physically challenging (Fallon et al, 2016).

A baby that breastfeeds frequently can give parents a sense of reassurance but it can also cause worry. Some people may think frequent feeding is a sign of insufficient milk, or that baby isn't getting enough breastmilk during feeds. This sometimes leads to women supplementing feeds with formula milk or deciding to stop breastfeeding (Leurer, 2015).

Try and keep in mind that a newborn baby's stomach is really small. They need to feed little and often (NHS, 2020). It's really common for babies to have a good feed and then appear to be hungry again quite quickly. This doesn't mean something is wrong or that they're not getting enough milk. It's just the way newborn babies feed (Kent et al, 2012).

All of this also means that newborn feeding is frequent. In fact, much of the time, it's not really a question of clearly-defined 'feeds' with clear beginnings and endings (WHO 1998).

Your baby knows your voice, your smell and your taste but they are much less familiar with the 'world' outside your womb. Staying close to you gives them a vital sense of safety and reassurance. This builds their confidence that they are loved and cared for (Crenshaw, 2007).

If you're worried, it can really help to talk through your concerns with a breastfeeding counsellor. So call our Infant Feeding Support line on 0300 330 0700.

Will I produce enough milk?

The more you breastfeed your baby, the more milk you will produce (Daly & Hartmann, 1995). If your baby is attached properly, and you're both comfortable and feeding them when they ask for it, you will make enough milk for them (Kent et al, 2012; WHO 2019).

How do I know when to feed my baby?

When your baby is hungry they may give you little signals, known as early feeding cues (NHS, 2019a,b). They might:

* get restless

* suck their fist or fingers

* make murmuring sounds

* turn their head and open their mouth (rooting).

Looking out for and responding to these cues is important. It can help prevent your baby from becoming upset and frustrated, which will make it more difficult to feed them (WHO, 2009). Here's what you might see...

How long should each feed last?

Every baby is different and they will go through different patterns of feeding as they grow (Kent et al, 2012). How much milk a baby needs per breastfeeding session will vary. It's best to be guided by your child (Kent et al, 2012).

Some feeds will seem to last a long time, with your baby dozing for short periods before wanting more. And more. And still more! It's normal for a young baby to be on the breast many times a day and night. 12-15 'visits' to the breast is well within a normal range (Entwistle, 2013).

As a general rule, babies who are feeding well will feed for between five and 40 minutes at each feed (UNICEF, 2010). Your baby will let you know when they've had enough milk. They will usually come off the breast themselves, look sleepy or calm, and look around (UNICEF, 2010).

During each breastfeed, your milk changes slightly. So the milk at the end of the feed is more creamy and filling than the milk at the beginning of the feed (Ballard and Morrow, 2013). Offer one breast and let your baby feed until they stop drinking. If they still appear hungry, offer the second breast - allowing them to drink as much as they want (NICE, 2015).

Should I wake my baby up to feed?

In most cases, healthy, thriving newborns will wake up for feeds and, provided they are well latched on, get all the milk they need (Australian Breastfeeding Association, 2017). But there might be reasons why a newborn might be more sleepy and therefore need to be woken up for feeds.

This includes medical reasons, such as jaundice, infection or a heart problem, or perhaps because the pain relief used during birth is still affecting them (Australian Breastfeeding Association, 2017). If you're worried your baby might be sleeping too much and this is affecting their feeding, talk to your health visitor or call our Infant Feeding Support line on 0300 330 0700.
This page was last reviewed in March 2021
Further information

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

National Breastfeeding Line (government funded): 0300 100 0212.

Australian Breastfeeding Association. (2017) Do I need to wake my baby for feeds? Available at: https://www.breastfeeding.asn.au/bfinfo/do-i-need-wake-my-baby-feeds [Accessed 20 March 2021].

Ballard O, Morrow AL. (2013) Human milk composition: nutrients and bioactive factors. Pediatric Clinics of North America. 60(1):49-74. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/ [Accessed 20 March 2021].

Crenshaw J. Care practice #6: No separation of mother and baby, with unlimited opportunities for breastfeeding. Journal of Perinatal Education2007;16(3):39-43. Available at: doi:  10.1624/105812407X217147 (Accessed 26 Apr 21)

Daly SEJ, Hartmann PE (1995). Infant Demand and Milk Supply. Part 1: Infant Demand and Milk Production in Lactating Women. Journal of Human Lactation. 11(1):21-26. doi:10.1177/089033449501100119 Available at https://journals.sagepub.com/doi/10.1177/089033449501100119 [Accessed 13 April 2021]

Entwistle FM. (2013) The evidence and rationale for the UNICEF UK Baby Friendly Initiative standards. UNICEF UK. Available at: https://www.unicef.org.uk/babyfriendly/about/evidence-and-rationale-for-the-baby-friendly-standards/ [Accessed 20 March 2021].

Fallon A, Van der Putten D, Dring C, Moylett EH, Fealy G, Devane D. (2016) Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding. Cochrane Database of Systematic Reviews. (9):CD009067. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009067.pub3/full [Accessed 20 March 2021].

Kent JC, Prime DK, Garbin CP. (2012) Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41(1):114-121. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1552-6909.2011.01313.x [Accessed 20 March 2021].

Leurer MD, Misskey E. (2015) "Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers. International Breastfeeding Journal. 10(10):2-11. Available at: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0036-7 [Accessed 20th March 2021].

NHS. (2019a) Breastfeeding: the first few days. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-first-days.aspx#building [Accessed 20 March 2021].

NHS. (2019b) Breastfeeding: is my baby getting enough milk? Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-is-baby-getting-enough-milk.aspx [Accessed 20 March 2021].

NHS. (2020) Your breastfeeding questions answered. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx [Accessed 20 March 2021].

NICE (2015) Postnatal care up to 8 weeks after birth. CG37. Available at: https://www.nice.org.uk/guidance/cg37 [Accessed 20 March 2021].

UNICEF. (2010) Baby Friendly Initiative. Breastfeeding checklist for mothers - How can I tell that breastfeeding is going well? Available at: https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2016/10/mothers_breastfeeding_checklist.pdf [Accessed 20 March 2021].

World Health Organization. (1998) Evidence for the Ten Steps to Successful Breastfeeding. Geneva: World Health Organization.

World Health Organization. (2009) Session 2 The physiological basis of breastfeeding. In: Infant and Young Child Feeding. Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Available at: https://www.ncbi.nlm.nih.gov/books/NBK148970/ [Accessed 20th March 2021].
Further reading
Hoddinott P, Craig, LCA, Britten J, McInnes RJ. (2012) A serial qualitative interview study of infant feeding experiences: idealism meets realism. BMJ Open 2:1-14. Available at: https://bmjopen.bmj.com/content/2/2/e000504 [Accessed 20 March 2021].

Martin CR, Ling PR, Blackburn GL. (2016) Review of infant feeding: key features of breast milk and infant formula. Nutrients, 8(5):279. Available at:   https://www.mdpi.com/2072-6643/8/5/279 [Accessed 20th March 2021].

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How often should I breastfeed my baby? | Baby & toddler, Feeding articles & support | NCT

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Read our tips on when to breastfeed your baby and how much milk they need.

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Sore nipples can be a sign that attachment isn't effective. This link highlights causes, prevention and ways to help.

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Some women get sore, cracked or painful nipples in the early days of breastfeeding.

Sore nipples are the most common breastfeeding complication and the most common reason women give up breastfeeding (NHS, 2019a). With a little breastfeeding support this can often easily be rectified.

What causes sore nipples when breastfeeding?

Some women find their nipples get very sore a few days after they begin breastfeeding their baby.

This usually happens if your baby isn't positioned or attached well at the breast. If a baby only sucks the nipple rather than taking a good mouthful of breast, then their tongue or roof of the mouth may rub on the nipple. This causes nipples to get sore quickly and might cause nipple cracking (NHS, 2019a).

What can help sore nipples?

Breastfeeding shouldn't be painful, so it's important to get breastfeeding support right from the start (NHS, 2019a). Breastfeeding support should be offered by a midwife before you leave the hospital or birth centre. They can help you to position and attach your baby to your breast, and explain the signs that your baby is feeding well (NHS, 2019a).

If your nipples are getting sore but you're already home, it's a good idea to ask for breastfeeding support from a midwife, health visitor or breastfeeding counsellor as soon as you start to notice a problem. They can watch you while you feed your baby and check your baby is positioned well and feeding effectively.

You might also be able to feel when your baby is well attached. Your nipple should rest comfortably against the soft palate at the back of their mouth. If the nipple is nearer to the front of their mouth, your baby might be poorly attached. This can cause pinching of your nipple against the hard palate, which can cause pain.

You can check with your local NCT group what local breastfeeding support might be available. You may be able to drop in to a breastfeeding group for support or you might be able to have an NCT breastfeeding counsellor visit you at home. You can call the NCT support line for practical and emotional support on 0300 330 0700.

Your midwife, health visitor or breastfeeding counsellor might be able to help identify any other underlying issues (NHS, 2019a). Read on to find out more...

What other less common causes of sore nipples are there?

Engorgement

When breasts become full of milk, they might become sore (Breastfeeding Basics, 2015). This can happen when your breastmilk first comes in.

Feed your baby as often as they would like and for as long as they like. You can also try using a warm heat pack or having a warm shower before feeding or expressing milk, or use cold packs after feeding for pain relief (NICE, 2017).

Flat or inverted nipples

Nipples come in all sorts of sizes and shapes. While most protrude, some are flat or inverted.

These differences don't usually affect your ability to breastfeed. Yet if one or both nipples are flat or inverted, you might find it takes you a bit longer to get breastfeeding established. It can help to get extra support with positioning and attachment.

Various techniques and devices have been suggested to help 'draw out' inverted nipples but it's uncertain how effective they are. Things that can help include stimulating the nipple before feeding, holding the breast while baby is latching on, or using an exaggerated latch position (La Leche League, 2016a). Here's a video showing you how to get an exaggerated latch or 'flipple'.

Tongue tie

Tongue-tie is when the skin joining the underside of the baby's tongue to the floor of their mouth (frenulum) restricts how they can move their tongue. This causes difficulty in latching, which can result in sore nipples.

Other symptoms of tongue tie include: your baby having difficulty latching or staying latched onto the breast; nipples becoming squashed in your baby's mouth; feeding very frequently or for a long time; slow weight gain; or making a clicking sound while feeding. Some parents notice that their baby has difficulty moving their tongue from side to side or sticking out their tongue.

If you're experiencing breastfeeding difficulties and you think your baby might have tongue-tie, speak to your health visitor and you could ask to be referred to a local tongue-tie practitioner. If your baby has tongue-tie, they might suggest dividing your baby's frenulum, which involves cutting the piece of skin; it's a quick, simple, painless procedure and can immediately improve feeding (NICE, 2017). You can find an independent tongue-tie practitioner here.

Thrush (candida) infection

Breast or nipple pain can sometimes be caused by a thrush infection. Candida can infect your nipples if they become cracked or damaged.

Babies who are breastfed can also develop thrush in their mouth. This is likely to be the cause if you have severe pain in both breasts for up to an hour after breastfeeding, despite weeks of pain-free breastfeeding (NHS, 2018).

Symptoms in the mum

Feeling new pain in or behind the nipples or through the breast after feeds. Pain can be described as shooting or pins-and-needles pain. Pain can last for several hours after a feed.

It's unlikely to be thrush if it's only in one breast, accompanied by fever or a red/dark patch on the breast (NHS, 2018).

Symptoms in the baby

Unsettled during feeds, white film on lips, and white spots in their mouth, which don't come off if rubbed; persistent nappy rash (NHS, 2018).

Treatment

If you think you have thrush, see your GP. They can prescribe cream to treat you and your baby. It's important that both mum and baby are treated for thrush because it is very easily transmitted from one to the other. Other members of the family might need to be treated too (NHS, 2018).

It's recommended that you wash and sterilise several times any bottle teats, dummies or anything else that has been in baby's mouth. It's also best not to use any expressed milk from when you had thrush because it might be contaminated with thrush (NHS, 2018).

Mastitis

Mastitis is an inflammation of the breast caused by uncleared blocked ducts or an infection, that often causes the breast to become darker or red (depending on skin colour) and inflamed. See our article on mastitis for more information on symptoms and treatment. Continue to feed your baby and make sure they are attached well to the breast.

Mastitis can lead to a breast abscess (collection of pus), which might need draining, so you may want to see your GP to discuss antibiotics (NHS, 2019b).

Nipple vasospasm

Sometimes painful and sore nipples can be caused by nipple vasospasm, where blood flow is restricted to the area. This can be triggered if a baby's latch is shallow and can also be connected to Raynaud's phenomenon (a condition affecting blood supply) (Breastfeeding Support, 2018).

Some mums' nipples look white (blanched) after a feed and they may experience a deep pain or burning sensation. If this is the case, avoid exposing your nipples to the cold, wear warm clothing and breastfeed in a warm environment (NICE, 2017).

Should I limit my baby's time at the breast to avoid sore nipples?

Limiting your baby's time at the breast is likely to decrease your milk supply. Continue breastfeeding if you can and get breastfeeding support to help you solve any issues like a poor latch or attachment (NICE, 2017).

What are nipple shields or breast shells and can they help?

Nipple shields are thin, protective covers worn over the nipple while breastfeeding. Breast shells are hard, protective covers worn inside the bra.

The use of nipple shields is controversial. They can reduce milk transfer but their use can help women to continue breastfeeding (McKechnie and Eglash, 2010).

For some women and babies, nipple shields can help to establish breastfeeding and make it more comfortable. They might also compensate for immature feeding behaviour in premature babies. On the other hand, they might reduce milk supply, leading to premature weaning from the breast. Babies can also become reliant on them, not wanting to feed without (Chow et al, 2015).

Nipple shields, while effective in helping some women to continue breastfeeding, do not correct the underlying problem (a poor latch). So skilled help is recommended for sore nipples and for women using nipple shields (La Leche League, 2016b).

Breastfeeding support can help you identify and solve any breastfeeding issues (NICE, 2017; NHS, 2019).

Treatment of sore nipples

Early breastfeeding support can help make sure your baby is positioned and attached well. Some women treat nipple cracks with nipple cream, but the evidence for this is inconclusive. You might wish to consider expressing breast milk if your nipples are very sore or cracked.

Getting sore nipples from breastfeeding suggests that it could be helpful to get support with the positioning and latching of your baby from an appropriately trained person (NHS, 2019a).

For more information, read our article on self-help tips for sore nipples.

Further information

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

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

Best Beginnings - Bump to Breastfeeding DVD Chapter 7 'Overcoming Challenges'.

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

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

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A useful page from NCT on different feeding positions to try and find out what works for you.  The page also has links to all aspects of feeding from birth to 24 months.

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

Breastfeeding positions for newborns

When you first start breastfeeding your newborn, they will not be able to hold themselves in a good position. So you'll have to maintain a comfortable position for both of you for quite long periods. It takes time for your baby to develop the muscles and skills to feed effectively.
Our video has some great tips on different ways to hold your baby.
If you're having problems breastfeeding, or with latching or attachment, do call our infant feeding support line on 0300 330 0700 to talk to a breastfeeding counsellor. Your midwife or health visitor can also signpost you to your nearest breastfeeding support group.

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

Here's how to get started...

Preparing to feed

Whichever nursing positions you use, your baby will feed better if they're calm and you're comfortable. Holding them against you, talking to them or perhaps wrapping them securely in a towel or shawl might help if they need to be calmed. Or they might want to have their hands free to touch and stroke your breast.

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

Laid-back, relaxing position

Sitting in a chair

Underarm or rugby ball

Lying down

Breastfeeding positions for a fast milk flow

If you have a fast milk flow, this could be due to a large supply of breast milk. Some mums who have a fast milk flow worry their baby might have reflux if they're having problems, but it could be that their baby needs more control when they're feeding. If this is the case, laid-back feeding could be useful as it helps your baby to attach better and pull back if they need to take a break.

Breastfeeding your baby as they get heavier

As your baby grows, they become more active in getting themselves into position, as well as being larger and heavier. You might need to adjust you and your baby's position to continue to feed comfortably and effectively.

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

Breastfeeding position tips

Whichever breastfeeding position you choose, remember...

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

Tuck your baby in closely to you.

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

Make sure your baby is facing your nipple - they shouldn't have to turn their head.

Using cushions, special breastfeeding pillows and other supports might help in the early days, but you might be equally comfortable without them.

(UNICEF Baby Friendly Initiative and Public Health England, 2015)

Many women take a while to get used to holding their baby comfortably. Trying different positions can help you find the ones that work best for you and your baby.
Page last reviewed: November 2019
Further information

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

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

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

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

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Breastfeeding positions: which are best for you?

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

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What to look out for, prevention, how to self-manage and when to get help.

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Some parents find these positions helpful.

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An article about your rights as a breastfeeding mother in the workplace.

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Can I continue breastfeeding when I return to work?

Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to.

How you do this will depend on your individual circumstances. Some mums might arrange their baby's childcare close to their work or place of study. They can then visit them to breastfeed when they can during the working day (NHS, 2018). Alternatively, your partner, childminder, friend or relative might bring your baby to your workplace so you can breastfeed them.

Some mums express milk during working hours to maintain their milk supply and so that their baby can be fed this expressed milk from a bottle while they're at work (NHS, 2018). Some parents opt for mixed feeding, also called combination feeding. This means continuing to breastfeed and offering suitable alternative milk when you're not able to breastfeed.

What are my legal rights around breastfeeding at work?

Before returning to work, it helps to let your employer know in writing that you are breastfeeding (NHS, 2018; HSE 2018). They can then complete a risk assessment and consider whether there are any specific risks to you for as long as you are breastfeeding (ACAS, 2014; HSE 2018).

There are few direct risks to breastfeeding but you should seek advice if you work with dangerous substances, such as organic mercury (HSE 2018).

Employers are legally required to provide a space for mums who are breastfeeding to lie down and rest if they need to (ACAS, 2014; NHS, 2018).

There is no legal right, however, for your employer to provide breastfeeding breaks at work. But they must meet their obligations to employees who breastfeed under health and safety law, flexible working law and discrimination law. (Maternity Action, 2017) This means your employer should make sure you don't feel unfairly treated because you are breastfeeding.

Can I express milk for my baby at work?

You should be able to express milk at your workplace if you wish. You can request that your employer provides you with a suitable private space where you can do this.

Guidelines recommend that you have access to a private, clean and comfortable room with a lockable door - not a toilet - in which to express. However, there is no legal obligation for your employer to provide this space (HSE 2018).

It's also recommended that you have use of a fridge to store your breast milk. (HSE 2018).

Can I change my hours to suit breastfeeding?

You might find that you'd like to make changes to your hours or working pattern to accommodate breastfeeding and/or expressing. Some parents share parental leave, some new mums choose to return part-time and others change their working hours. Have a think about what might suit you best and discuss different options with your employer.

One thing that could support your case is outlining the many benefits of employing and supporting mums who breastfeed, including fewer absences from the workplace and greater staff retention (Maternity Action, 2014; Steurer, 2017). There is also a long-term public health impact of continued breastfeeding and workplaces should be encouraging women to breastfeed (Rojjanasrirat, 2010). You could ask your employer to read Maternity Action's employer leaflet about this.

Your options may be partly determined by your financial situation and how flexible your workplace is. There are lots of sources of support and information to help you with this, such as Maternity Action (see Further information below).

My employer is not supportive of breastfeeding, what should I do?

Your employer must not refuse to allow you access to training or stop you returning to work because you're breastfeeding. If they refuse to act to protect your health and safety, you may have a claim under the Equality Act and you should seek advice.

If you feel like you are being discriminated against in the workplace contact Maternity Action.

This page was last reviewed in February 2019

Further information

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

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

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

Maternity Rights Advice Line: 0808 802 0029.

Maternity Action is a UK charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children - from conception through to the child's early years.

Maternity Action's employer leaflet.

Health and Safety Executive information on breastfeeding and returning to work.

ACAS. (2014) Accommodating breastfeeding in the workplace. Available from: http://www.acas.org.uk/media/pdf/b/s/Acas-guide-on-accommodating-breastfeeding-in-the-workplace.pdf [Accessed 1st Oct 2017].

Borelli JL, Nelson SK, River SL, Birken SA, Moss-Racusin C (2017) Gender differences in work-family guilt in parents of young children. Sex Roles; 76(5-6): 356-368. Available from: https://link.springer.com/article/10.1007/s11199-016-0579-0. [Accessed 1st September 2017].

Gatrell CJ (2007) Secrets and lies: Breastfeeding and professional paid work. Soc Sci Med. 2007;65(2):393-404. Available from: http://www.sciencedirect.com/science/article/pii/S0277953607001487. [Accessed 1st September 2017].

HSE. The Health and Safety Executive Expectant Mothers - FAQs. Available from: http://www.hse.gov.uk/mothers/faqs.htm [Accessed 20 February 2019]

Maternity Action. (2014) Accommodating breastfeeding on return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/11/BORTW-employer-leaflet-FINAL.pdf [Accessed 1st Oct 2017].

Maternity Action. (2017) Continuing to breastfeed when you return to work. Available from: https://www.maternityaction.org.uk/wp-content/uploads/2014/03/Continuing-to-breastfeed-when-you-return-to-work-2017.pdf [Accessed 1st Oct 2017].

NHS Choices. (2018) Breastfeeding and going back to work. Available from: https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-back-to-work/ [Accessed 1st Oct 2017].

Rojjanasrirat W, Sousa VD (2010) Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA. J Clin Nurs. 2010;19(13-14):2014-2022. DOI 10.1111/j.1365-2702.2009.03152.x Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2009.03152.x/full [Accessed 1st September 2017].

Steurer LM (2017) Maternity Leave Length and Workplace Policies' Impact on the Sustainment of Breastfeeding. Public Health Nurs. 34(3):286-294. DOI: 10.1111/phn.12321. Available from: http://onlinelibrary.wiley.com/doi/10.1111/phn.12321/full [Accessed 1st September 2017].
Further reading
Dettwyler KA (2017) A Time to Wean: The Hominid Blueprint For the Natural Age of Weaning in Modern Human Populations. In: Dettwyler KA, Stuart-Macadam P Breastfeeding: Biocultural Perspectives. Chapter 6. Available from: https://books.google.co.uk/books?hl=en&lr=&id=_8s3DwAAQBAJ&oi=fnd&pg=PT56&dq=+benefits+of+breastfeeding+beyond+two+years&ots=KPM3VOOAYR&sig=F0157OTEF3SC2SzIOsTKKkDfg6E (Accessed 1st October 2017).

Grether T, Wiese BS (2016) Stay at home or go back to work? Antecedents and consequences of mothers' return to work after childbirth. Research perspectives on work and the transition to motherhood Soc Sci Med. 65(2): 105-128. Available from: https://link.springer.com/chapter/10.1007/978-3-319-41121-7_6 [Accessed 1st September 2017].

La Leche League GB. (2016) Working and Breastfeeding. Available from: https://www.laleche.org.uk/working-and-breastfeeding [Accessed 1st Oct 2017].

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Yes, of course. Lots of mums continue to breastfeed when they return to work or study. Depending on the age and nature of your baby, you can usually find ways to continue breastfeeding if you wish to. How you do this will depend on your individual circumstances.

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Information on NCT's postnatal services including early days, introduction of solids and baby massage and yoga.

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Having a baby is life-changing. Help yourself adjust and grow in confidence with an Early Days course. You’ll be guided by one of our highly experienced course leaders, meet other mums in the same boat, build a network of support and gain valuable knowledge, skills and insight.

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Signs, self help and treatments

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds.

Women describe the pain of thrush as severe, even excruciating. They dread feeds, even though they want to nurse their babies, and have real worries about how they will continue breastfeeding. Without appropriate help and support, many mothers give up breastfeeding before they are ready. The good news is that appropriate treatment can protect mother and baby from stopping breastfeeding before they are ready.

Signs and Symptoms
Research about thrush and its treatment
Eliminating other possibilities
Treatment
Hygiene
Diet
Supplements and complementary therapies
Thrush medication
Topical medication for the mother
Medication for baby
Applying ointments or creams
Oral medications
When treatment doesn't work as hoped
Eliminating thrush

Signs and symptoms

Symptoms of thrush in a baby
Your baby may have one or more of the following symptoms:

White patches inside his cheeks or on his tongue or gums. These look like left over milk. When wiped off they leave red sore areas which may bleed.

Your baby's mouth may be uncomfortable or painful, making him fussy during and between feeds. He may slip on and off the breast and may make a clicking sound.

Symptoms of thrush in a mother
Having two or more of these symptoms makes it more likely that thrush is involved, especially if these include shiny or flaking skin:

Burning nipple pain

Flaking skin on the nipple or areola

Shiny skin on the nipple or areola

A loss of colour in the nipple or areola

Painful breasts without tender spots or sore lumps

Stabbing pains in the breasts behind the areola.

Nipple thrush is more likely when:

A mother has thrush affecting any other part of her body - such as vaginal thrush.

Any other family member has a candida infection, for example athlete's foot, nappy rash or jock itch.

Mother or baby has been treated with antibiotics or corticosteroids, or mother takes the contraceptive pill.

Thrush is also associated with:
Research about thrush and its treatment

Researchers have conflicting views on the diagnosis and treatment of thrush. This is not helped by the fact that thrush can be associated with bacterial infection. It has been suggested that thrush cannot spread in milk ducts. However, some practitioners believe thrush may enter milk ducts by tracking back from skin at the nipple, causing stabbing pains in the front of the breast.

Eliminating other possibilities

Try adjusting your nursing position and your baby's latch-on before assuming pain is due to thrush. This is especially important if:

Breastfeeding has always been painful.

Your nipples are flattened, wedge-shaped or appear white after feeds.

An LLL Leader can help with this. Sudden onset of pain after a period of comfortable breastfeeding may suggest a thrush infection. Visiting your GP for a diagnosis is important as other skin diseases, including eczema, dermatitis, psoriasis, impetigo, herpes and bacterial infection can have similar symptoms to thrush. A mother may also experience breast pain for other reasons, e.g. engorgement, blocked ducts, mastitis, circulatory problems (Raynaud's syndrome) or if her baby is sucking incorrectly.

Treatment

With appropriate treatment, many women and babies overcome thrush and continue their nursing relationship. There are practical, effective steps you can take to combat thrush alongside any medication you use. Thrush spreads easily and spores linger on anything they touch ready to infect the next contact. Therefore, a fourfold approach to treatment may be needed:

Hygiene

Diet

Dietary supplements and complementary therapies

Medication.

Hygiene

Careful hand washing by all family members is essential, particularly after nappy changing or using the toilet. Wash your baby's hands too.

Keep a separate towel for each person in the family, or at least for you and your baby. Wash towels frequently at 60ºC. Or use paper towels for drying hands and dispose of them immediately.

Keep your nipples as dry as possible between feeds and, ideally, avoid breast pads. If you use breast pads choose disposable ones and wrap and dispose of them immediately after use, or wash re-usable ones immediately at a high temperature.

Wash anything that comes into contact with the affected area, immediately after use at a high temperature.

Wear a clean cotton bra every day and wash all clothes in hot water, at least 50ºC if possible. Hang in the sun to dry or dry them at a hot temperature. A hot iron can also kill yeasts.

Use sterilising fluid to regularly clean any items that could carry thrush: toys, pump equipment, bottles, teats, dummies. Or boil feeding and pump equipment for 20 minutes and replace teats and dummies weekly.

Replace toothbrushes, toiletries and cosmetics as they may have become infected.

Thrush cannot thrive in acidic conditions. Add 120 - 240ml (½ - 1 cup) distilled white vinegar to baths and in final rinses in washing machines.

Diet

When fighting any infection, eating a balanced diet and drinking enough water is a good idea. Limit sugar and other refined carbohydrates as they seem to make thrush symptoms worse. This can be a challenge as those with thrush often crave these foods. Many processed foods contain refined carbohydrates, so read food labels carefully. Note that fruits and juices contain sugar in the form of fruit sugar.

Some mothers have found that particular foods exacerbate their thrush and decide to limit them. These can include yeasty foods (such as bread, alcohol and mushrooms), dairy products or artificial sweeteners. If you decide to make major changes to your diet, you may find it helpful to consult a dietician.

Avoid giving your baby infant formula

Research has shown that bottle-fed babies are more likely to develop thrush.2 Although yeasts can grow in breastmilk, your breastmilk contains substances that help limit thrush growth. Formula, on the other hand, has high levels of added iron, which may encourage the growth of yeasts.

Avoid storing expressed milk

when you and your baby have a thrush infection. Freezing does not kill yeast cells so it's possible to reinfect your baby with thrush in stored milk.

Supplements and complementary therapies

Thrush is more common in mothers who are run down or under stress. Sweetened and processed foods are low in nutrients. So try to eat a varied diet of vitamin and mineral rich foods instead. Although scientific evidence is lacking, some mothers decide to try the following alongside prescribed medication:

Nutritional supplements from health food stores and chemists.

Therapies from registered homeopaths or naturopaths.

Altering the relative acidity (pH) of your nipple skin may reduce itching. Rinse your nipples with:

5 - 10 ml (1 - 2 tsp) of distilled white vinegar in 160 ml (1/4 pint) of water four times a day

Or 5 ml (1 tsp) of sodium bicarbonate in 240 ml (1 cup) of water once or twice a day Herbal products and essential oils should not be applied to your nipples, as it is not clear how safe they are for your baby.

Lactobacillus acidophilus tablets

Follow dosage on the packet until you are free of symptoms for 2 weeks

Grapefruit seed extract

250mg daily or 5 - 15 drops in 150 ml water 2 - 5 times daily

Garlic

3 triple strength deodorized tablets, 3 times daily

Zinc acetate or zinc gluconate

45mg daily

B vitamins

100 mg of each daily (avoid nutritional yeast)

Thrush medications

Prescribed medication

Complete the course of medication

Even if symptoms improve earlier, certain medication needs to be used for a particular period of time to clear the infection. Follow the guidelines provided with the specific medication or ask your doctor or pharmacist for more detailed guidance.

Treat both mum and baby

Thrush spreads easily, so both you and your baby need simultaneous treatment to avoid reinfecting one another - even if one of you is symptom free. Research has shown that mothers often test positive for thrush before symptoms appear.

Topical medications for the mother

When deciding whether to use medications you will want to weigh the potential benefit against the possible side effects. Treatment will depend on whether there is any inflammation or an associated bacterial infection. You can discuss this with your GP and health care team. You may find it helpful to share this page with your doctor. Doctors may prescribe one of the following creams or ointments when thrush is diagnosed. See Applying creams or ointments for information on application and oral treatment.

NYSTATIN

Nystatin

Some strains of thrush are becoming resistant to nystatin. Use for at least 14 days.

CLOTRIMAZOLE

Canestan

Risk of contact dermatitis. Clotrimazole is less effective for topical infections of the breasts than miconazole

NYSTATIN Tri-adcortyl Contains a corticosteroid. Used occasionally for persistent with triamcinolone

Tri-adcortyl

Contains a corticosteroid. Used occasionally for persistent with triamcinolone eczema-like inflammation associated with a thrush infection. Ask your doctor about safe use while breastfeeding.

Medications for baby

Treatments for thrush in a baby's mouth are in the form of liquids or gels. To work effectively, they need to be applied to all the nooks and crannies in a baby's mouth as directed by your doctor or pharmacist. Always wash your hands before and after application.

* MICONAZOLE (Daktarin Gel) is recommended as first-line treatment in children under two years.7 Due to risk of choking, manufacturers recommend it is not used for babies under 4 months of age and used only with care from 4 to 6 months. Divide each dose before applying and keep away from your baby's throat to avoid choking. If applying using a finger, keep your fingernails short.

* NYSTATIN (Nystan) oral suspension is recommended as the second-line of treatment where miconazole is ineffective or causes side-effects. The easiest way to apply this is to pour the correct dose onto a measuring spoon and apply with a dropper or swab. Discard the swab after use. If the dropper has been in contact with your baby's mouth, sterilise it before replacing in the bottle. Some strains of thrush are becoming resistant to nystatin.

Please note: Oral gel applied to your breast is unlikely to be effective; it has not been formulated for this use in this way, so will not have effective topical properties.

Applying ointments or creams

Unless your doctor states otherwise, creams (usually water-soluble) or ointments (usually oily) need to be applied after feeds several times a day for the recommended period of time and until you've been free of symptoms for at least two days. Take care to wash your hands before and after application. Wipe away any excess cream or ointment before nursing your baby. A water-soluble cream is more likely to have been absorbed by the skin. An oily ointment is best avoided as it may need removing with warm water and mild soap. Vigorous washing can cause further soreness.

* As you will be feeding your baby more often than you apply the medication, ask your doctor how often and how much to apply.
* You may find it helpful to use the cream after your baby nurses to sleep, especially if he is likely to sleep for a while.
* Resistant yeasts can replicate themselves every 30 minutes, so if thrush is persistent, ask your GP about applying the above medications in smaller more frequent doses while using the same amount in 24 hours.
* Be aware that symptoms may get worse as the thrush starts to die off, before you notice any improvement.
* Always taste a topical medication yourself as your baby will be tasting it. Some medications used for athletes foot (eg Timodine) are foul-tasting and should be avoided at all costs!

Oral treatments

Oral fluconazole (Diflucan) is usually only used when there is a definite diagnosis of thrush and topical treatments have been ineffective. A loading dose of 150-200mg followed by 100mg daily is required for up to 2 weeks. If things do not improve within this time, seek help for other causes. Although it is licensed to be given to babies in neonatal units, fluconazole is not licensed in the UK for use by breastfeeding mothers of babies under 6 months. It is only available for mothers of younger babies at the discretion of the GP.

When treatment doesn't work as hoped

Sometimes it can take time to find an effective treatment for your infection. If symptoms don't improve or get worse:
* Check for other sources of pain. An LLL Leader will be able to share information on other possible causes of nipple and breast pain.
* Check for possible sources of reinfection, especially if symptoms improved at the start of treatment. Treating any other candida infections in the family may help.
* Consider whether diet and hygiene need to be changed.

Let your doctor know if treatment was not effective or improved things only slightly:
* Another cream or ointment may be more effective if the diagnosis for thrush is certain.
* You and your doctor may need to investigate other possible causes of pain and skin changes.
* Other family members who have a candida infection may need treatment. In particular, if you have vaginal thrush, your partner may need treatment too.

If you are considering switching treatments, try the new preparation on just one side, while continuing on the other breast with the original treatment. You have two breasts so using them to experiment with treatments may help!

Eliminating thrush

It may take a little time and persistence to deal with a thrush infection and enjoy comfortable feeds once more. Sometimes it takes a little effort to find the right medication for your thrush. Many mothers have found using diet, hygiene, supplements and alternative therapies alongside any medication can make a great deal of difference and help prevent thrush returning.

Written by Sue Upstone and mothers of LLLGB

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
Nipple pain

References
1. Francis-Morrill, J. Diagnostic value of signs and symptoms of mammary candidosis among lactating women. J Hum Lact 2004; 20(3): 288-94.
2. da Costa Zöllner, MSA et al. Candida spp. occurrence in oral cavities of breast feeding infants and in their mothers' mouths and breasts. Pesqui Odontol Bras 2003;17(2): 151-5.
3. Francis Morrill, J et al. Risk factors for mammary candidosis among lactating women. JOGNN 2005; 34: 37-45.
4. Francis Morrill, J et al. Detecting Candida albicans in human milk. J Clin Microbiol 2003; 41(1): 475-478. 5. Wiener,
S. Diagnosis and management of Candida of the nipple and breast. J Midwifery Womens Health 2006; 51(2):125-8.
6. Chetwynd, EM et al. Fluconazole for postpartum candidal mastitis and infant thrush. J Hum Lact 2002; 18(2): 168-71.
7. http://www.nhs.uk/chq/Pages/2448.aspx
8. Brent, NB. Thrush in the breastfeeding dyad: results of a survey on diagnosis and treatment. Clin Pediatrics 2001; 40(9): 503-6.
9. Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
10. *Medications and Mothers' Milk. Hale, TW. TX: Hale publishing, 2010
11. Moorhead, AM et al. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeeding Review 2011; 19(3): 25-29.

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

Please note: Information is provided for educational purposes only. If you are concerned about your health, or that of your child, consult with your health care provider regarding the advisability of any opinions or recommendations with respect to your individual situation.

Copyright LLLGB 2016

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Thrush and Breastfeeding - La Leche League GB

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A breastfeeding mother with a thrush infection of the nipple, areola and/or breast can experience pain in these areas both during and between feeds. If a baby's mouth is infected it can be sore, making him fussy during feeds. Women describe the pain of thrush as severe, even excruciating.

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Information on ways to establish breastfeeding after a cesarean birth.

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During pregnancy your body is preparing to give birth and your breasts are getting ready to feed your baby. If you are told you need to have a caesarean birth you may wonder if you will still be able to breastfeed as you planned. Mothers successfully breastfeed after a caesarean birth and you can expect your healthcare professionals to support you with getting breastfeeding established straight away.

Whichever way we give birth, our bodies need time to recover and to adjust to feeding a new baby. Birth by caesarean usually means a longer hospital stay, and a longer recovery time because this is major abdominal surgery so practical support from friends and family can make a big difference to you.

Before the birth
Common concerns
A good start for breastfeeding
Practical help and support

Before the birth

Whichever way you will be giving birth, find out as much as you can beforehand about labour and breastfeeding. Whilst some aspects will be out of your control, choosing your place of birth and your caregiver can reduce your chance of a caesarean.

An induced birth can lead to more interventions, increasing the chance you'll need a caesarean.

Continuous support during labour from a woman you feel comfortable with and trust can reduce the risk of a caesarean birth.

Simple things like eating and drinking, moving around and relaxation can improve your experience of labour.

Tell hospital staff beforehand that you plan to breastfeed and to emphasise:

You want to keep your baby with you, provided neither of you needs special care.

You don't want your baby to be given bottles or dummies without your permission, because this will interfere with breastfeeding.

An unplanned caesarean
A caesarean after a long or difficult labour can leave you feeling extremely tired and frustrated. However the hormones released during labour have already prepared you and your baby for breastfeeding.

A planned caesarean
Knowing in advance that you will be having your baby by caesarean can let you prepare, both emotionally and practically. When possible, going into labour first can help get breastfeeding off to an easier start. If you have had a previous caesarean, it is not always necessary to have one the next time. Discuss your options with your health professionals.

After an caesarean
Whether or not your caesarean was planned, you may still feel upset or sad about what happened and mourn the loss of the birth experience you were hoping for. It is quite understandable to feel this way and these feelings may affect the way you feel about your baby and breastfeeding at first.

Breastfeeding can give you confidence in your body's abilities. When you breastfeed, your baby needs you. The close physical contact can also help you to feel better emotionally. Breastfeeding helps your womb to contract, which will help you heal more quickly. And it's nature's way of ensuring you spend time sitting or lying down, resting and recovering.

Common concerns

IVs or drips
To make holding and feeding your baby easier, ask that your IV drip be inserted into your forearm, rather than in the back of your hand (and without the supporting board if one is used). You can request that your catheter be inserted after your spinal anaesthetic has taken effect, to make the procedure more comfortable.

The extra fluid from an IV can increase engorgement. Before breastfeeding, you can easy any swelling back by pressing your fingers around the nipple area (reverse pressure softening) and see Engorged Breasts-Avoiding and Treating for suggestions.

IV fluid will also transfer to your baby. This can lead to an artificially high brith weight which may result in a higher percentage weight loss in the early days. Weighing your baby at 24 hours old may give a more accurate baseline weight.

Anaesthetic
Any anaesthetic in your system will not be harmful to your baby. However the anaesthetic may make your baby very sleepy during the first few days-you may have to wake them up and encourage them to nurse. Keep them close and offer the breast whenever they stir.

Antibiotics and pain relief
Pain relief and antibiotics are routinely given after a caesarean. Pain relief will be essential to help you through the early days. Over the counter pain medications, such as paracetamol and ibuprofen, are considered safe for breastfeeding. If you need something stronger, then discuss this with your health care team, who can check which drugs are compatible with breastfeeding. You may need further antibiotics, but be aware that these increase the risk of a thrush infection for you and your baby.

A good start for breastfeeding

Express your milk
Separation or feeding problems are more likely if your baby is born early, if you have an induced birth, or if you have a health problem such as diabetes. It can be very helpful to express and store colostrum before the birth so that your milk will be available for your baby if separation occurs. See Antenatal Expression of Colostrum.

If your baby is a bit sleepy at first you can hand express drops of colostrum and give it on a spoon. You partner could help with this.

It can sometimes take a little longer to have a plentiful milk supply after a caesarean birth. Hand expressing frequently will encourage this process. If you baby needs a supplement offer it with a spoon, syringe, feeding cup or supplementer.

Breastfeed as soon as possible
You can breastfeed as soon as you are alert enough to hold your baby, in the recovery room or even on the delivery table. At this stage you will be free from pain as the anaesthetic will not have worn off. Although you may be lying flat on your back and may need some help positioning your baby, you don't need to be sitting up to breastfeed. Simply lying there, skin-to-skin is enough to prompt a baby to nuzzle onto your breast themself. If you are drowsy your partner can help by holding your baby close to you.

Skin-to-skin contact with your baby
It's important and never too late, to enjoy skin-to-skin contact with your baby. Tuck a blanket over both of you to keep warm. Skin-to-skin

Encourages your baby to latch on and feed frequently.

Helps colonise your baby's skin with your own individual 'good' bacteria.

Calms your baby and regulates their temperature.

Encourages bonding.

If your need for medical care prevents this happening straight away, your birth partner can step in. Babies still benefit from sking-to-skin contact even when they can't be with you.

Get comfortable for breastfeeds
Getting your baby attached well at the breast helps them to feed effectively and helps prevent nipple damage. Lying down, laid back or using the underarm position may be easiest at first. Use extra pillows for support and comfort-behind your back, under your arms or between your knees. A rolled up towel or small pillow can cover and protect your incision. . See Positioning & Attachment for tips. Be aware that pain relief can mask pain during breastfeeding. If your nipples are squashed or flattened after feeds, or look sore or damaged, seek help without delay.

Baby feeding cues
Mothers often find they need help responding to their babies' early feeding cues. If you feel groggy after birth, it helps if the people supporting you are aware of the signs your baby needs to feed. These include, in increasing urgency:

Opening their mouth, making sucking motions and turning their head (rooting) looking for the nipple.

Moving their tongue.

Furrowing their eyebrows-perhaps showing tension in their face.

Clenching and unclenching their fists.

Flexing their arms.

Moving their hands to their mouth.

Followed by restless movement.

Then crying-the last resort.

Practical help and support

It is useful to check hospital policies on visitors, so you can arrange as much help as possible. Even in hospital, it will be much easier with your partner, family member or friend to help you care for your baby. If you are on your own, ring for help from hospital staff when you need it.

Once at home, extra help will be essential. You will be recovering from major abdominal surgery and need to rest, recover and concentrate on nursing your baby. You may be advised not to drive for about six weeks. Organise as much help as possible with meals, laundry and essential housework, and with caring for any older children. Drink enough fluids to keep your urine pale, and eat a balanced diet. Simple meals will be easier to prepare.

See Supporting a Breastfeeding Mother and Adjusting to Motherhood include practical tips on making life easier after birth.

Support for breastfeeding
Try to contact an LLL Leader, attend an LLL meeting or join an LLL Facebook group before your baby arrives to establish your support network. The LLL Leaders and other mothers will be able to give you ongoing support and enouragement, along with useful practical ideas. You can find your local LLL group here.

Written by Sara Walters, Karen Butler, Sue Upstone, Bronwyn Davies and mothers of LLLGB.

Further Reading
The Womanly Art of Breastfeeding. LLLI. London: Pinter & Martin, 2010.
NICE Clinical Guidance: Caesarean Section. www.nice.org.uk/guidance/ng192

Antenatal Expression of Colostrum
Birth and Breastfeeding
Beginning Breastfeeding
Comfortable Breastfeeding
Engorged Breasts - Avoiding and Treating
Hand Expression of Breastmilk
My Baby Won't Breastfeed
Positioning and Attachment
Sleepy Baby - Why and What to do
Supporting a Breastfeeding Mother
Treating Thrush

References
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.
Impacts of Birthing Practices on Breastfeeding 2nd edition, Smith, LJ. Jones and Bartlett Publishers, 2010.

You can buy this information in a printed leaflet from the LLLGB Shop here

Updated March 2022

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Caesarean Birth and Breastfeeding - La Leche League GB

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A quick guide on formula and how to respond to your baby's cues if you decide to bottle feed.

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Frequently asked questions about tongue tie and how it can be treated.

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Skip to main content

Read more for support for parents on tongue-tie

Many babies have a piece of membrane under their tongue (the frenulum) which does not usually cause problems. Tongue-tie (ankyloglossia) occurs when the frenulum is abnormally short, stopping the tip of the tongue from protruding beyond the lower gum. This may cause problems with feeding as a result of the inability to move the tongue in a normal way and therefore attach and suck effectively. The frenulum may reach the tip of the tongue and be easily seen, and may be either thin and stretchy or thicker/tighter. A posterior frenulum, which is at the back of the tongue, can be less easy to see and in some cases may only be felt. If you and/or your baby are experiencing feeding difficulties, an assessment of your baby's tongue function and a feeding assessment by a specially trained professional will determine whether a division of the membrane ( frenulotomy) could help.

Many tongue-ties are asymptomatic and do not require treatment, and some may resolve spontaneously over time. In some instances, support to improve attachment is all that is needed. However, if the condition is causing problems with feeding, surgical division of the lingual frenulum can be recommended and carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding.
NICE has approved the division of tongue-tie.

FIND OUT MORE

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Information for parents and health professionals on identifying and managing tongue tie, and other useful resources on the condition.

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BFN Drugs in breastmilk information page

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BFN Drugs in breastmilk information page

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This facebook page is run by the breastfeeding network and a trained pharmacist who can provide evidence based information on medication and alcohol while breastfeeding.

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Being a pharmacist, as well as a feeding mum and peer supporter, I often get questions around medica... tion use. Wendy has given me information and answers to questions that I have posed. I recommend this service to everyone that I come across on a personal and professional basis ��

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The Breastfeeding Network Drugs in Breastmilk information service

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Being a pharmacist, as well as a feeding mum and peer supporter, I often get questions around medica... tion use. Wendy has given me information and answers to questions that I have posed. I recommend this service to everyone that I come across on a personal and professional basis ��

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If you decide to use a bottle to feed it is important to sterilise the bottle effectively. This guide from the NHS looks at the different methods available.

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It's important to sterilise all your baby's feeding equipment, including bottles and teats, until they are at least 12 months old.
This will protect your baby against infections, in particular diarrhoea and vomiting.

Before sterilising, you need to:

Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.

Use a clean bottle brush to clean bottles (only use this brush for cleaning bottles), and a small teat brush to clean the inside of teats. You can also turn teats inside out then wash them in hot soapy water. Do not use salt to clean teats, as this can be dangerous for your baby.

You can put your baby's feeding equipment in the dishwasher to clean it if you prefer. Putting feeding equipment through the dishwasher will clean it but it does not sterilise it. Make sure bottles, lids and teats are facing downwards. You may prefer to wash teats separately by hand to make sure they are completely clean.

Rinse all your equipment in clean, cold running water before sterilising.

The advice above applies to all your baby's feeding equipment, and whether you are using expressed breast milk or formula milk.

How to sterilise baby feeding equipment

There are several ways you can sterilise your baby's feeding equipment. These include:

cold water sterilising solution

steam sterilising

boiling

Cold water sterilising solution

Follow the manufacturer's instructions.

Leave feeding equipment in the sterilising solution for at least 30 minutes.

Change the sterilising solution every 24 hours.

Make sure there are no air bubbles trapped in the bottles or teats when putting them in the sterilising solution.

Your steriliser should have a floating cover or a plunger to keep all the equipment under the solution.

Steam sterilising (electric steriliser or microwave)

It's important to follow the manufacturer's instructions, as there are several different types of sterilisers.

Make sure the openings of the bottles and teats are facing downwards in the steriliser.

Manufacturers will give guidelines on how long you can leave equipment in the steriliser before it needs to be sterilised again.

Sterilising by boiling

Make sure the items you want to sterilise in this way are safe to boil.

Boil the feeding equipment in a large pan of water for at least 10 minutes, making sure it all stays under the surface.

Set a timer so you do not forget to turn the heat off.

Remember that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.

After you've finished sterilising

It's best to leave bottles and teats in the steriliser or pan until you need them.

If you do take them out, put the teats and lids on the bottles straightaway.

Wash and dry your hands before handling sterilised equipment. Better still, use some sterile tongs.

Assemble the bottles on a clean, disinfected surface or the upturned lid of the steriliser.

Find out more about expressing breast milk and how to make up formula feeds.

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It's important to sterilise all your baby's feeding equipment, including bottles and teats, until they are at least 12 months old. This will protect your baby against infections, in particular diarrhoea and vomiting. Before sterilising, you need to: Clean bottles, teats and other feeding equipment in hot, soapy water as soon as possible after feeds.

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The twins trust is an organisation that supports and works with parents of multiple babies

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We rely on the generosity of our members and supporters to fund our work. Every penny we receive goes to wherever the need is greatest.

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The exaggerated latch or "Flipple" technique 

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The exaggerated latch or "Flipple" technique 

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A link to a video which demonstrates techniques to encourage your baby to latch on.

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How to latch a baby using the exaggerated latch technique.