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Advice on how to responsively bottle feed your baby

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For any questions or concerns about infant feeding please email:

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huh-tr.homertoninfantfeeding@nhs.net

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City & Hackney Infant Feeding flyer April 2026

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Sign up for our online infant feeding classes where members of the Homerton Infant Feeding Team will talk you through all aspects of infant feeding and answer any questions you may have.
Homerton Antenatal Infant Feeding Class Tickets, Multiple Dates | Eventbrite

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Infant Feeding Antenatal Class (revised May 2022)

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Homerton Essential guide to feeding and caring for your baby - pdf 2026

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NHS important information on feeding your baby

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NHS important information on feeding your baby

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You may decide to have a go at hand expressing colostrum towards the end of your pregnancy (we recommend from 36 weeks pregnant).

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This technique involves expressing colostrum in the final few weeks of pregnancy. It can also be referred to as 'colostrum harvesting' and is advocated by some NHS Trusts.

Mothers are normally advised to wait until around 36 weeks before starting antenatal expression. Mums who are having multiple births may sometimes start sooner as giving birth earlier is more likely.
Why do it?
For some mothers, it can be a useful tool that helps ensure their baby will start life without the need for formula supplementation. The importance of exclusive breastfeeding for all babies has been well-established by scientific research.

Colostrum contains vital immunological properties and helps to colonise the baby's gut with healthy bacteria that protect against allergy and disease.

It also contains the perfect balance of proteins, fats and micronutrients needed for human babies as well as acting as a laxative to help the passing of the first tarry meconium stools.

Some babies may experience difficulties with feeding or maintaining their blood sugar levels during the first few days after birth and therefore may require supplementary feeds.

These include babies:

whose mother had diabetes in pregnancy or who has a history of diabetes.

with a cleft lip or palate identified during pregnancy.

with congenital conditions e.g. Down syndrome or cardiac complications.

diagnosed with intrauterine growth restriction.

whose mother is taking beta blockers to control high blood pressure.

who are twins or triplets.

Where there is a family history of cow's milk protein sensitivity or type 1 diabetes, families may be particularly keen to avoid the use of early formula supplementation.

Some women may need to consider supplementing feeds from an early stage if there are concerns over their ability to make and/or secrete milk.

These include women:

who have a breast hypoplasia (limited breast development).

who have had previous breast surgery.

It is important for a mother to discuss her plans to express antenatally with her healthcare provider. It may not be recommended if you've been at risk of preterm labour in previous pregnancies, or have a surgical stitch, for example.

It is recommended to express antenatally by hand rather than use an electric or manual breast pump. Colostrum will be produced in quite small quantities and can easily stick to the bottles or pump parts and be harder to collect. A pump at this stage is likely to be more uncomfortable than gentle hands. Try hand expressing for a few minutes, 2 or 3 times a day.

If you hand express and use a syringe to draw up the individual drips of colostrum, you can use these syringes for storage prior to birth. Your health care provider may be able to supply you with sterile syringes.
How to hand express:

Always wash your hands before expressing.

Applying a warm compress to your breast or expressing after a warm bath or shower can help the flow of colostrum.

Get yourself comfortable. Perhaps seated and leaning slightly forward but find what works best for you.

Start with a gentle breast massage, stroking from the back of your breast towards the nipple to encourage the let-down reflex.

Put your thumb above the nipple and your first few fingers below the nipple. You will be cupping the breast in a 'C' shape.

With your thumb and fingers, feel a few centimetres back from the nipple.

Press back towards your chest, then compress (press your fingers together), and release.

Repeat this process, building up a rhythm. Press, compress, release.

It may be useful to look online for videos of hand expression techniques.

Colostrum should start to arrive drop by drop. Initially it may just be a glisten on the end of your nipple, and it may take a few days of practice before drops appear.

Collect the colostrum into a clean container, like a syringe (1ml or 2ml syringe). If nothing happens, adjust your finger position slightly to find the spot that works for you. Try not to pinch your nipple or slide your fingers uncomfortably over the skin.

Rotate the position of your fingers and thumb around the areola (imagine a clock face) and repeat the expressing process to stimulate and remove colostrum from different parts of your breast.

Express each breast twice during each session.

Colostrum can vary in appearance. Sometimes it may appear quite thick and yellow or orange and at other times paler and thinner. Expressing colostrum antenatally will not decrease or increase your milk supply after baby is born.
Storage of human breast milk
Colostrum can be collected two to three times each day in the same syringe. You will need to store the syringe in the fridge between uses.

At the end of the collecting day, the colostrum can be frozen - place the syringe into a zip-lock bag before putting into the freezer. Label the syringe and bag (separately) with the date and time of when you expressed.

The frozen colostrum can be stored for up to six months in the freezer. Once thawed, it should be used within 24 hours.
Is it safe?
The oxytocin hormone released when expressing, stimulates the uterus. Opinions differ on whether expressing colostrum antenatally is likely to induce labour. Those who advocate it do not believe that expressing would constitute sufficient stimulation to start labour. Sex while pregnant and breastfeeding through pregnancy both release oxytocin and both are generally considered safe while pregnant. If you experience any cramping in your uterus however, you should stop expressing and discuss your choice with your healthcare provider.
Transporting your frozen colostrum
You can take syringes of frozen colostrum into hospital using a freezer block and insulated bag. The colostrum can be defrosted under a running warm tap or at room temperature.

It's a good idea to mention your colostrum stores on your birth plan and make sure staff are aware in advance of your wishes in certain situations. The hospital may have access to a freezer for storage once you arrive.

After the birth, breastfeeding should usually be unrestricted. Ideally, a baby should feed successfully at the breast and the antenatally expressed colostrum would remain unused.

If your baby is experiencing difficulties with breastfeeding at this time, you may be encouraged to express some fresh colostrum to give to your baby. You may also use any colostrum you have brought into hospital with you in preference to using any formula.

If harvested colostrum ends up being 'wasted' because you are able to establish early exclusive breastfeeding, this is a cause for celebration rather than commiseration!

The process of antenatal expressing however, gives you a back-up if things don't go to plan which many families find reassuring. You'll also start your breastfeeding with a good sense of how to hand express and confidence about how your breasts work.

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Expressing your milk before your baby arrives - ABM

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Antenatal expressing is expressing colostrum in the final few weeks of pregnancy. Find out if it could be a useful tool for you.

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Hackney timetable General - updated April 2026

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City and Hackney Enhanced Health Visting Services April 2026

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Come along to one of the four breastfeeding drop-ins run by NCT in Hackney

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Hackney infant feeding peer support and parenting courses | About us | NCT

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Infant Feeding peer support in the community and hospital and Empowering Parents Empowering Communities parenting courses coming soon to Hackney.

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Need to talk? Call the NCT Infant Feeding Support Line on 0300 330 0700

Open everyday from 8:00am to midnight

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0300 100 0212

24 hours a day every day

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National Breastfeeding Helpline - Helpline

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Friendly breastfeeding support from pregnancy onwards

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Friendly breastfeeding support from pregnancy onward.

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Impartial, evidence-based information on different types of infant formula

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First Steps Nutrition Trust is an independent public health nutrition charity. We endeavour to fill practical and policy-relevant information gaps and provide resources for health workers supporting eating well from pre-conception to five years.

Our Mission

To influence policies which enable the safe, appropriate and optimal feeding of infants and young children in the UK, and to protect them from commercial interest.

To ensure that the importance of good nutrition from pre-conception to age five remains on everyone's agenda.

To provide conflict of interest-free information on infant milks marketed in the UK, and to promote better regulation and marketing of breastmilk substitutes.

To provide resources for health workers to support them in their work with pregnant women and young families.

Our Resources:

Are put together by nutrition experts and are regularly updated.

Can be used in Unicef UK Baby Friendly Initiative accredited settings.

Are available as free pdf downloads for use by anyone promoting better public health on a not-for profit basis.

Everyone who works at First Steps Nutrition Trust feels passionately about the need for better information and support for good nutrition - and good food - from pre-conception to five years.

First Steps Nutrition Trust is supported by generous individual donations and conflict of interest free grants. First Steps Nutrition Trust does not work with organisations or individuals that work with, or take funding from, the breastmilk substitute industry and we reserve the right not to sell them our subsidised resources.

First Steps works with and supports a number of organisations including Unicef UK Baby Friendly Initiative, the Baby Feeding Law Group, the Obesity Health Alliance, the Children's Food Campaign and the APPG on Infant Feeding and Inequalities.

First Steps Nutrition Trust host and regularly update their partner site infantmilkinfo.org which contains comprehensive information about infant milks (for 0-12 month olds) available on the UK market.

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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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Guide to bottle feeding including how to sterilise equipment

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Watch a 10 minute video on how to attach your baby at the breast.
Global Health Media has lots of other useful videos too.

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

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

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

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Try to respond to your baby's early feeding cues.
Crying is a late cue and you may need to calm your baby before you can feed them.

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A video and some written information about some of the amazing components of human breastmilk

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Recent News: Dutch researchers find Covid-19 antibodies in human milk

'We think when drinking the milk, the antibodies attach themselves to the surface of our mucous membranes,' Hans van Goudoever, head of the Emma children's hospital at the UMC, said. 'Then they attack the virus particles before they force their way into the body.' The UMC has now started a campaign to find 1,000 women who are willing to donate 100ml of breast milk for the research project. 'Women who may have had coronavirus without noticing it may also have made antibodies which can be found in milk,'

Here you'll find references and research supporting the information in the advert.

"Nature has been researching your milk for hundreds of millions of years"

"Your milk contains ingredients that kill cancerous cells"

"Your milk contains stem cells. These are cells that create and repair the body, and are being researched worldwide to cure conditions like Alzheimers and diabetes."

"Your body identifies bacteria and viruses found in your baby's body and environment. You then produce antibodies specifically tailored for those infections, and deliver them to your baby through your milk. The more milk she drinks, the more antibodies she receives."

"Your milk appears to switch on a gene in your baby's body, which produces a hormone called Leptin. This hormone tells your baby when his tummy is full, protecting him against over eating."

"Your milk contains Oxytocin, a hormone that induces relaxation, and feelings of well-being in your child and in you."

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The science of human milk and breastfeeding

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There are many benefits of breastfeeding for both mother and baby

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

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

breast milk protects your baby from infections and diseases

breastfeeding provides health benefits for you

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

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

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

Health benefits of breastfeeding for your baby

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

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

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

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

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

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

Health benefits of breastfeeding for you

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

Breastfeeding lowers your risk of:

Got a breastfeeding question?

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

Get Better Health: Start for Life

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

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

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Breastfeeding lowers the risk of Sudden Infant Death Syndrome. Find out what else you can do reduce risk.

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The safest cot is a clear cot

The safest cot for a baby is a clear cot. That means removing anything that isn't essential. Babies need just two items in their cot:

It's important to remove anything that isn't essential because items such as toys, blankets and bumpers could cover their face and obstruct their breathing.

When preparing your baby's sleep space, remember:

No pillows or duvets

No cot bumpers

No soft toys or comforters

No weighted or bulky bedding

No products designed to keep your baby in one sleeping position, such as wedges or straps

No pods or nests, rolled up towels or anything soft placed on top of the mattress.

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Safer sleep overview - The Lullaby Trust

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

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Things to remember when bed sharing

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An app to help you with your infant sleeping decisions

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The Infant Sleep Info website is full of helpful sleep info for parents and health practitioners, but it can be hard to read on a mobile device, especially a smart phone.

The *NEW 2017* Infant Sleep Info App provides key information from the Basis website in a handy format for mobile devices. Covering normal sleep development, sleep location and sleep safety the familiar info from the website is delivered in smaller chunks. Two features are exclusive to the app

A bed-sharing decision tool guides parents through the key considerations for safe bed-sharing, and explains when bed-sharing may be inadvisable and why.

A sleep log tool helps parents track their baby's sleep, displaying this info on a chart depicting the range of normal sleep for infants of different ages to provide reassurance!

Download here from the Apple App Store Download here from the Google Play store
Or search for 'Infant Sleep Info' or 'Infant Sleep Info Durham Uni' and locate the baby icon.

Key Features of Infant Sleep App

* Bed-sharing decision tool.

* Where will my baby sleep?

* How will my baby sleep?

* Sleep log to track baby's sleep

* Links to Basis info sheets.

* Links to Basis partner organisations

Frequently asked questions about the app

1. How much does the Basis app cost? Nothing! It is free :)

2. Is this a new app? Yes the previous version required updating for the new iOS update, so we redesigned the app, refreshed the look and the content, and added several new info sections. The old app has now been withdrawn.

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The Infant Sleep Info website is full of helpful sleep info for parents and health practitioners, but it can be hard to read on a mobile device, especially a smart phone. The *NEW 2017* Infant Sleep Info App provides key information from the Basis website in a handy format for mobile devices.

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Great 5 minute video about how lactation works

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Expecting a baby? - Find out how your milk making Superpower works! Check out our fab new video explaining all about how lactation works.

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Some tips and myth-busting from UNICEF about the early days of infant feeding

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Lots of helpful videos in different languages

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Breastfeeding Videos - Global Health Media Project

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© 2023 Global Health Media Project | a 501(c)(3) nonprofit

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Written information on breastfeeding in lots of different languages

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Using straightforward language and simple illustrations to aid understanding, these infosheets on breastfeeding and bottle feeding are available in multiple languages and can be used to support parents with the basics of feeding and responding to their baby.

The infosheets are free to download and print, and are currently available in:
Please note: Following feedback, these translations were updated in 2019 to ensure the language used was as straightforward as possible.
The English versions of these resources are available below for reference:

Breastfeeding guidance: English (for reference)

Bottle feeding guidance: English (for reference)

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Foreign language resources - Baby Friendly Initiative

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These infosheets are available in multiple languages and can be used to support parents with feeding and responding to their baby.

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to a successful start.

Before your baby arrives
Your premature newborn
Establishing breastfeeding
Looking after your own health and wellbeing
Taking your breastfed baby home

Before your baby arrives

If you know your baby will be arriving soon, you may wish to try antenatal expression of colostrum. This is where you hand express some of the thick, creamy first milk into a sterile container such as a syringe. This can be given to your baby immediately after birth reducing the possibility of them needing to have early formula feeds. Hypoglycaemia (low blood sugar) can cause serious long term health problems if left untreated, and preterm babies are at higher risk of low blood sugar than babies born at term. Having some colostrum ready means that this is available instead of formula (or donor milk if available).

If you are at risk of early labour and taking precautions to avoid it, then consult with your healthcare professionals about your individual case before starting antenatal expression as it may be considered to increase your risk of going into labour.
You can read more about antenatal expression here.

If there is time before your baby arrives, someone from the paediatric team on the neonatal unit where your baby will be cared for should come and talk to you about how you plan to feed your baby. You can supply them with any expressed colostrum you have in a labelled container, and discuss how you wish your baby to be fed while you are establishing your milk supply.

Some neonatal units will have access to donor breastmilk, and will be able to tell you if your baby will be eligible to receive this - as supply is limited, this is likely to be restricted to the babies who need it the most. They will discuss and get your consent if formula may need to be given while you are building your milk supply. This may also be the time to talk about how you want supplementary feeds to be given to your baby.

Smaller or weaker babies will be given a nasogastric tube, to allow milk (your own, donor or formula) to be fed down the tube. Bigger and stronger babies may be given bottles. You may wish to discuss paced bottle feeding (the art of giving bottle feeds in a way that supports breastfeeding) or cup feeding.

If you wish to express breastmilk for your baby, then your hospital should be able to provide you with a breastpump - asking for this before your baby is born means that you have it ready as early as possible. In the early days you need to be stimulating milk production in your breasts between eight and twelve times in twenty four hours, including at least once at night - this might be by your baby feeding effectively at the breast, or pumping sessions.

To read more about successfully expressing breastmilk, click here.

Your premature newborn

When you baby arrives there is likely to be a sudden rush of activity as your baby is checked and stabilised. They may be rushed off to the neonatal unit leaving you feeling stranded in the delivery unit. Be kind to yourself. You may feel that starting to express milk is a practical way that you can be involved in their care even when you are apart from each other. There is evidence to show that if you start expressing within the first hour after birth it can have a long term positive effect on your milk supply.

Establishing breastfeeding

You may be expressing on your ward (if you are still an inpatient) or on the neonatal unit. Many mothers find that being close to their babies while they are expressing can help to increase the amount that they are able to express. If you are separated, looking at photos of your baby can help or smelling something that has been close them.

If you are expressing on the unit, you may wish to be close to your baby as you do so. Some mothers use screens for privacy. You can ask for these to be provided. You don't have to use screens if you prefer not to - using scarves or nothing at all is a completely acceptable choice. Do what you feel comfortable with and helps your milk to flow easily. Listening to music may help you to relax and increase your milk production.

You are the person most known and familiar to your baby. Being with you is the safest and most secure they can possibly feel. If your baby is very fragile they may not be able to come out of their incubator at first. Ask the staff how you can be involved in their care and to show you how to hold and comfort them through the vents in the incubator. Once your baby is able to come out of the incubator, then kangaroo care can become an important part of your time together. This is where your baby is placed skin to skin on your chest for as long as possible and a blanket put over both of you. Your baby is able to enjoy the sensations of your closeness and the deep relaxation and comfort they feel helps them to regulate their breathing, temperature and other health indicators. It also helps your breast to become a familiar environment and allows them to practise feeding directly from the breast easily.

It used to be thought that babies under a certain gestation didn't have the ability to suck and swallow, or that directly breastfeeding was tiring to them. Happily, more recent studies have disproved these concerns. Once babies are well enough to breathe unaided (off ventilation and continuous positive airway pressure - CPAP), they can be brought to the breast. Smaller and younger babies will still need to have some of their milk given to them via tube feeds, but this allows you and your baby to learn to breastfeed together without a feeling of pressure.

Smaller babies have smaller mouths and lower muscle tone. This may mean you need extra support to get breastfeeding established. Seek skilled help early and often. Keep asking until you find someone who is able to support you effectively.

Premature babies often find it easier to feed in laid back breastfeeding positions. This is where you are supported in a reclined position with your baby tummy down on top of you. This helps gravity to 'stick' your baby to you and stops them slipping off. If you need to sit in a more upright position, then supporting the whole length of your baby's body close to yours with a hand behind their shoulders means they don't have to support their weight and stops them from curling in on themselves. Read more about laid back breastfeeding here.

You may find that your baby quickly falls asleep when breastfeeding. This isn't a sign that you are exhausting them, but that they are small and being soothed. You can help them to stay awake for longer by washing their face with cool water, gently blowing on them or tickling their feet. You may find that breast compressions - gently smoothing down your breast towards the nipple - helps your baby to stay alert and interested in feeding as this makes the milk flow more quickly and easily for them.

All new babies need to feed frequently - and premature babies are no different. The volume of milk that their stomachs can take at each feed is very small, and breastmilk is easily digested. It is normal for babies to feed between 8-12 times in a 24 hour period, including at least once at night.

Neonatal unit staff need to be able to ensure that all the babies in their care are receiving the right amount of milk for them to grow. Premature or sick babies may be less able to communicate their need for milk. These two things combined mean that units often use feeding schedules, with feeds timetabled every two, three, or even four hours.

When you agree how often your baby is to be offered supplemental feeds (any milk not directly from the breast) it may be helpful to remember that four hourly is less frequently than you would expect a healthy, full term newborn to feed. You may also choose to consider these as 'backup' feeds - any time spent feeding directly from the breast doesn't reset the clock, but is bonus extra calories. Keep writing down how often you are breastfeeding in your baby's notes, as this may help you and the staff to feel confident about the transition from scheduled, measured feeds, to baby led, responsive feeding.

One of the things the unit staff will look for in a baby coming close to going home is that your baby is able to rouse themselves to feed. If your baby is waking for feeds more often than their feeding 'schedule' (and you are spotting signs of effective feeding), this may be a sign that they are becoming better able to manage their own need for milk. You will probably need to keep offering more frequently than they ask for milk - this is true for many babies. Remember, you can't feed too often, and your baby can always say no if they don't want milk right now!

Breastmilk is an incredibly responsive food, made specially for each baby. The milk that you are making for your premature baby will be even more densely nutritious than the milk of a full term mother. Every drop of milk that you can supply for your baby is like medicine - strengthening and building their immune system and providing the calories they need to grow. Some mothers feel that providing milk for their babies is a unique way that they can care for their babies. It can be an important part of bonding with a new and fragile baby. While your baby will continue to benefit from your milk for as long as you provide it, you aren't tied to expressing for longer than you want to do so. If you decide it's time to stop, then gradually reducing your pumping sessions will slow and stop your milk production without causing problems for you.

Looking after your own heath and wellbeing

You will be recovering from pregnancy and birth, and may be experiencing additional health problems. It is important to remember to look after yourself - the more smoothly your recovery goes, the more strength and energy you will have to become more and more involved in your baby's care. If you have older children at home, you may be struggling to balance meeting their needs with being present with your newborn. Many mothers have to leave hospital long before their baby is ready to come home and have to travel back and forwards to be with their baby. This is a time to say yes to as many offers of help as you possibly can. If someone can provide a lift, deliver a meal, entertain an older child or do a load of washing - or just sit with you to talk things over in the hospital cafe - these may make life a little easier for you and help you to keep going at a difficult time.

You may be taking medications yourself and be concerned about them passing through your milk. Discuss your concerns with your and your baby's medical teams. They may be able to reassure you or find suitable alternatives. For specialist information about whether a drug is compatible with breastfeeding, you can contact your local LLL Leader who has access to resources and professional support.

It may feel impossibly painful to keep leaving your baby. Remember that by looking after yourself - eating, sleeping and taking the medication you need to get well - you are making sure that you carry on being able to be there to look after your baby.

Taking your breastfed baby home

Separately to any health issues your baby may be facing, your neonatal unit will want to know that you are able to make sure your baby is getting enough milk to continue growing. Being aware of your baby's early hunger cues is important so that you can feed responsively and before baby gets too upset. You may have a very sleepy baby who still needs your help to wake themselves up to feed beyond their due date. Setting an alarm for the middle of the night can help you to make sure they don't go for longer than a four hour stretch without feeding at night.

Read more about recognising early hunger cues and about waking a sleepy baby here.

Read more about how to tell if your baby is getting enough milk here.

Many breastfeeding mothers and babies enjoy safe cosleeping. Premature babies are at greater risk of Sudden Infant Death Syndrome or Sudden Unexplained Death in Infancy (SIDS/SUDI). While they will benefit from sleeping close to their mother, premature babies should sleep on a separate, firm surface such as a sidecar cot.

It can be scary to make the transition from caring for your baby in hospital with a team of staff around you, to being at home. Your healthcare professionals are likely to make extra visits to support you and to keep an eye on your baby's weight gain. You may find that being home together, able to stay together all the time, and in a comfortable environment, you rapidly get to know and understand your baby more easily and become more confident in your mothering skills.
Photo credits: Olivia Brown and other mothers
Other resources

You can read a mother's story about mothering her premature baby through special care

This video looks at breastfeeding in the first hour after birth

The drugs in breastmilk service, while not an LLL resource, gives quick access to information from a qualified pharmacist

The Small Wonders films follow families through their experiences of having a baby on a neonatal unit

Global Health Media have a series of videos about various aspects of life with a small baby

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Successfully breastfeeding your premature baby - La Leche League GB

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You may be reading this because you have a preterm baby, or because you are expecting to deliver your baby before full term and you want to be prepared. Perhaps you're supporting someone who has recently had a preterm baby. Whatever your situation then we hope this information will help to get breastfeeding off to [...]

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing.

Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

Expressing can be helpful:

If your baby is not well enough or strong enough to feed from the breast straight away

So that both partners or others are able to share feeding

If you are too sick to feed your baby from the breast

If you cannot be near your baby and want to establish a good milk supply

If your baby has difficulty latching on to the breast, but you still want to give them your breast milk.

If your baby is not able to breastfeed straight away, the staff at the hospital will help you to express (collect) your breast milk as soon as possible after your baby is born. This means that your baby will still get the benefits of breast milk until they are ready to feed from the breast or bottle, as it can be given to them by a feeding tube.
It is important to express in the way that is most comfortable and convenient for you.
A small amount of milk is produced in the first few days after a baby is born. This milk is called colostrum, and is often thicker and more yellow in colour than breastmilk. Colostrum is really important for your baby. It helps to boost your baby's immune system, protect them from infections and helps them grow.

Some parents are worried that they are not producing enough milk in these first few days. This is normal - most parents start by expressing less than 1ml of milk at a time. This will increase gradually the more times you express. Around two to four days after giving birth, you will notice your milk becoming more white and your breasts might feel fuller. This is often referred to as your milk 'coming in'.

Later on, the amount of milk you express may change depending on the time of day and how you feel.

After expressing your milk, the milk can be kept in the fridge or be frozen and stored until your baby is ready to have feeds. We have some more information about how to store breast milk at the bottom of this page.

Your milk is best suited to your baby's needs, but sometimes premature or sick babies need more nutrients than are provided in breastmilk alone. If this is the case for your baby, your baby's doctor may prescribe a preterm fortifier (which is usually a powder made from cow's milk) to go in your milk. This will provide more nutrients that will help with your baby's growth and bone health.

Many parents tell us that expressing can feel like a big pressure. It is important not to be too hard on yourself if you are not able to express a lot of milk in the early stages. No matter how much or how little you can express, your baby will benefit.

Many parents find comfort in expressing as it is something positive and important they can do for their baby. Try not to compare the amount you are expressing with others, as they may have faced different challenges or situations to you.

Expressing breast milk can also take time to learn. The staff looking after your baby will give you support and practical help with this. Speak to your neonatal nurse, feeding specialist or midwife for more support.

In this section, we have more specific information about:

If you have any questions about expressing or are not sure what to do, you should always ask questions or seek more support. Most units will provide specific support with expressing, and your neonatal nurse will be happy to help with any questions that you have.

How often should I be expressing milk for my baby?

It is important to start expressing milk as soon as possible after your baby is born - ideally within two hours. It is recommended you express frequently to keep your milk supply up. To begin with, this is around eight to ten times in 24 hours, including at least once at night. This is because breast milk is produced on a demand and supply system, so you are likely to produce less milk overall if long periods of time are left between expressing.

In time you will find what works best for you. You may find that your milk flow responds to a fixed routine and will trigger a let-down reflex (see below), which will make it easier to express. This might include actions when you prepare to express, such as removing equipment from the steriliser, or putting the pump together.

The let-down reflex

When you express milk, you may notice tingling or prickling in your breasts and nipples, or a feeling as if the milk is rushing in to fill them. This is called the let-down reflex (it is sometimes called the milk ejection reflex). During the let-down reflex, a hormone called oxytocin is released, which helps with milk flow. This takes a few minutes to appear at first, but later it will happen in a few seconds.

The let-down reflex feels different to different women. Some mothers describe a slight pain and some mothers have no sensations at all. Your body may respond to certain things you do, which can trigger your let-down reflex. For example, it is normal for the let-down reflex to happen in response to having a warm bath or shower, or to breast massage (see below). It can also happen in response to being close to your baby, hearing your baby cry or having a picture or something close by that smells of them.

Staying as relaxed as possible and having skin-to-skin contact with your baby can all help to trigger the let-down reflex. Taking some deep breaths and concentrating on your breathing can help with this. It will also help to express at your baby's cotside if this is possible, so you can be close to your baby. Speak to the staff looking after your baby about this.

Gentle breast massage

Breast massage before expressing can help to trigger the let-down reflex and stimulate your milk flow. You can do this by gently stroking, rolling, kneading, and tapping your breasts with warm hands before hand expressing and/or using a breast pump. You should do this for at least two minutes. Breast massage during expressing can help to drain your breasts.

Looking after yourself when expressing

Expressing milk for your baby can be a great way for parents to feel more empowered and in control of their baby's care. Many mothers also tell us how difficult and exhausting it can be to express, especially at night. This can be a particularly difficult experience if their baby is not with them.

It can be a very stressful time, but it is important that you try to stay as relaxed as possible when expressing, as this helps with the let-down reflex and milk flow. Some research has shown that higher stress levels may contribute to the delay of milk production. Some parents find that having a photograph or something that smells of their baby nearby when expressing helps. It may also help to distract yourself by doing something like reading a book or watching TV when you express. Listening to soothing music, meditation or taking time to focus on your breathing may also help you to relax.

Partners can help with expressing. For example, they can offer encouragement, help you to relax, or get equipment ready.

It is not unusual to find feeding your baby a difficult experience. In our survey of over 100 parents, over 60% said that their mental health got slightly or significantly worse during the experience of feeding their premature or sick baby. It is okay to find the experience difficult, no matter your situation. Every parent will have a very different experience of neonatal care.

It is important to talk to someone if feeding your baby is having an impact on your mental health. This could come from your feeding specialist, neonatal nurse, midwife, doctor, partner, or friends and family. We have lots of information about the impact having a premature or sick baby can have on your mental health, and where you can get support.

How to store expressed milk safely

You can store milk if your baby is unable to drink it at the time it is expressed. It is very important that expressed milk is stored safely. This is something that partners can be involved with. On the neonatal unit, breast milk is stored in fridges and freezers that only store infant milk.

Many units supply sterile disposable bottles and labels for you to use. You should label each container with your baby's name, the date and time of collection.

If you will be using your breast milk within 48 hours of expressing, you should refrigerate it. If you are at home, breast milk that has recently been expressed will keep in a refrigerator for 48 hours (24 hours if it is defrosted). The breast milk should be stored at the back of the fridge and not in the fridge door. This is because the temperature in the door compartments goes up and down when the fridge is opened and closed.

If you will not be using your breast milk within 48 hours of expressing, it should be frozen. Milk can be frozen for up to 6 months in a home freezer. If you are freezing your milk, always leave at least one centimetre of free space at the top of the milk container. This is because milk will expand when frozen.

If you are on the neonatal unit, ask the unit staff about the best way to safely refrigerate and freeze milk. Different units may have different guidelines.

Once your milk is defrosted, it will need to be used within 24 hours. Try to use small containers to freeze your milk so that no milk is wasted. Defrosted milk may have a slightly soapy or sour smell, but this will not be harmful to your baby.

Fortified b reast milk that has been supplemented with addi tives should be used with the following one to two feeds. It is not suitable f or freezing and defrosting.

Talk to the hospital staff looking after your baby for more guidance on storing and defrosting breast milk.

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Expressing milk can take time to learn. Find out how to express in neonatal care and how to look after yourself while expressing. Expressing means collecting breast milk which you can store and feed to your baby later. You can express milk by hand or with a breast pump, which can be electric or manual.

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

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

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

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

See other benefits of breastfeeding.

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

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

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

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

Skin-to-skin contact with your premature baby

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

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

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

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

reduces stress and pain

promotes healthy weight gain

helps to establish breastfeeding

helps them sleep better

helps to regulate and support their heart rate and breathing

For mums, skin-to-skin contact:

helps reduce your chance of developing postnatal depression

increases your confidence as a new parent

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

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

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

helps you feel more confident as a parent

Expressing milk if your baby is premature

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

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

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

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

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

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

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

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

Tube feeding your baby

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

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

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

Using donor breast milk

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

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

Moving on to breastfeeding your premature baby

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

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

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

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

Using a lactation aid (supplementer)

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

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

Got a breastfeeding question?

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

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

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Checklist to see whether bottle feeding is going well

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Twins Trust is a fantastic organisation with lots of resources on all aspects of twin parenting, including this one on breastfeeding more than one

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A useful website including a link to their Facebook support group info@breastfeedingtwinsandtriplets.co.uk

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Here at Breastfeeding Twins and Triplets UK we will answer all of these questions and more. We will try to put your mind at rest whilst being honest about journey on which you are about to embark. Breastfeeding more than one baby is challenging, but it is definitely possible and a lot of mums go on to have a really enjoyable experience.

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Alternative ways to top-up a breastfed baby

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Alternative ways to top-up a breastfed baby

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If you are breastfeeding and your baby needs a bit of extra milk this video shows you some alternatives to using a bottle

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Beyond Bottles: alternative ways to supplement a breastfed baby